2型糖尿病患者微量白蛋白尿与血管内皮功能关系的探讨

目的　观察 2型糖尿病 (DM)患者伴微量白蛋白尿时肾外血管病变的发病情况 ,并探讨尿白蛋白排泄率 (UAER)与血管内皮功能障碍之间的关系。方法　将 2型糖尿病患者分为正常白蛋白尿组 (NA组 )和微量白蛋白尿组 (MA组 ) ,观察肾外血管病变的发病率 ,检测内皮功能障碍标志物vonWillebrandfactor(vWF)、endothelin 1 (ET 1 )的血浆水平。结果　MA组视网膜病变、周围神经病变、下肢动脉硬化闭塞症的发病率均比NA组增高 (P <0 0 5 )。血浆vWF水平 :NA组为 (1 1 8 95± 46 72 ) % ,MA组为 (2 0 2 0 7± 73 3 0 ) % (P <0 0 1 ) ;血浆ET 1水平 :NA组为 (5 0 60± 1 2 3 9) μg·L-1,MA组为 (79 1 3± 1 4 0 4) μg·L-1(P <0 0 1 )。vWF水平与尿白蛋白排泄率显著正相关 (r=0 .72 ,P <0 0 1 ) ;ET 1的血浆水平与vWF的血浆水平显著正相关 (r=0 .69,P <0 0 1 )。结论　伴有微量白蛋白尿的 2型DM患者血管内皮功能障碍比正常白蛋白尿患者更为明显 ,UAER升高的程度可反映内皮功能障碍的程度

Association between microalbuminuria and endothelial dysfunction in type 2 diabetes mellitus

Objective In order to study the incidence of extrarenal vascular complications of the type 2 diabetic patients with microalbuminuria (MA) and to investigate the relationship between the UAER and the endothelial dysfunction. Methods The patients with type 2 diabetes mellitus were divided into two groups, normal albuminuria (NA) group (UAER<20?μg·min -1 ) and MA group (UAER 20～200?μg·min -1 ). We studied the incidence of diabetic retinopathy, peripheral neuropathy, and lower extremity arterial sclerosis occlusion, measured the levels of plasma von Willebrand factor (vWF) and endothelin 1 (ET 1).Results The incidences of retinopathy, peripheral neuropathy and lower extremity arterial sclerosis occlusion were significantly higher in MA group than in NA group ( P <0.05). The levels of plasma vWF markedly elevated in MA group (202.07±73.30)% as compared with those of NA group (118.95±46.72)% ( P <0.01).The plasma ET 1 levels in MA group (79.13±14.04)?pg·mL -1 were significantly higher than those in NA group (50.60± 12.39 )?pg·mL -1 . The levels of plasma vWF were significantly correlated with UAER ( r=0.72 , P <0.01),and the plasma levels of ET 1 were closely associated with those of vWF ( r = 0.69 , P < 0.01 ).Conclusion Type 2 diabetic patients with MA have more remarkable endothelial dysfunction than the patients without MA. The increase of UAER is correlated with the degree of endothelial dysfunction. It explains the association between microalbuminuria and extrarenal vascular complications.