Frystyk J, Tarnow L, Hansen T Krarup, Parving H-H, Flyvbjerg A
Medical Research Laboratories, Clinical Institute and Medical Department M (Diabetes and Endocrinology), Aarhus University Hospital, Aarhus C, Denmark.
Diabetologia. 2005 Sep;48(9):1911-8. doi: 10.1007/s00125-005-1850-z. Epub 2005 Aug 3.
AIMS/HYPOTHESIS: Low serum adiponectin (ADPN) has been associated with increased risk of cardiovascular disease (CVD) and retinopathy in patients with type 2 diabetes mellitus. In type 1 diabetic patients, the relationship between ADPN and the presence of vascular complications is largely unknown.
We investigated the relationship between serum ADPN and the presence of retinopathy, nephropathy and CVD in patients with type 1 diabetes, divided into matched groups with normoalbuminuria and no retinopathy (n=67), simplex retinopathy (n=106) or proliferative retinopathy (n=19), and nephropathy with simplex (n=62) or proliferative retinopathy (n=137). Healthy control subjects (n=25) were included.
Serum ADPN was increased in subjects with type 1 diabetes compared with control subjects (p<0.0001). Further, serum ADPN was higher in patients with than in those without nephropathy (p<0.0001). It was also higher in normoalbuminuric patients with than in those without proliferative retinopathy (p<0.0001). These differences remained significant after adjustment for known risk factors (p<0.03). CVD was also associated with elevated ADPN levels (p<0.05), but this difference became insignificant after risk factor adjustment. The most important predictor of serum ADPN was sex (r2=19%) in normoalbuminuric patients and GFR in patients with nephropathy (r2=18%).
CONCLUSION/INTERPRETATION: Patients with type 1 diabetes and microvascular complications have higher serum levels of ADPN than patients without complications. It remains to be clarified whether elevated levels of ADPN are pathogenically related to the development of microvascular complications or represent a beneficial counter-regulatory response.
目的/假设：低血清脂联素（ADPN）与2型糖尿病患者心血管疾病（CVD）和视网膜病变风险增加相关。在1型糖尿病患者中，ADPN与血管并发症的关系很大程度上尚不清楚。
我们研究了1型糖尿病患者血清ADPN与视网膜病变、肾病和CVD之间的关系，将患者分为尿白蛋白正常且无视网膜病变组（n = 67）、单纯性视网膜病变组（n = 106）或增殖性视网膜病变组（n = 19），以及伴有单纯性（n = 62）或增殖性视网膜病变（n = 137）的肾病组。纳入健康对照受试者（n = 25）。
与对照受试者相比，1型糖尿病患者的血清ADPN升高（p < 0.0001）。此外，有肾病的患者血清ADPN高于无肾病的患者（p < 0.0001）。在尿白蛋白正常的患者中，有增殖性视网膜病变的患者血清ADPN也高于无增殖性视网膜病变的患者（p < 0.0001）。在对已知危险因素进行校正后，这些差异仍然显著（p < 0.03）。CVD也与ADPN水平升高相关（p < 0.05），但在危险因素校正后，这种差异变得不显著。在尿白蛋白正常的患者中，血清ADPN的最重要预测因素是性别（r2 = 19%），而在肾病患者中是肾小球滤过率（GFR）（r2 = 18%）。
结论/解读：与无并发症的患者相比，患有微血管并发症的1型糖尿病患者血清ADPN水平更高。ADPN水平升高是否与微血管并发症的发生存在致病关系，抑或是一种有益的代偿性反应，仍有待阐明。
