1型糖尿病肾病与血脂异常及血小板参数变化的关系

目的探讨血脂异常及血小板参数变化与1型糖尿病肾病（DN）的关系。方法根据1999年世界卫生组织糖尿病诊断标准和尿清蛋白排泄率（UAER），将46例1型糖尿病患者分为3组，即糖尿病无肾病组（单纯DM）22例、早期糖尿病肾病组（早期DN）16例和临床糖尿病肾病组（临床DN）8例。另选35例健康体检人员作为对照组。观测患者血糖、血脂及脂蛋白、血小板（PLT）、血小板平均体积（MPV）、血小板分布宽度（PDW）和糖化血红蛋白（HbAlc）变化。结果与对照组比较，DN患者的三酰甘油（TG）：低密度脂蛋白胆固醇（LDL—C）均升高（P〈0．05或P〈0．01），而单纯DM组TG升高，LDL—C正常；早期DN组和临床DN组TC、载脂蛋白B（ApoB）均升高（P〈0．05或P〈0．01），HDL、载脂蛋白A1（ApoAl）均下降（P〈0．05或P〈0．01）。单纯DM与DN组，随着DN程度的加重，TC、ApoB升高（P〈0．05或P〈0．01），HDL、ApoAl均下降（P〈0．05或P〈0．01）。TG、LDL—C、ApoB水平与HbAlc呈正相关（P〈0．01）。DN组PLT水平较健康对照组均明显下降（P〈0．05），MPV、PDW均明显增大（P〈0．05）。结论DN早期即存在脂质代谢紊乱与血小板参数的变化，血脂及血小板因素可能参与了1型糖尿病肾病的发生与进展。

Correlation of type 1 diabetes mellitus complicated with nephropathy and blood lipid disorder as well as platelet parameters

Objective To explore the correlation of type 1 diabetes mellitus （DM） complicated with nephropathy and blood lipid disorder as well as platelet parameters. Methods Forty-six patients with type 1 diabetes mellitus and 35 healthy people （set as control group） were enrolled in the investigation. The patients were divided into three groups （simple DM group, n ： 22; early-phase diabetic nephropathy group, n = 16; clinical diabetic nephropathy group,n： 8） according to the 1999 WHO criterion of DM and urinary albumin excretion rate （UAER）. Plasma blood glucose, blood lipids, apolipoprotein, platelet parameters platelet count, mean platelet volume （MPV）, platelet distribution width （PDW）] and HbAlc were examined for all subjects. Results As compared with those of control group, the levels of plasma triglyceride （TG） and low density lipoprotein cholesterol （LDL-C） in diabetic nephropathy groups were significantly elevated （P〈0.05 or P〈0.01）. In simple DM group, plasma TG increased and LDL-C kept a normal level. In early-phase diabetic nephropathy group and clinical diabetic nephropathy group, the levels of total cholesterol （TC） and ApoB were significantly elevated,while levels of HDL-C and ApoA1 were much lower than those of control group （P〈0.05 or P〈0.01）. With the severity of diabetic nephropathy, the levels of TC and ApoB were gradually increasing,while levels of HDL and ApoA1 gradually decreasing （P〈0.05 or P〈0.01）. The levels of TG,LDL-C and ApoB were positively correlated with HbAlc （P〈0.01）. The level of platelet was much lower and MPV as well as PDW much higher than that of control group （P〈0.05）. Conclusion The lipid metabolic disorder and changes of blood platelet parameter occur during DN early-phase of diabetic nephropathy, which may contribute to the occurrence and progress of type 1 diabetes mellitus complicated with nephropathy.