【作者】 范成吉；

【导师】 吕学爱；

【作者基本信息】 泰山医学院 ， 内科学， 2011， 硕士

【摘要】 目的本研究通过检测糖尿病肾病患者不同时期血清骨桥蛋白和白细胞介素-18水平变化,旨在探讨二者在糖尿病肾病发生发展中的作用及二者之间是否存在相关性,从而为2型糖尿病肾病的发病机制及演变过程的认识提供新的思路。方法选取2009年12月-2010年12月在泰安市中心医院确诊的2型糖尿病患者90例,糖尿病诊断符合2008年美国糖尿病学会(American diabetes association,ADA)的诊断标准。根据尿白蛋白排泄率(UAER)分为3组:单纯2型DM组(DM1组)30例(UAER<20μg/min)。微量白蛋白尿组(DM2组)30例:(UAER 20μg-200μg/min)。临床蛋白尿组(DM3组)30例: (UAER > 200μg/min)。正常对照组(NC组)30例,为体检正常者。性别、年龄两组无统计学差异。采用酶联免疫吸附试验(Enzyme-linked immunosorbent assay,ELISA)测定血清骨桥蛋白(OPN)及白介素-18(IL-18)水平,24小时尿白蛋白排泄率(UAER)采用放免法测定。结果1、与健康对照组相比,糖尿病肾病各组在年龄、腰臀比、体重指数方面差异无统计学意义(P>0.05),具有可比性;与健康对照组比较,糖尿病各组收缩压、舒张压、空腹血糖、餐后2h血糖、糖化血红蛋白显著升高,差异有统计学意义(P<0.01)。2、糖尿病肾病各组血清OPN浓度显著高于正常对照组(P<0.01),血清OPN与UAER成正相关(P<0.01),与空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、血肌酐(Scr)、尿素氮(BUN)无明显相关性。3、糖尿病肾病各组血清IL-18浓度显著高于正常对照组(P<0.01),血清IL-18与UAER成正相关(P<0.01),与空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、血肌酐(Scr)、尿素氮(BUN)均成正相关。4、血清OPN与IL-18之间存在较好的相关性,相关系数为0.97。结论2型糖尿病肾病患者较正常对照组存在血清OPN、IL-18水平升高,OPN、IL-18在2型糖尿病肾病患者中随UAER的增加浓度升高,且二者之间存在相关性。OPN、IL-18及慢性炎性病变可能参与了2型糖尿病肾病的发病。更多还原

【Abstract】 ObjectiveIn this study, we detected the different stages of serum osteopontin and IL - 18 levels in type 2 diabetic nephropathy patients to discuss their role in the development of diabetic nephropathy and whether there is correlation between the two,in order to provide new und- erstanding of pathogenesis and evolution in type 2 diabetic nephropathy.MethodsWe select 90 patients diagnosed as type 2 diabetes from December 2009 to December 2010 in Tai’an Central Hospital, All the cases were confirmed according to the American Diabetes Association(ADA) 2008 diagnostic criteria. According to urinary albumin excretion rate (UAER) they were divided into 3 groups: a simple group of type 2 DM (DM1 group) 30 patients (UAER <20μg/min). Microalbuminuria group (DM2) were 30: (UAER 20μg-200μg/min).Clinical albuminuria group (DM3) were 30: (UAER> 200μg /min). The normal control group consisted of 30 healthy people,who were no significant difference.with theT2DM group in age and sexuality.Serum level of OPN and IL-18 was detected by means of enzyme-linked immunosorbent assay (ELISA). 24-hour urinary albumin excretion rate (UAER) was measured by radio- immunoassay .Results1.There were no significant differences between normal control group and diabetic nephropathy group in age,waist-hip ratio and body mass index. Compared with normal control group,Diabetic nephropathy group had statis- tically significant differences in systolic blood pressure, diastolic blood pressure,fasting blood glucose,2-hour postprandial blood glucose, HbA1c(P<0.01).2. Serum OPN concentration was significantly higher in diabetic nephropathy patients than normal control(P<0.01). Serum OPN was positively correlated with UAER(P< 0.01),and it had no significant correlation with FBG,2hPG,HbA1c,TG,Scr,BUN.3. Serum IL-18 concentration were significantly higher in diabetic nephropathy patie- nts than normal control(P<0.01). Serum IL-18 was positively correlated with UAER(P<0.01),and it was positively correlated with FBG,2hPG,HbA1c,TG,Scr,BUN.4. Serum OPN and IL-18 had correlation and the correlation coefficient was 0.97. ConclusionThere was an elevation in the serum level of OPN and IL-18 in type 2 diabetic nephropathy patients.The concentration of OPN and IL-18 increased with UAER increase- ing and OPN was positively correlated with IL-18 in type 2 diabetic nephropathy patients. OPN,IL-18 and chronic inflammatory disease may play an role in the development of type 2 diabetic nephropathy.更多还原