核磁共振波谱法可识别早期糖尿病肾病中致动脉粥样硬化脂蛋白异常情况，而传统分析方法无法识别这些异常。

NMR identifies atherogenic lipoprotein abnormalities in early diabetic nephropathy that are unrecognized by conventional analysis.

作者信息

Al-Shahrouri H Z, Ramirez P, Fanti P, Abboud H, Lorenzo C, Haffner S

机构信息

Division of Clinical Nephrology Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.

出版信息

Clin Nephrol. 2010 Mar;73(3):180-9. doi: 10.5414/cnp73180.

DOI:10.5414/cnp73180

PMID:20178716

Abstract

UNLABELLED

Lipoprotein abnormalities are likely contributors to the high risk of cardiovascular disease in the chronic kidney disease (CKD) population, although information is limited. Specifically, little is known about lipoprotein abnormalities during the early stages of diabetic kidney disease. The aim of this study was to investigate the relationship between lipoproteins and early manifestations of CKD in the 517 Type 2 diabetes mellitus (T2DM) patients who participated in the Insulin Resistance Atherosclerosis Study (IRAS).

METHODS

Lipoprotein abnormalities were measured by conventional lipid analysis, nuclear magnetic resonance (NMR) spectroscopy, gel gradient electrophoresis (GE), immunoprecipitation (IP), and ELISA. We grouped the cases into albumin to creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) quartiles.

RESULTS

In the conventional lipid analysis, triglycerides (TG) correlated directly with ACR and inversely with eGFR quartiles (p = 0.01), while LDL, HDL cholesterol did not correlate with change in ACR or eGFR. ACR was directly associated with apoB, total VLDL, medium VLDL, IDL and small LDL particle concentrations (p < or = 0.03), and inversely with large LDL particles (p = 0.01) and LDL size (p = 0.008). Estimated GFR quartiles were inversely associated with total VLDL, small VLDL, IDL, and medium HDL particles (p < or = 0.01).

CONCLUSION

In subjects with T2DM, mild albuminuria and reduction in eGFR were associated with numerous atherogenic lipoprotein abnormalities that were detected by the combination of NMR spectroscopy, gel gradient electrophoresis, immunoprecipitation and ELISA but not by the standard clinical lipid analysis.

摘要

未标注

脂蛋白异常可能是慢性肾脏病（CKD）人群心血管疾病高风险的促成因素，尽管相关信息有限。具体而言，对于糖尿病肾病早期阶段的脂蛋白异常知之甚少。本研究的目的是调查参与胰岛素抵抗动脉粥样硬化研究（IRAS）的517例2型糖尿病（T2DM）患者中脂蛋白与CKD早期表现之间的关系。

方法

通过常规脂质分析、核磁共振（NMR）光谱法、凝胶梯度电泳（GE）、免疫沉淀（IP）和酶联免疫吸附测定（ELISA）来测量脂蛋白异常。我们将病例按照白蛋白与肌酐比值（ACR）和估算肾小球滤过率（eGFR）四分位数进行分组。

结果

在常规脂质分析中，甘油三酯（TG）与ACR呈正相关，与eGFR四分位数呈负相关（p = 0.01），而低密度脂蛋白（LDL）、高密度脂蛋白胆固醇与ACR或eGFR的变化无相关性。ACR与载脂蛋白B、总极低密度脂蛋白（VLDL）、中密度VLDL、中间密度脂蛋白（IDL）和小LDL颗粒浓度呈正相关（p≤0.03），与大LDL颗粒（p = 0.01）和LDL大小（p = 0.008）呈负相关。估算的GFR四分位数与总VLDL、小VLDL、IDL和中密度高密度脂蛋白颗粒呈负相关（p≤0.01）。