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目的探讨血清脂联素、内脂素、白介素18(IL-18)水平对2型糖尿病性肾病患者的临床检测价值。方法选取2011年11月—2012年6月四川省人民医院收治的2型糖尿病性肾病患者96例作为病例组,根据尿蛋白排泄率(UAER)将其分为正常尿蛋白组(UAER<20μg/min)、微量尿蛋白尿组(20μg/min200μg/min),各32例;取同时期在本院进行体检的健康成年人32例作为对照组。比较4组受试者临床指标,并分析血清脂联素、内脂素、IL-18与其他实验室检测指标的关系。结果大量尿蛋白组患者病程长于微量尿蛋白组,微量尿蛋白组患者病程长于正常尿蛋白组(P<0.05);大量尿蛋白组患者收缩压高于对照组、正常尿蛋白组及微量尿蛋白组(P<0.05)。病例组亚组患者的空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、三酰甘油(TG)及低密度脂蛋白(LDL)高于对照组,高密度脂蛋白(HDL)低于对照组(P<0.05);大量尿蛋白组患者的BUN和血肌酐(SCr)高于其他3组(P<0.05);大量尿蛋白组的UAER、C反应蛋白(CRP)、脂联素、内脂素及IL-18水平高于微量尿蛋白组,微量尿蛋白组高于对照组和正常尿蛋白组(P<0.05)。Pearson相关性分析结果显示,血清脂联素水平与病程、SBP、Hb A1c、FPG、TC、TG、LDL、BUN、SCr、UAER、CRP、内脂素及IL-18均呈正相关,与HDL呈负相关(P<0.05);血清内脂素水平与病程、SBP、Hb A1c、FPG、TC、TG、LDL、BUN、SCr、UAER、CRP、脂联素及IL-18均呈正相关,与HDL呈负相关(P<0.05);血清IL-18水平与病程、SBP、Hb A1c、FPG、TC、TG、LDL、BUN、SCr、UAER、CRP、脂联素及内脂素均呈正相关,与HDL呈负相关(P<0.05)。结论血清脂联素、内脂素、IL-18水平与2型糖尿病性肾病的发生发展密切相关,对临床的诊断、治疗具有重要意义。
Objective To investigate the clinical value of serum adiponectin, visfatin and interleukin 18 (IL-18) levels in patients with type 2 diabetic nephropathy. Methods Ninety-six patients with type 2 diabetic nephropathy admitted from Sichuan Provincial People’s Hospital from November 2011 to June 2012 were selected as the case group and divided into normal urinary protein (UAER <20μg / min), microalbuminuria group (20μg / min 200μg / min), 32 cases in each group. Cases as a control group. The clinical indicators of the four groups were compared and the relationship between serum adiponectin, visfatin and IL-18 and other laboratory parameters was analyzed. Results The duration of the patients with urinary albumin was longer than that of the patients with microalbuminuria and the duration of patients with microalbuminuria was longer than that of the normal urine protein (P <0.05). The systolic blood pressure of patients with urinary albumin was significantly higher than that of the control group, normal urine protein and microalbuminuria Group (P <0.05). Fasting plasma glucose (FPG), Hb A1c, total cholesterol (TC), triglyceride (TG) and low density lipoprotein (LDL) were significantly higher in patients in the subgroup of patients than those in the control group. High density lipoprotein (P <0.05). The levels of BUN and serum creatinine (SCr) in a large number of urine protein group were significantly higher than those in the other three groups (P <0.05). UAER, C-reactive protein The level of diastolic blood lipids, triglyceride, visfatin and IL-18 were higher than those of microalbuminuria and microalbuminuria in the control group and normal urine protein group (P <0.05). Pearson correlation analysis showed that serum adiponectin levels were positively correlated with duration of disease, SBP, Hb A1c, FPG, TC, TG, LDL, BUN, SCr, UAER, CRP, visfatin and IL- (P <0.05). There was a positive correlation between serum visfatin and duration of disease, SBP, Hb A1c, FPG, TC, TG, LDL, BUN, SCr, UAER, CRP, adiponectin and IL- (P <0.05). There was a positive correlation between serum IL-18 level and duration of disease, SBP, Hb A1c, FPG, TC, TG, LDL, BUN, SCr, UAER, CRP, adiponectin and visfatin HDL was negatively correlated (P <0.05). Conclusions Serum levels of adiponectin, visfatin and IL-18 are closely related to the occurrence and development of type 2 diabetic nephropathy, which is of great significance for clinical diagnosis and treatment.