139例2型糖尿病肾病患者血脂代谢异常与肾损害

目的了解2型糖尿病肾病(DN)患者血脂代谢异常与肾损害的相关关系.方法根据24h尿白蛋白排泄量将139例2型糖尿病肾病分为正常白蛋白尿组(24 h尿白蛋白＜30mg)、微量白蛋白尿组(30mg≤24 h尿白蛋白＜300mg)和临床白蛋白尿组(24h尿白蛋白≥300mg);并设正常对照组30例.分别测定胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-C)、载脂蛋白A1(apo-A1)、载脂蛋白B(apo-B)、空腹血糖(FBG)及糖化血红蛋白(HbA1c)水平.结果(1)4组间年龄、体重指数(BMI)差异均无显著意义(F=1.42,P＞0.05);DN组间病程、FBG和HbA1c的差异无显著意义(F=3.13,P＞0.05).(2)3个DN组间,TG和LDL-C均显著升高(F为4.71和5.11,P＜0.05),而HDL-C明显降低(F为4.37,P＜0.05);多元线性回归分析发现尿白蛋白排泄量与FBG和TG水平成正相关(R2=0.182).结论2型糖尿病肾病患者血脂代谢的异常以TG升高为主,随病程进展伴LDL-C增高及HDL-C减低.血糖和TG是尿白蛋白排泄量的主要影响因素,并与DN的发生发展密切相关.

Relationship between abnormal metabolism of serum lipids and renal damage in patients with diabetic nephropathy

Objective: To explore the relationship between abnormal metabolism of serum lipids and renal damage in patients with diabetic nephropathy (DN). Methods: According to 24 h urinary albumin, 139 cases of type 2 diabetic nephropathy were divided into three groups and another control group was established. The serum concentrations of total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein-A1 (Apo-A1), apolipoprotein-B (Apo-B), fasting blood glucose (FBG) and HbA1c were measured. Their differences among the above groups were observed. Results: (1) Age and BMI were not of significant difference among all the groups (F =1.42, P >0.05). Duration of the disease, FBG and Hb1Ac were not of significant difference among DN groups (F =3.13, P >0.05). (2) The levels of TG and LDL-C increased significantly (v was 4.71 and 5.11, P <0.05) and HDL-C levels decreased significantly among DN groups. Multiple linear regression showed urinary albumin excretion (UAE) was positively correlated with FBG and TG (R2 =0.182). Conclusion: Increased TG is the main abnormal metabolism of serum lipids in patients with diabetic nephropathy, which is accompanied by increased LDL-C and decreased HDL-C with the progression of DN. FBG and TG are major influencing factors of UAE in type 2 DN. They may be related to occurrence and progression of DN.