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目的探讨血清脂蛋白(a)[Lp(a)]质量浓度变化与糖尿病肾病(DN)进展之间的关系以及降低血清Lp(a)质量浓度在防治DN进展中的意义。方法对广东省东莞市人民医院2002-04～2004-09门诊及住院270例糖尿病患者分为单纯糖尿病(SDM)组、早期糖尿病肾病(EDN)组和临床糖尿病肾病(CDN)组各90例,比较其与正常对照组的血清Lp(a)水平;两组DN患者在常规治疗基础上每晚服用氟伐他汀40mg。分析血清Lp(a)质量浓度变化与DN进展之间的关系。结果⑴SDM组血清Lp(a)质量浓度与正常对照组比较无显著性差异(P>0.05),EDN、CDN组血清Lp(a)质量浓度明显高于正常对照组和SDM组(P<0.01),CDN组血清Lp(a)质量浓度明显高于EDN组(P<0.01)。血清Lp(a)质量浓度与尿白蛋白排泄率(UAER)呈直线正相关(r=0.396,P<0.01)。⑵两组DN患者血清Lp(a)水平显著降低(P<0.01)。结论血清Lp(a)质量浓度升高与DN进展有关,降低血清Lp(a)质量浓度能有效减轻EDN患者的蛋白尿、改善肾功能,但对CDN患者无效。
Objective To investigate the relationship between the changes of serum lipoprotein (a) [Lp (a)] and the progression of diabetic nephropathy (DN) and the significance of decreasing serum Lp (a) concentration in preventing and treating DN. Methods A total of 270 outpatients and inpatients with diabetes from 2002-04 to 2004-09 in Guangdong Province were divided into two groups: 90 cases of SDM group, 90 cases of EDN group and 90 cases of diabetic nephropathy group, Compared with the normal control group serum Lp (a) levels; two groups of patients with DN on the basis of routine treatment of fluvastatin 40mg per night. The relationship between the changes of serum Lp (a) concentration and the progression of DN was analyzed. Results (1) Serum Lp (a) concentration in SD group had no significant difference compared with that in normal control group (P> 0.05). Serum Lp (a) concentration in EDN and CDN group was significantly higher than that in normal control group and SDM group The serum Lp (a) concentration in CDN group was significantly higher than that in EDN group (P <0.01). Serum Lp (a) concentration and urinary albumin excretion rate (UAER) showed a linear correlation (r = 0.396, P <0.01). (2) Serum Lp (a) level was significantly lower in both DN patients (P <0.01). Conclusions The increase of serum Lp (a) concentration is related to the progress of DN. Decreasing serum Lp (a) concentration can effectively reduce proteinuria and improve renal function in patients with EDN, but is not effective in patients with CDN.