2 型糖尿病患者血清ChREBP 水平 与糖尿病肾病的相关性

Association of serum carbohydrate-responsive element-binding protein with diabetic kidney disease in patients with type 2 diabetes mellitus

摘要:

目的 探讨2 型糖尿病患者血清ChREBP 水平与糖尿病肾病的关系。方法 选取2017 年1 月— 2018 年1 月于吉林大学第二医院内分泌科确诊为2 型糖尿病的80 例患者，分为糖尿病肾病组[DN 组，24 h 尿白蛋白排泄率（24 h UAER）≥ 30 mg/24 h] 和单纯2 型糖尿病组（T2DM 组，24 h UAER<30 mg/24 h）， 每组40 例，从体检中心收集同期健康群众40 例作为对照组（NC 组）。采集研究对象的性别、年龄、病程、 身高及体重等资料，计算体重指数。测定空腹血糖（FPG）、糖化血红蛋白（HbA1c）、甘油三酯（TG）、总 胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、尿素氮、血清肌酐（Scr）、 空腹胰岛素（FINS）及24 h UAER，计算肾小球滤过率（eGFR）和稳态胰岛素评价指数（HOMA-IR）。采 用酶联免疫吸附（ELISA）法检测血清中ChREBP、高迁移率族蛋白-1、TNF-α、IL-1β 及IL-6 水平。 结果 血清ChREBP 水平DN 组最高，NC 组最低（P <0.05）。ChREBP 与eGFR 呈负相关（r s =-0.694， P =0.000）；ChREBP 与24 h UAER、IL-1β、IL-6、TNF-α 及HMG-1 呈正相关（r s =0.596、0.711、 0.650、0.684 和0.515，P <0.05）。Logistic 回归分析显示，病程[Ol ^ R=1.44，95% CI（1.10，1.87）]、HOMAIR[ Ol ^ R=2.22，95% CI（1.31，3.76）]、24 h UAER[Ol ^ R=1.03，95% CI（1.00，1.06）] 及ChREBP[Ol ^ R=1.01，95% CI（1.00，1.03）] 是糖尿病患者肾脏病变的独立危险因素（P <0.05）。结论 2 型糖尿病患者血清ChREBP 水 平升高可能与糖尿病肾病的发生、发展相关。

Abstract:

Objective To explore the relationship between the serum levels of ChREBP with the development of diabetic kidney disease in patients with type 2 diabetes mellitus (T2DM). Methods A total of 80 patients with T2DM in the Department of Endocrinology of the Second Hospital of Jilin University were included. They were divided into two groups as: T2DM with DN group (DN, 24 hUAER≥30 mg/24 h, n = 40), T2DM without DN group (T2DM, 24 hUAER<30 mg/24 h, n = 40). In the same period, 40 healthy subjects were collected from the medical examination center as normal control group (NC, n = 40). Data including gender, age, duration of diabetes, height,weight, body mass index. Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), urea nitrogen (BUN), serum creatinine (Scr), fasting insulin (FINS), 24h urinary albumin excretion rate (24 hUAER) was determined. Estimated glomerular filtration rate (eGFR) and insulin resistance index (HOMA-IR) were calculated. The serum levels of ChREBP, HMG1 and inflammatory cytokines including TNF-α, IL-1β, IL-6 were determined by ELISA. Results ① The serum levels of ChREBP from high to low were DKD group, T2DM group and NC group (P = 0.000). ② There was a negative correlation between ChREBP and eGFR (r s=-0.694, P < 0.001). There was a positive correlation between ChREBP and 24hUAER, IL-1β, IL-6, TNF-α, HMG-1 (r s=0.596, r s=0.711, r s=0.650, r s=0.684, r s=0.515, P < 0.05). ③ Logistic regression analysis showed that duration of diabetes [Ol ^ R=1.44, (95% CI 1.10 ～ 1.87)], HOMA-IR [Ol ^ R=2.22, (95% CI 1.31 ～ 3.76)], 24hUAER [Ol ^ R=1.03, (95% CI: 1.00 ～ 1.06)] and ChREBP [Ol ^ R=1.01, (95% CI: 1.00 ～ 1.03)] were independent risk factors of diabetic kidney disease in T2DM. Conclusions The elevated of serum ChREBP in T2DM may be related to the occurrence and development of diabetic kidney disease.