在无明显糖尿病肾病的1型糖尿病患者中，尿白蛋白排泄与纤维蛋白原水平及蛋白S活性相关。

Urinary albumin excretion is correlated to fibrinogen levels and protein S activity in patients with type 1 diabetes mellitus without overt diabetic nephropathy.

作者信息

Lengyel Zoltán, Vörös Péter, Tóth Lajos K, Németh Csilla, Kammerer László, Mihály Mária, Tornóci László, Rosivall László

机构信息

II. Department of Medicine, Szent István Hospital, Budapest, Hungary.

出版信息

Wien Klin Wochenschr. 2004 Apr 30;116(7-8):240-5. doi: 10.1007/BF03041054.

DOI:10.1007/BF03041054

PMID:15143863

Abstract

The aim of the study was to test the hypothesis that in diabetic patients without overt nephropathy there may be a correlation between the activity of natural anticoagulant proteins and glomerular dysfunction. Assays for functional activity of proteins S and C, measurements of urinary albumin excretion, lipid parameters and haemoglobin A1c were performed in 91 patients with type 1 diabetes mellitus and 85 patients with type 2. Patients with type 1 diabetes and microalbuminuria had significantly higher mean age (44.1 +/- 10.9 vs. 37.9 +/- 12.7 years; p<0.05), fibrinogen level (3.75 +/- 1.0 vs. 3.21 +/- 0.8 g/l; p<0.01), protein S activity (92.3 +/- 17.6 vs. 84.5 +/- 15.5%; p<0.05) and higher prevalence of retinopathy (p<0.01) and macrovascular disease (p<0.01) than those with normoalbuminuria. Albumin excretion was significantly correlated to age (r=0.25, p<0.05), fibrinogen level (r=0.39, p<0.01), protein S activity (r=0.27; p<0.05), total cholesterol (r=0.23; p<0.05), apoprotein B (r=0.22; p<0.05), retinopathy (r=0.33; p<0.01) and macrovascular disease (r=0.33; p<0.01). Patients with type 2 diabetes mellitus and microalbuminuria had significantly higher apoprotein B levels (1.17 +/- 0.3 vs. 1.06 +/- 1.2 mg/dl; p<0.05) than those with normoalbuminuria, and apoprotein B was significantly correlated to albumin excretion (r=0.22; p<0.05). In a multivariate model of type 1 diabetes mellitus with fibrinogen, protein S and C activity, cholesterol, triglycerides, haemoglobin A1c, retinopathy, and macrovascular disease as independent parameters (r=0.53; p<0.003), there was significant independent correlation of fibrinogen (beta=0.28; p<0.01), protein S activity (beta=0.27; p<0.05) and retinopathy (beta=0.21; p<0.01) with albumin excretion. We conclude that in type 1 diabetes, relative elevation of fibrinogen level and protein S activity appear in the early stages of development of diabetic nephropathy, and may be related to the pathogenesis of diabetic kidney disease.

摘要

本研究的目的是检验以下假设

在无明显肾病的糖尿病患者中，天然抗凝蛋白的活性与肾小球功能障碍之间可能存在相关性。对91例1型糖尿病患者和85例2型糖尿病患者进行了蛋白S和C的功能活性检测、尿白蛋白排泄量测定、血脂参数及糖化血红蛋白检测。1型糖尿病合并微量白蛋白尿的患者平均年龄（44.1±10.9岁 vs. 37.9±12.7岁；p<0.05）、纤维蛋白原水平（3.75±1.0 vs. 3.21±0.8 g/l；p<0.01）、蛋白S活性（92.3±17.6 vs. 84.5±15.5%；p<0.05）显著高于正常白蛋白尿患者，视网膜病变（p<0.01）和大血管疾病（p<0.01）的患病率也更高。白蛋白排泄与年龄（r=0.25，p<0.05）、纤维蛋白原水平（r=0.39，p<0.01）、蛋白S活性（r=0.27；p<0.05）、总胆固醇（r=0.23；p<0.05）、载脂蛋白B（r=0.22；p<0.05）、视网膜病变（r=0.33；p<0.01）和大血管疾病（r=0.33；p<0.01）显著相关。2型糖尿病合并微量白蛋白尿的患者载脂蛋白B水平（1.17±0.3 vs. 1.06±1.2 mg/dl；p<0.05）显著高于正常白蛋白尿患者，且载脂蛋白B与白蛋白排泄显著相关（r=0.22；p<0.05）。在以纤维蛋白原、蛋白S和C活性、胆固醇、甘油三酯、糖化血红蛋白、视网膜病变和大血管疾病为独立参数的1型糖尿病多变量模型中（r=0.53；p<0.003），纤维蛋白原（β=0.28；p<0.01）、蛋白S活性（β=0.27；p<0.05）和视网膜病变（β=0.21；p<0.01）与白蛋白排泄存在显著的独立相关性。我们得出结论，在1型糖尿病中，纤维蛋白原水平和蛋白S活性的相对升高出现在糖尿病肾病发展的早期阶段，可能与糖尿病肾病的发病机制有关。