2型糖尿病肾病患者血栓调节蛋白的变化

目的　探讨血浆内血栓调节蛋白 (TM)含量变化与 2型糖尿病肾病的关系及其在 2型糖尿病肾病发病中的意义 ,为早期诊断和治疗提供依据。方法　采用ELISA法 ,同时测定 6 9例 2型糖尿病患者和 12例正常人 (NC组 )血浆TM ;并根据 2 4h尿白蛋白排泄率 (UAER)将 2型糖尿病患者分为正常白蛋白尿组 (SDM组 ) ,微量白蛋白尿组 (即早期糖尿病肾病组 ,EDN组 ) ,大量白蛋白尿组 (即临床期糖尿病肾病组 ,CDN组 )。结果　①与NC组 (1.4 6 11± 0 .392 6 ) μg·L-1比较 ,血浆TM水平在SDM组 (2 .0 2 81± 0 .5 813) μg·L-1、EDN组 (2 .6 6 32± 1.0 0 3) μg·L-1、CDN组 (4 .5 86 1±2 .5 2 91) μg·L-1,均显著升高 (P <0 .0 0 5 ,P <0 .0 0 5 ,P <0 .0 0 1) ;与SDM组比较 ,EDN组和CDN组血浆TM显著升高 (P<0 .0 5 ,P <0 .0 0 1) ,CDN组血浆TM水平显著高于EDN组 (P <0 .0 0 1)。②血浆TM与UAER呈显著正相关 (r值为 0 .5 74 ,P <0 .0 0 1)。③血浆TM分别与病程、FPG、GHbAc、BUN、Cr、TC、LDL、SBP、DBP呈显著正相关 (r值分别为 0 .4 33、0 .2 2 7、0 .315、0 .2 2 8、0 .2 2 6、0 .2 0 7、0 .2 96、0 .4 77、0 .372 ,P均小于 0 .0 5 )。结论　血浆TM水平的测定有助于 2型糖尿病肾病的早期诊断

The relationship between levels of plasma thrombomodulin and type 2 diabetic nephropathy

Objective To investigate the relationship between levels of plasma thrombomodulin (TM) and type 2 diabetic nephropathy and the significance of TM in the pathogenesis of diabetic nephropathy (DN). Methods The levels of plasma TM were determined using ELISA in 69 patients with type 2 diabetes mellitus (DM) and 12 normal control subjects (NC). DM patients were divided into SDM group (simple diabetes mellitus, or normoalbuminuria), EDN group (early diabetic nephropathy, or microalbuminuria) and CDN group (clinical diabetic nephropathy, or macroalbuminuria) according to their 24-hour urinary albumin excretion rate (UAER). Results ① As compared with that of NC group (1.461 1±0.392 6)μg·L -1 , the plasma TM increased markedly in SDM group(2.028 1±0.581 3)μg·L -1 , EDN group (2.66 32±1.003)μg·L -1 and CDN group(4.586 1±2.529 1)μg·L -1 (P< 0.005, P< 0.005 and P< 0.001), respectively. Significant differences were found between SDM group and EDN group (P<0.05), and between CDN group and EDN group (P< 0.001). Moreover, the level of plasma TM in CDN group was remarkably higher than in EDN group (P< 0.001). ② There was positive correlation between TM and UAER (r= 0.574, P< 0.001). ③ Plasma TM was correlated with the duration of disease (r= 0.433, P< 0.001), fasting blood glucose (r=0.227, P<0.05), glycosylated hemoglobin (r=0.226, P<0.05), blood urea nitrogen (r=0.315, P< 0.005), creatinine (r=0.228, P<0.05), total cholesterol (r=0.207, P< 0.05), low density lipoprotein (r=0.296, P<0.001), systolic blood pressure (r=0.477, P<0.001) and diastolic blood pressure (r=0.372, P<0.005). Conclusion Measurement of plasma TM is useful for early diagnosis of type 2 diabetic nephropathy.