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目的 :探讨血清脂蛋白 (a) [Lp(a) ]水平变化与早期糖尿病肾病 (EDN)进展之间的关系以及降低血清Lp(a)水平在防治EDN进展中的意义。 方法 :(1)根据尿白蛋白排泄率 (UAER)测定结果将 186例糖尿病患者分为单纯DM组 (糖尿病肾损害Ⅰ～Ⅱ期 ) 90例和EDN组 96例 ,比较上述两组和正常对照组的血清Lp(a)水平 ;(2 )将 96例EDN患者随机分为两组 ,对照组 4 8例予常规治疗 ,治疗组 4 8例在常规治疗基础上每晚服用氟伐他汀 4 0mg。分别于治疗前和治疗后 9个月时检测血清Lp(a)、FBG、UAER和Scr ,分析血清Lp(a)水平变化与EDN进展之间的关系。 结果 :(1)单纯DM组血清Lp(a)水平与正常对照组比较无统计学差异 (P >0 .0 5 ) ,EDN组血清Lp(a)水平明显高于正常对照组和单纯DM组 (P <0 .0 1) ,血清Lp(a)水平与UAER呈直线正相关 (r =0 .4 0 5 ,P <0 .0 5 )。 (2 )治疗组血清Lp(a) 水平显著降低 (P <0 .0 1) ,且随着Lp(a)水平的下降 ,UAER和Scr亦同步下降。 结论 :血清Lp(a)水平升高与EDN进展有关 ,降低血清Lp(a)水平能有效减少EDN患者的蛋白尿、改善肾功能。
Objective: To investigate the relationship between the changes of serum lipoprotein (a) [Lp (a)] and the progression of early diabetic nephropathy (EDN) and the significance of lowering serum Lp (a) level in the prevention and treatment of EDN. Methods: (1) According to the results of urinary albumin excretion rate (UAER), 186 diabetic patients were divided into 90 cases of DM group (diabetic nephropathy stage Ⅰ ~ Ⅱ) and 96 cases of EDN group. The above two groups were compared with the normal control (2) 96 cases of EDN patients were randomly divided into two groups, 48 cases in the control group for routine treatment, the treatment group, 48 cases on the basis of routine treatment with fluvastatin 40mg . Serum Lp (a), FBG, UAER and Scr were measured before treatment and at 9 months after treatment, and the relationship between serum Lp (a) levels and the progression of EDN was analyzed. Results: (1) Serum Lp (a) levels in DM group were not significantly different from those in normal control group (P> 0.05), while serum Lp (a) levels in EDN group were significantly higher than those in normal control group and DM group (P <0.01), and the level of serum Lp (a) was positively correlated with UAER (r = 0.405, P <0.05). (2) The level of serum Lp (a) in treatment group decreased significantly (P <0.01), and UAER and Scr decreased with the decrease of Lp (a) level. CONCLUSION: Elevated serum Lp (a) level is associated with the progression of EDN. Decreasing serum Lp (a) levels can effectively reduce proteinuria and improve renal function in EDN patients.