中国血液净化

›› 2006, Vol. 5 ›› Issue (6): 316-319.

• 基础研究 • 上一篇    下一篇

2型糖尿病肾病患者内皮素、血栓调节蛋白、血管内皮生长因子的变化及相关研究

孙 岩1 王秀玲1 高锦凤2 胡晓娟3   

  1. 1. 830000 乌鲁木齐，新疆医科大学第一附属医院肾病科 2. 834000 克拉玛依，新疆克拉玛依市职工医院，3. 新疆克拉玛依市医院
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-06-12 发布日期:2006-06-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-06-12 Published:2006-06-12

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摘要： 目的 探讨不同阶段2型糖尿病肾病(diabetic nephropathy DN)血清内皮素（endothelin ET）、血栓调节蛋白（thrombomodulin TM）和血管内皮生长因子（vascular endothelial growth factor VEGF）的变化，并且进行相关分析以明确其在糖尿病肾病发生发展中的重要意义。方法 选择新疆医科大学第一附属医院肾病科患者按照尿白蛋白排泄率（urinary albumin excretion rate UAER）及肾功能将已确诊为2型糖尿病(diabetes mellitus DM)的61例患者分4组：糖尿病正常白蛋白尿组、微量蛋白尿组、临床蛋白尿组、终末肾衰竭组。采用放射免疫法(RIA)检测血清内皮素(ET)水平，采用双抗体夹心酶联免疫吸附法(ELISA)检测血浆可溶性血栓调节蛋白(sTM)及血管内皮生长因子(VEGF)水平，并与21例正常人进行对照。结果 ① DM正常白蛋白尿组ET、sTM、VEGF与对照组无差异(P＞0.05)；②DM微量蛋白尿组ET、sTM高于对照组 (P＜0.01)，VEGF与对照组无差异(P＞0.05)；③ 临床蛋白尿组ET高于对照组(P＜0.01)，sTM、VEGF浓度高于对照和正常白蛋白尿组(P＜0.01)；④ 终末肾衰竭组ET、sTM、VEGF浓度高于对照和正常白蛋白尿组(P＜0.01)；⑤ ET、sTM、VEGF之间呈正相关(r =0.5126,0.6526)，并与UAE呈正相关(r=0.5126,0.6525,0.6443,P＜0.01)，与内生肌酐清除率呈负相关(r =-0.5380,-0.5347,-0.6486,P＜0.01)。结论 ① 血清ET、血浆sTM、VEGF随着糖尿病肾病的进展而升高；② ET、sTM及VEGF之间显著相关，并与尿白蛋白呈正相关，提示了血管内皮细胞损伤参与糖尿病肾病的发生发展。

关键词: 糖尿病肾病, 内皮素, 血栓调节蛋白, 血管内皮生长因子

Abstract: Objective To observe the plasma levels of endothelin (ET)、soluble thrombomodulin (sTM) and vascular endothelial growth factor (VEGF) in patients with diabetic nephropathy and to explore the interrelationship among ET、sTM and VEGF and identify their significance during the pathogenesis of diabetic nephropathy. Methods Sixty-one patients with type 2 diabetes were classified into four groups (normoalbuminuria,microalbuminuria,overt proteinuria and end-stage renal failure) according to urinary alburmin excretion (UAE) and the status of renal function. Plasma endothelin was measured by Radioimmunoassay (RIA); The concentrations of plasmas TM and VEGF were measured by enzyme-linked immunosolvent assay (EUSA) methods.Theresults were compared with those of 21 healthy subjects. Results ①There was no significant difference in plasma ET、sTM and VEGF between the controls and the patients with normoalbuminuric group (P ＞0.05); ②The serun levels of ET and sTM in patients with microalbuminuric group were significantly higher than controls(P＜0.01)，while the levels of VEGF were similar in controls and in patients with microalbuminuria (P＞0.05); ③ Plasma ET level in patients with overt proteinuria was significantly higher than that in controls(P＜0.01); Plasma sTM and VEGF levels in overt nephropathy group were higher than those in normoalbuminuria and those in microalbminuria group; ④Plasma ET、sTM and VEGF from patients with end-stage renal failure were greater than those in controls and in normoalbuminuric group; ⑤ There were significant correlation among ET、 sTM and VEGF (r =0.5126, 0.6526, and 0.6398, respectively, P ＜ 0.01), and the markers were correlated with UAE (r=0.5126, 0.6525, 0.6442 and respectively, P ＜0.01), and creatinine clearance (r=-0.5380、 -0.5347、-0.6486，P ＜0.01). Conclusion ① Plasma ET、sTM、and VEGF increased with progressive renal dysfunction; ② There were significant correlation among plasma ET、sTM、and VEGF. Furthermore，the three indexes were positively correlated with the level of UAER. These suggest that endothelial injury may be involved in the pathogenesis of DN. ③ Our results suggest that the measurement of plasma ET、sTM and VEGF may be important in evaluating the diagnosis and analysis of type 2 DN.

Key words: Endothelin, Thrombomodulin, Vascular endothelial growth factor

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