2型糖尿病肾病患者血清nesfatin-1的变化及其临床意义

Change of serum level of nesfatin-1 in type 2 diabetic patients with nephropathy

摘要:

目的 检测2型糖尿病肾病（DN）患者血清nesfatin-1水平，探讨血清nesfatin-1水平与2型糖尿病肾病的关系。方法 根据尿清蛋白/肌酐比值（ACR）将115例2型糖尿病患者分为正常清蛋白尿组（NA组，38例）、微量清蛋白尿组（MA组，39例）及临床清蛋白尿组（CP组，38例），选取同期健康体检人群作为对照组（NC组，40例）。采用酶联免疫吸附法（ELISA）测定血清nesfatin-1水平，同时测定患者空腹血糖（FPG）、空腹胰岛素（FINS）、糖化血红蛋白（HbA1c）、血脂、血肌酐（Scr）、尿素氮（BUN）、C反应蛋白（CRP），计算体重指数（BMI）、胰岛素抵抗指数（HOMA-IR），比较各组间的差异并进行相关分析。结果 与NC组比较，3组糖尿病患者血清nesfatin-1水平均显著降低（P <0.05）；与NA组、MA组比较，CP组的nesfatin-1最低（P <0.05），而NA组和MA组比较差异无统计学意义（P >0.05）；相关分析显示血清nesfatin-1与收缩压、HOMA-IR、Scr、ACR、CRP呈负相关（r =-0.243、-0.486、-0.374、-0.228和-0.219，P <0.05）；多元线性回归分析显示HOMA- IR、Scr、ACR与血清nesfatin-1独立相关r =0.352、0.264和0.225）；控制HOMA-IR影响，偏相关分析结果发现血清nesfatin-1与其他指标均无明显相关性（P >0.05）。结论 T2DM患者nesfatin-1水平降低，而且DN患者CP组nesfatin-1水平最低。DN患者血清nesfatin-1水平的下降可能与胰岛素抵抗的加重密切相关。

Abstract:

【Objective】 To investigate the change of serum nesfatin-1 in type 2 diabetic patients with nephropathy. 【Methods】 A total of 115 patients with type 2 diabetes mellitus were divided into three groups according to the urinary albumin/creatinine ratio (ACR): normal albuminuria group (NA group) with 38 cases, micro-albuminuria group (MA group) with 39 cases and macro-albuminuria group (CP group) with 38 cases; and 40 healthy subjects were included as controls. Serum level of nesfatin-1 was assayed by enzyme linked immunosorbent assay (ELISA). Fasting plasma glucose (FPG), fasting plasma insulin (FINS), HbA1c, lipids, serum creatinine (Scr), blood urea nitrogen (BUN) and C-reactive protein (CRP) levels together with ACR were also determined. 【Results】 Serum nesfatin-1 level in the diabetic patients was significantly lower than that in the controls (P < 0.05); the lowest level was in the CP group which was significantly different from those in the groups NA and MA (P < 0.05). The levels of nesfatin-1 were negatively correlated with systolic pressure, HOMA-IR, Scr, ACR and CRP (r = -0.243, -0.486, -0.374, -0.228 and -0.219, P < 0.05). Multiple linear regression analysis showed that HOMA-IR, Scr and ACR were independent related factors to the serum nesfatin-1 (r =0.352, 0.264 and 0.225). Control the effect of HOMA-IR, partial correlation analysis showed that serum nesfatin-1 and other parameters were not significantly correlated (P > 0.05). 【Conclusions】 Serum nesfatin-1 level in diabetic patients is significantly lower than that in health controls, and it is the lowest in the patients with macro-albuminuria. The decrease of serum nesfatin-1 level could be associated with increased insulin resistance.