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目的探讨血清淀粉样蛋白A(serum amyloid A,SAA)与糖尿病肾病患者血糖及血脂代谢的关系。方法 115例2型糖尿病患者依据24h尿微量白蛋白排泄率分为单纯糖尿病组37例,微量白蛋白尿组40例,临床白蛋白尿组38例,同期35名体检健康者为对照组,测定4组空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血肌酐、血尿素氮、糖化血红蛋白、血清SAA、24h尿微量白蛋白排泄率,并进行比较。结果单纯糖尿病组SAA、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平高于对照组(P<0.01);微量白蛋白尿组SAA、空腹血糖、糖化血红蛋白、总胆固醇水平高于单纯糖尿病组(P<0.05);临床白蛋白尿组糖化血红蛋白、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、SAA、血肌酐、24h尿微量白蛋白排泄率、三酰甘油水平高于微量白蛋白尿组(P<0.05);SAA与24h尿微量白蛋白排泄率、空腹血糖、糖化血红蛋白、总胆固醇呈正相关(r=0.463,P<0.01;r=0.278,P<0.05;r=0.402,P<0.01;r=0.216,P<0.05),与高密度脂蛋白胆固醇呈负相关(r=-0.265,P<0.05)。结论 SAA与空腹血糖、糖化血红蛋白、高脂血症及尿微量白蛋白关系密切,SAA水平增高是糖尿病肾病进展的重要危险因素。
Objective To investigate the relationship between serum amyloid A (SAA) and blood glucose and lipid metabolism in patients with diabetic nephropathy. Methods According to the urinary albumin excretion rate of 24h, 37 patients with type 2 diabetes mellitus were divided into simple diabetic group (n = 40), microalbuminuria group (n = 40), clinical albuminuria group (n = 38) and 35 healthy subjects as control group The fasting blood glucose, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, serum creatinine, blood urea nitrogen, glycosylated hemoglobin, serum SAA, 24h urinary albumin excretion rate in the four groups were compared and compared. Results The levels of SAA, triglyceride, high density lipoprotein cholesterol and low density lipoprotein cholesterol in diabetic group were significantly higher than those in control group (P <0.01). SAA, fasting blood glucose, glycosylated hemoglobin and total cholesterol in microalbuminuria group were higher than those in control group (P <0.05). In the patients with clinical albuminuria, the levels of HbA1c, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, SAA, serum creatinine, 24h urinary albumin excretion rate and triglyceride level were high (P <0.05). There was a positive correlation between SAA and urinary albumin excretion rate, fasting blood glucose, glycosylated hemoglobin and total cholesterol (r = 0.463, P <0.01; r = 0.278, P <0.05 = 0.402, P <0.01; r = 0.216, P <0.05), and negatively correlated with high density lipoprotein cholesterol (r = -0.265, P <0.05). Conclusion SAA is closely related to fasting blood glucose, glycosylated hemoglobin, hyperlipidemia and urinary microalbumin. SAA level is an important risk factor for the progression of diabetic nephropathy.