红细胞钠-锂逆向转运与增殖性糖尿病视网膜病变

Erythrocyte sodium-lithium countertransport and proliferative diabetic retinopathy.

作者信息

Lopes de Faria J M, Silveira L A, Morgano M, Pavin E J, Lopes de Faria J B

机构信息

Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), SP, Brazil.

出版信息

Invest Ophthalmol Vis Sci. 2000 May;41(6):1482-5.

PMID:10798666

Abstract

PURPOSE

To investigate whether elevated erythrocyte Na+/Li+ countertransport (Na+/Li+ CT) activity is present in patients with proliferative diabetic retinopathy (PDR).

METHODS

The rate of Na+/Li+ CT activity assayed in 21 patients with type 1 diabetes mellitus (DM) presenting PDR was compared with 10 patients with nonproliferative retinopathy (NPDR) and with 11 patients with normal fundi. Twelve normal volunteers with no family history of hypertension were used as a control group. The albumin excretion rate was determined by nephelometry, and the glomerular filtration rate was measured by the plasma clearance of eidetic acid labeled with chromium-51.

RESULTS

Patients with PDR showed higher diastolic blood pressure levels (mean +/- SD) compared with those with NPDR or normal fundi (95 +/- 13 versus 90 +/- 09 and 82 +/- 19 mm Hg, P = 0.02, respectively). The albumin excretion rate was higher [geometric mean (range)], and the glomerular filtration rate was lower (mean +/- SD) in patients with PDR than in those with NPDR or normal fundi [333 (2 to 5140) versus 32 (5.9 to 2200) and 6 (1.5 to 306) microg/min, P = 0.01, and 63 +/- 33 versus 99 +/- 37 and 93 +/- 43 ml/min, P = 0.02, respectively]. The mean Na+/Li+ CT in patients with PDR was significantly higher than in patients with NPDR or normal fundi and control group (0.46 +/-0.20 versus 0.32 +/- 0.12, 0.32 +/- 11, and 0.21 +/- 0.07 mM/L red blood cells (RBC)/h, respectively, P = 0.0001). In a multiple logistic regression analysis, with PDR as the dependent variable, Na+/Li+ CT (odds ratio [OR]: 4.7, confidence interval [CI]: 1.2-17.6, P = 0.02), diastolic blood pressure (OR, 3.4; CI, 1.3 to 9.6; P = 0.018), and glomerular filtration rate (OR, 5.1; CI, 1.6-17.7; P = 0.007) were the only variables that were maintained in the equation, indicating that they were the main determinants of PDR.

CONCLUSIONS

Patients with type 1 DM and proliferative retinopathy have elevated erythrocyte Na+/Li+ CT.

摘要

目的

研究增殖性糖尿病视网膜病变（PDR）患者是否存在红细胞钠/锂逆向转运（Na+/Li+ CT）活性升高。

方法

对21例患有PDR的1型糖尿病（DM）患者的Na+/Li+ CT活性测定率与10例非增殖性视网膜病变（NPDR）患者及11例眼底正常的患者进行比较。选取12名无高血压家族史的正常志愿者作为对照组。采用散射比浊法测定白蛋白排泄率，通过51铬标记的依地酸血浆清除率测量肾小球滤过率。

结果

与NPDR患者或眼底正常的患者相比，PDR患者的舒张压水平更高（均值±标准差）（分别为95±13与90±9以及82±19 mmHg，P = 0.02）。PDR患者的白蛋白排泄率更高[几何均值（范围）]，肾小球滤过率更低（均值±标准差），与NPDR患者或眼底正常的患者相比[分别为333（2至5140）与32（5.9至2200）以及6（1.5至306）μg/min，P = 0.01，以及63±33与99±37以及93±43 ml/min，P = 0.02]。PDR患者的平均Na+/Li+ CT显著高于NPDR患者、眼底正常的患者及对照组（分别为0.46±0.20与0.32±0.12、0.32±0.11以及0.21±0.07 mM/L红细胞（RBC）/h，P = 0.0001）。在多因素逻辑回归分析中，以PDR作为因变量，Na+/Li+ CT（比值比[OR]：4.7，置信区间[CI]：1.2 - 17.6，P = 0.02）、舒张压（OR，3.4；CI，1.3至9.6；P = 0.018）和肾小球滤过率（OR，5.1；CI，1.6 - 17.7；P = 0.007）是方程中仅保留的变量，表明它们是PDR的主要决定因素。