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目的探讨2型糖尿病(T2DM)肾病患者血清色素上皮源因子(PEDF)水平变化及其在糖尿病肾病发生发展中的意义。方法选取49例健康对照,132例 T2DM 患者,并根据24 h 尿微量白蛋白排泄率(UAER)将患者分为正常白蛋白尿组(NA)48例、微量白蛋白尿组(MA)50例、临床蛋白尿组(PR)34例。采用酶联免疫(ELISA)法检测血清 PEDF 水平,免疫比浊法检测尿微量白蛋白,同时检测糖化血红蛋白(HbA11c)、空腹血糖(FPG)、血脂和高敏 C 反应蛋白(hs-CRP)。结果T2DM 患者血清 PEDF 水平显著高于健康对照组(2.7±1.3)mg/L,MA 组患者血清 PEDF(4.7±2.9)mg/L 显著高于 NA 组(3.7±2.2)mg/L,(P<0.01);PR 组(5.7±2.8)mg/L 显著高于 MA 组(P<0.05)。血清 PEDF 水平与 HbA1c(r=0.198,P<0.01)、FPG(r=0.231,P<0.01)、甘油三酯(TG)(r=0.302,P<0.01)、hs-CRP(r=0.214,P<0.01)和 UAER(r=0.169,P<0.05)呈显著正相关,而与高密度脂蛋白胆固醇(r=-0.237,P<0.01)呈显著负相关。多元回归分析发现 TG(β=0.314,P<0.01)、hs-CRP(β=0.260,P<0.01)、UAER(β=0.148,P<0.05)是血清 PEDF 的独立决定因子。结论 PEDF 在 T2DM 患者中显著升高,并随白蛋白尿严重程度而逐渐升高;TG、hs-CRP 和 UAER 是血清 PEDF 的独立影响因子。血清 PEDF 水平的升高可能参于了糖尿病肾病的发生和发展。
Objective To investigate the changes of serum pigment epithelium factor (PEDF) in patients with type 2 diabetes mellitus (T2DM) and its significance in the development of diabetic nephropathy. Methods Forty-nine healthy controls and 132 T2DM patients were enrolled in this study. Patients were divided into 48 cases of normal albuminuria (NA) and 50 cases of microalbuminuria (MA) according to the 24-hour urinary albumin excretion rate (UAER) , Clinical proteinuria group (PR) 34 cases. Serum PEDF levels were measured by enzyme-linked immunosorbent assay (ELISA), urine microalbumin was detected by immunoturbidimetry, and HbA11c, FPG, hs-CRP were also detected. Results The serum PEDF level in T2DM patients was significantly higher than that in healthy controls (2.7 ± 1.3) mg / L, PEDF (4.7 ± 2.9) mg / L in MA patients was significantly higher than that in NA patients (3.7 ± 2.2) mg / L <0.01). PR group (5.7 ± 2.8) mg / L was significantly higher than MA group (P <0.05). The level of serum PEDF was positively correlated with HbA1c (r = 0.198, P <0.01), FPG (r = 0.231, P <0.01), triglyceride (TG) P <0.01) and UAER (r = 0.169, P <0.05), but negatively correlated with high density lipoprotein cholesterol (r = -0.237, P <0.01). Multiple regression analysis showed that TG (β = 0.314, P <0.01), hs-CRP (β = 0.260, P <0.01) and UAER (β = 0.148, P <0.05) were independent determinants of serum PEDF. Conclusions PEDF increased significantly in patients with T2DM and gradually increased with the severity of albuminuria. TG, hs-CRP and UAER were independent influencing factors of serum PEDF. Elevated serum levels of PEDF may be involved in the occurrence and development of diabetic nephropathy.