糖尿病肾病病人血清脂质变化及意义

目的探讨糖尿病肾病(diabeticnephropathy，DN)病人血清脂质代谢异常与肾脏损害间的关系。方法64例2型糖尿病(diabetesmellitus，DM)病人，按尿清蛋白排泄率(urinaryalbuminexcretionrate，UAER)分组，并设对照组，分别测定血清总胆固醇(totalcholesterol，TC)、甘油三脂(triglycerides，TG)、高密度脂蛋白胆固醇(highdensitylipoprotein-cholesterol，HDL-C)、低密度脂蛋白胆固醇(1owdensitylipoprotein-cho1esterol，LDL-C)、载脂蛋白A1(apolipoprotein-A1，Apo-A1)及载脂蛋白B(apolipoprotein-B，Apo-B)，比较组间差异及与UAER的关系；同时比较血脂与血糖间的关系。结果正常清蛋白尿组仅Apo-A1显著降低(P＜0．01)；微量清蛋白尿组Apo-A1显著降低，Apo-B显著升高(P＜0．05)；临床期DN组Apo-A1显著降低(P＜0．05)，Apo-B、TC、LDL-C显著升高(P＜0．05，0．01)，Apo-A1／Apo-B在DM三组均显著降低(P＜0．01，0．05)；TG、LDL-C及ApoB与UAER呈显著正相关(P＜0．01，0．001)；TC、TG及LDH-C与血糖呈显著正相关。结论DN病人存在明显的脂质代谢异常，与血糖控制不良有关，且随肾脏损害程度加重而加重，其中TG、HDL-C及Apo-B的异常增高与肾脏损害程度密切相关，推测脂质代谢异常可能是DN诱发或(和)加重因素之一；控制血糖有助于预防血脂代谢紊乱．而控制血脂代谢异常有助于廷缓DN发展，有重要临床意义。

Changes and Significance on Seruin Lipids inPatients with Diabetic Nephropathy

Objective To investigate the relation between abnormal metabolism of serum lipids and renal damage in patients with diabetic nephropathy(DN). Methods 64 patients with type 2 diabetes mellitus were divided into three groups according to urinary albumin excretion rate (UAER), and another control group was established. The serum concentrations of total cholesterol (TC), triglycerides (TG), high-density lipoprotein -cholesterol (HDL-C), low-density lipoprotein-eholesterol (LDL-C), apolipoprotein-A 1 (ApoA1 ) and apolipoprotein-B (Apo-B) were measured. Their differences in between above groups were observed. Results The level of Apo-A1 in normal albuminuria group decreased significantly (P＜0.01). In the microalbuminuria group,the level of Apo-A1 decreased significantly and the Apo-B increased significantly (P＜0.05). For DN patients in clinical phase,the Apo-A1 level decreased significantly (P＜0.05) yet the Apo-B,TC and LDL-C increased significantly (P＜0.01,0. 05). The ratio of Apo-A1 and Apo-B decreased significantly in all three groups of DN (P＜0. 01,0. 05). Conclusion Patients with DN have a significant abnormal lipid metabolism which aggravates gradually alongwith the progression of renal damage. Abnormal lipid metabolism might be one of the factors that causes inducement and progression of DN.To notice this metabolic disorder and give a correct treatment will be important in delaying the process of DN.