2019 年第 7 期 第 14 卷

小而密低密度脂蛋白胆固醇对糖尿病患者早期肾损伤的评估价值

Evaluation value of small dense low density lipoprotein cholesterol for early renal injury in patients with diabetes mellitus

作者：周立忠

英文作者：

单位：261041山东省潍坊市人民医院检验科

英文单位：

关键词：糖尿病肾病；小而密低密度脂蛋白胆固醇；尿微量白蛋白排泄率；肾小球滤过率；早期预测

英文关键词：

• 摘要：

• 【摘要】目的    探讨小而密低密度脂蛋白胆固醇(sdLDL-C)对糖尿病患者早期肾损伤的评估价值。方法    选取2016年1月至2017年1月山东省潍坊市人民医院内分泌科和肾内科收治的2型糖尿病患者321例。根据尿微量白蛋白排泄率(UAER)将患者分为正常白蛋白尿组(NA组，125例)、微量白蛋白尿组(MA组，102例)和临床肾病组(CN组，94例)。随机选取同期本院体检中心的健康体检者108名作为对照组。全自动生化分析仪分别测定血糖、糖化血红蛋白（HbA1c）、sdLDL-C、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A、载脂蛋白B、同型半胱氨酸(Hcy)、胱抑素C，测算UAER、估算肾小球滤过率(eGFR)等指标。用Pearson检验分析糖尿病CN组患者eGFR与sdLDL-C及其他指标的相关性；Logistic回归方法分析糖尿病肾损伤的危险因素。结果    3组糖尿病患者HDL-C、载脂蛋白A水平均低于对照组，而糖尿病病程、血糖、HbA1c水平及sdLDL-C、三酰甘油、LDL-C、Hcy水平均长于/高于对照组，差异均有统计学意义（均P＜0.05）；MA组与NA组比较，sdLDL-C、UAER明显高［（1.01±0.42）mmol/L比（0.88±0.35）mmol/L、（169±56）mg/24 h尿比（18±6）mg/24 h尿］，差异均有统计学意义（均P＜0.05）；CN组与NA组比较，糖尿病病程长，sdLDL-C、总胆固醇、三酰甘油、LDL-C、载脂蛋白B、Hcy、胱抑素C、UAER高，eGFR低，差异均有统计学意义（均P＜0.05）。CN组eGFR与sdLDL-C、总胆固醇、三酰甘油、LDL-C、载脂蛋白B、Hcy呈正相关(r=0.556、0.301、0.221、0.385、0.495、0.519，均 P＜0.05)；与HbA1c、HDL-C、载脂蛋白A呈负相关(r=-0.245、-0.182、-0.168，均P＜0.05)。Logistic回归分析结果显示，糖尿病病程（比值比=1.233，P=0.018）、sdLDL-C（比值比=3.452，P=0.012）、总胆固醇（比值比=5.004，P=0.042）、载脂蛋白B（比值比=2.451，P=0.039）是糖尿病患者UAER增高的独立危险因素。结论    糖尿病患者sdLDL-C水平与UAER和eGFR有较好的相关性，sdLDL-C可以作为糖尿病肾损伤的早期风险判断指标，并对DN的发展进行预测。

• 【Abstract】Objective    To explore the evaluation value of small dense low density lipoprotein cholesterol(sdLDL-C) for early renal injury in patients with diabetes mellitus. Methods    From January 2016 to January 2017, 321 patients with type 2 diabetes mellitus were enrolled from departments of endocrinology and nephrology of Weifang People′s Hospital, Shandong Province. They were detected urinary microalbumin excretion rate(UAER) and divided into normal albumin group(NA group, 125 cases), microalbuminuria group(MA group, 102 cases) and clinic nephropathy group(CN group, 94 cases). One hundred and eight healthy people were enrolled as control group. Blood glucose, glycosylated hemoglobin(HbA1c), sdLDL-C, total cholesterol, triacylglycerol, high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholestero (LDL-C), apolipoprotein A, apolipoprotein B, homocysteine(Hcy) and cystatin C were detected. UAER and estimated glomerular filtration rate(eGFR) were measured. Correlations of eGFR with sdLDL-C and other indicators in CN group were analyzed by Pearson test. Risk factors of diabetic renal injury were analyzed by logistic regression. Results    Levels of HDL-C and apolipoprotein A in NA, MA, CN groups were significantly lower, duration of diabetes, levels of blood glucose, HbA1c, sdLDL-C, triacylglycerol, LDL-C and Hcy were significantly longer/higher than those in control group(all P<0.05). Levels of sdLDL-C and UAER in MA group were significantly higher than those in NA group［（1.01±0.42）mmol/L vs （0.88±0.35）mmol/L, （169±56）mg/24 h urine vs (18±6）mg/24 h urine］(both P<0.05). Duration of diabetes, levels of sdLDL-C, total cholesterol, triacylglycerol, LDL-C, apolipoprotein B, Hcy, cystatin C and UAER in CN group were significantly higher and eGFR was significantly lower than those in NA group（all P＜0.05）. In CN group, eGFR was positively correlated with sdLDL-C, total cholesterol, triacylglycerol, LDL-C, apolipoprotein B and Hcy(r=0.556, 0.301, 0.221, 0.385, 0.495, 0.519; all P<0.05); it was negatively correlated with HbA1c, HDL-C and apolipoprotein A(r=-0.245, -0.182, -0.168; all P<0.05). Logistic regression showed that duration of diabetes(odds ratio=1.233, P=0.018), sdLDL-C(odds ratio=3.452, P=0.012), total cholesterol(odds ratio=5.004, P=0.042) and apolipoprotein B(odds ratio=2.451, P=0.039) were independent risk factors of elevated UAER in diabetic patients. Conclusion    There is significant correlation among sdLDL-C level, UAER and eGFR in patients with diabetes mellitus; sdLDL-C may be an early predictor of diabetic nephropathy.