von Hertzen L, Forsblom C, Stumpf K, Pettersson-Fernholm K, Adlercreutz H, Groop P-H
Folkhälsan Genetic Institute, Folkhälsan Research Centre, Biomedicum Helsinki, Helsinki University, Helsinki-00014, Finland.
J Intern Med. 2004 May;255(5):602-9. doi: 10.1111/j.1365-2796.2004.01330.x.
Phyto-oestrogens, naturally occurring phenolic, hormone-like compounds, have raised considerable interest due to their anticarcinogenic, antiatherogenic and antioxidative potential. Oxidative stress may be one of the key factors in the development of vascular complications in patients with type 1 diabetes. Here, we tested the hypothesis that high concentrations of phyto-oestrogens in serum may be associated with lower occurrence of vascular complications in these patients.
A total of 400 patients, recruited consecutively from the participant register of the nationwide FinnDiane study of type 1 diabetes and divided into four parallel groups according to the severity of their renal disease with 100 patients to each group: (i) normoalbuminuric patients, (ii) microalbuminuric patients, (iii) macroalbuminuric patients, and (iv) patients with end-stage renal disease (ESRD).
Phyto-oestrogen concentrations in serum (enterolactone, daidzein, genistein and equol) and urine (enterolactone), assessed by time-resolved fluoroimmunoassay.
Highly elevated serum concentrations of phyto-oestrogens were measured amongst patients with diabetic nephropathy, and low concentrations amongst patients without diabetic complications. The pattern was similar for all phyto-oestrogens measured, although the increase in mean serum concentrations along with the increasing severity of renal disease was steepest for enterolactone, ranging from 13 nmol L(-1) amongst women and 18 nmol L(-1) amongst men in normoalbuminuric patients to 181 and 206 nmol L(-1) in women and men, respectively, in patients with ESRD (P < 0.001 for both genders between the groups). A strong correlation between serum enterolactone and creatinine concentration was found (r = 0.60, P < 0.001).
The serum concentration of phyto-oestrogens and the severity of diabetic renal disease showed a close positive association, suggesting that phyto-oestrogens are unable to provide any major protective effect, through antioxidative or other mechanisms, on the development of diabetic renal and cardiovascular complications.
植物雌激素是天然存在的酚类、激素样化合物，因其抗癌、抗动脉粥样硬化和抗氧化潜力而备受关注。氧化应激可能是1型糖尿病患者血管并发症发生发展的关键因素之一。在此，我们检验了一个假设，即血清中高浓度的植物雌激素可能与这些患者血管并发症发生率较低有关。
总共400名患者，从全国性的1型糖尿病FinnDiane研究参与者登记册中连续招募，并根据肾病严重程度分为四个平行组，每组100名患者：（i）正常白蛋白尿患者，（ii）微量白蛋白尿患者，（iii）大量白蛋白尿患者，以及（iv）终末期肾病（ESRD）患者。
通过时间分辨荧光免疫分析法评估血清（肠内酯、大豆苷元、染料木黄酮和雌马酚）和尿液（肠内酯）中的植物雌激素浓度。
在糖尿病肾病患者中检测到血清植物雌激素浓度显著升高，而在无糖尿病并发症的患者中浓度较低。尽管所测的所有植物雌激素情况类似，但随着肾病严重程度增加，血清肠内酯平均浓度的上升最为明显，从正常白蛋白尿患者中女性的13 nmol/L和男性的18 nmol/L，分别增至ESRD患者中女性的181 nmol/L和男性的206 nmol/L（两组间男女P均<0.001）。血清肠内酯与肌酐浓度之间存在强相关性（r = 0.60，P < 0.001）。
植物雌激素的血清浓度与糖尿病肾病的严重程度呈密切正相关，表明植物雌激素无法通过抗氧化或其他机制对糖尿病肾病和心血管并发症的发生发展提供任何主要的保护作用。
