外周血高密度脂蛋白水平与糖尿病肾病病人炎性指标、肾功能及胰岛素抵抗的关系

查秀婧; 邵晨; 马续祥

doi:10.13898/j.cnki.issn.1000-2200.2022.04.016

外周血高密度脂蛋白水平与糖尿病肾病病人炎性指标、肾功能及胰岛素抵抗的关系

Study on the correlation between the level of high density lipoprotein in peripheral blood and inflammatory index, renal function and insulin resistance in diabetic nephropathy

摘要

摘要:
目的探讨外周血高密度脂蛋白(HDL-C)水平与糖尿病肾病病人炎性指标、肾功能及胰岛素抵抗的相关性。
方法选取246例2型糖尿病病人，根据24 h尿微量白蛋白排泄率(UAER)将入组糖尿病病人分为3组，即正常白蛋白尿组(UAER < 30 mg/24 h)98例、微量白蛋白尿组(30 mg/24 h≤UAER < 300 mg/24 h)60例和大量白蛋白尿组(UAER≥300 mg/24 h)88例，另选取92名正常体检人群作为对照组，对比各组炎症因子表达水平、肾功能指标和胰岛素抵抗指标的差异，进行HDL-C与各指标的相关性分析。
结果4组研究对象胆固醇水平间差异均无统计学意义(P>0.05)；对照组空腹血糖(FBG)、三酰甘油(TG)、糖化血红蛋白(HbA1c)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、超敏C反应蛋白(hs-CRP)、血尿素氮(BUN)、血肌酐(Scr)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)均显著低于其余3组，而HDL-C、肾小球滤过率(eGFR)和胰岛素敏感指数(ISI)、胰岛素分泌指数(HOMA-β)水平均显著高于其余3组，差异有统计学意义(P < 0.05~P < 0.01)；正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组的FBG、TG、HbA1c、IL-6、TNF-α、hs-CRP、BUN、Scr、FINS、HOMA-IR呈递增趋势，而HDL-C、eGFR、ISI和HOMA-β水平呈递减趋势(P < 0.05~P < 0.01)；糖尿病肾病病人HDL-C水平与病程、FBG、IL-6、hs-CRP、Scr、FINS呈负相关，与eGFR、HOMA-β呈正相关(P < 0.05~P < 0.01)。
结论HDL-C与糖尿病肾病病人的炎症反应、肾功能和胰岛功能具有相关性，HDL-C检测具有较高的临床指导意义。

Abstract:
ObjectiveTo explore the correlation between the level of high density lipoprotein(HDL-C) in peripheral blood and inflammatory index, renal function and insulin resistance in diabetic nephropathy.
MethodsAccording to the 24-hour urinary microalbuminuria excretion rate(UAER), 246 patients with type 2 diabetes mellitus were divided into the normal albuminuria group(98 cases with UAER < 30 mg/24 h), microalbuminuria group(60 cases with UAER < 300 mg/24 h) and massive albuminuria group(88 cases with UAER≥300 mg/24 h), and 92 healthy subjects were set as the control group.The differences of the expression levels of inflammatory factors, renal function index and insulin resistance index were compared among four groups, and the correlation between HDL-C and each index was analyzed.
ResultsThere was no statistical significance in the levels of cholesterol among four groups(P>0.05).The levels of the fasting blood glucose(FBG), triglyceride(TG), glycosylated hemoglobin(HbA1c), interleukin-6(IL-6), tumor necrosis factor α(TNF-α), hypersensitive C-reactive protein(hs-CRP), blood urea nitrogen(BUN), blood creatinine(Scr), fasting insulin(FINS) and insulin resistance index(HOM) in control group were lower than those in other three groups, while the levels of HDL-C, glomerular filtration rate(eGFR), insulin sensitivity index(ISI) and insulin secretion index(HOMA-β) in control group were significantly higher than those in other three groups(P < 0.05 to P < 0.01).In the normoalbuminuria group, microalbuminuria group and macroalbuminuria group, the levels of the FBG, TG, HbA1c, IL-6, TNF-α, hs-CRP, BUN, Scr, FINS, HOMA-IR showed an increasing trend, and the levels of HDL-C, eGFR, ISI and HOMA-β showed a decreasing trend(P < 0.05 to P < 0.01).The levels of HDL-C in diabetic nephropathy patients were negatively correlated with the course of disease, FBG, IL-6, hs-CRP, Scr and FINS, but positively correlated with eGFR and HOMA-β(P < 0.05 to P < 0.01).
ConclusionsThe HDL-C is correlated with the inflammatory response, renal function and islet function in diabetic nephropathy patients, which has high clinical guiding significance.

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