2型糖尿病患者急性期反应物动态变化与微血管功能障碍的发生率

Acute phase reactant dynamics and incidence of microvascular dysfunctions in type 2 diabetes mellitus.

作者信息

Azenabor Alfred, Ogbera Anthonia O, Adejumo Ngozi E, Adejare Adejimi O

机构信息

Lecturer, Department of Medical Laboratory Science, School of Basic Medical Sciences, College of Medicine, University of Lagos, Nigeria.

出版信息

J Res Med Sci. 2011 Oct;16(10):1298-305.

PMID:22973323

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3430019/

Abstract

BACKGROUND

Acute Phase Reactants (APRs) have a wide range of activities that contribute to host defense. The aim of this report was to evaluate the dynamics and magnitude of these proteins in various microvascular complications in diabetes mellitus (DM). We also sought to assess the predictive values of APRs and other clinical variables for microvascular complications in DM.

METHODS

This was a case control study carried out in 200 Nigerian subjects with type 2 DM and 100 sex and age matched healthy controls. The studied APRs included C-reactive protein, beta 2 microglobulin, fibrinogen and lipoprotein (a).

RESULTS

The mean values of the APRs were significantly higher in type 2 DM compared with the controls and were observed in higher concentrations in those with microvascular complications, except beta 2 microglobulin. Presence of microvascular complications was observed in those with dilated fundus examination (retinopathy), symptom score of 3.0 (neuropathy), urea and creatinine levels above 50mg% and 1.5mg%, respectively, with significant proteinuria (nephropathy). Significant increase in mean ± SEM values of lipoprotein (a) was observed in diabetic retinopathy in comparison with those without complications (25.76 ± 1.13 mg/dl vs. 22.37 ± 0.73 mg/dl, p = 0.005). Elevated C-reactive protein was observed in diabetic neuropathy in comparison with those without complications (11.43 ± 2.33 u/ml vs. 8.30 ± 1.15 u/ml, p = 0.048). Increased beta 2 microglobulin levels were observed in patients with diabetic foot ulcers in comparison with those without complications (3.04 ± 0.51 mg/dl vs. 2.54 ± 0.14 mg/dl, p = 0.049). Circulating levels of Lipoprotein (a) predicted retinopathy in DM with both good and poor long-term glycemic control while duration of DM predicted the occurrence of foot ulcers..

CONCLUSIONS

Increased level of APRs was associated with a number of microvascular complications and may play a role in the pathogenesis.

摘要

背景

急性期反应物（APRs）具有广泛的活性，有助于宿主防御。本报告的目的是评估这些蛋白质在糖尿病（DM）各种微血管并发症中的动态变化和水平。我们还试图评估APRs和其他临床变量对DM微血管并发症的预测价值。

方法

这是一项病例对照研究，纳入了200名2型糖尿病尼日利亚受试者和100名年龄和性别匹配的健康对照。所研究的APRs包括C反应蛋白、β2微球蛋白、纤维蛋白原和脂蛋白（a）。

结果

与对照组相比，2型糖尿病患者的APRs平均值显著更高，且在有微血管并发症的患者中观察到更高浓度，但β2微球蛋白除外。眼底检查发现眼底扩张（视网膜病变）、症状评分为3.0（神经病变）、尿素和肌酐水平分别高于50mg%和1.5mg%且有显著蛋白尿（肾病）的患者存在微血管并发症。与无并发症者相比，糖尿病视网膜病变患者的脂蛋白（a）平均±标准误水平显著升高（25.76±1.13mg/dl对22.37±0.73mg/dl，p = 0.005）。与无并发症者相比，糖尿病神经病变患者的C反应蛋白升高（11.43±2.33u/ml对8.30±1.15u/ml，p = 0.048）。与无并发症者相比，糖尿病足溃疡患者的β2微球蛋白水平升高（3.04±0.51mg/dl对2.54±0.14mg/dl，p = 0.049）。DM患者中，无论长期血糖控制良好与否，脂蛋白（a）的循环水平均可预测视网膜病变，而DM病程可预测足溃疡的发生。