Koluman Basak Unver, Mutluay Ruya, Derici Ulver Boztepe, Arinsoy Turgay, Senlik Zeynep, Bahar Burak, Sancak Banu, Oktan Suna Ozhan, Sindel Sukru
Department of Hematology, Diskapi Yildirim Beyazit Training and Research Hospital, Turkey.
Clin Nephrol. 2013 Jul;80(1):9-16. doi: 10.5414/CN107920.
Vascular calcification and atherosclerosis play a vital role in the development of cardiovascular morbidity and mortality in diabetic patients, especially when complications of diabetic nephropathy occur. Osteoprotegerin (OPG) and fetuin-A are two markers of vascular calcification. We evaluated the association between these vascular markers and urinary albumin excretion in diabetic patients.
Three groups were arranged containing 40 patients: normoalbuminuric (Group 1), microalbuminuric (Group 2), and macroalbuminuric (Group 3). In addition to the obtained data, levels of hs-CRP (high sensitivity-CRP) and homocysteine were examined.
OPG levels of patients in Group 2 were higher than in Group 1 (p = 0.058). OPG levels in Group 3 were lower than in Groups 1 or 2 (p = 0.014 and 0.000, respectively). Levels of fetuin-A in Group 2 were determined to be lower than in Groups 1 and 3 (p = 0.001 and 0.000, respectively). Carotid intima media thickness (CIMT) in Group 3 was higher than in Group 1 (p = 0.002). CIMT in Group 2 was also higher than in Group 1 (p = 0.039). A positive correlation between fetuin-A and OPG was found (p = 0.012, r = 0.393). Additionally, a positive correlation between hs-CRP and fetuin-A in Group 2 (p = 0.020, r = 0.367) and a negative correlation between hs-CRP and OPG in Group 3 (p = 0.036, r = -0.333) were observed.
The differences found between albuminuria and OPG or fetuin-A may be due to the different doses and variety of medications the patients received, in addition to genetic and racial factors. So far, in our country, polymorphisms related to OPG and fetuin-A have not been defined. Further detailed studies about polymorphisms will have additional value.
血管钙化和动脉粥样硬化在糖尿病患者心血管疾病的发生和死亡中起着至关重要的作用，尤其是在糖尿病肾病并发症出现时。骨保护素（OPG）和胎球蛋白-A是血管钙化的两个标志物。我们评估了这些血管标志物与糖尿病患者尿白蛋白排泄之间的关联。
将40名患者分为三组：正常白蛋白尿组（第1组）、微量白蛋白尿组（第2组）和大量白蛋白尿组（第3组）。除了收集到的数据外，还检测了高敏C反应蛋白（hs-CRP）和同型半胱氨酸水平。
第2组患者的OPG水平高于第1组（p = 0.058）。第3组的OPG水平低于第1组或第2组（分别为p = 0.014和0.000）。第2组的胎球蛋白-A水平低于第1组和第3组（分别为p = 0.001和0.000）。第3组的颈动脉内膜中层厚度（CIMT）高于第1组（p = 0.002）。第2组的CIMT也高于第1组（p = 0.039）。发现胎球蛋白-A与OPG之间存在正相关（p = 0.012，r = 0.393）。此外，观察到第2组中hs-CRP与胎球蛋白-A之间存在正相关（p = 0.020，r = 0.367），第3组中hs-CRP与OPG之间存在负相关（p = 0.036，r = -0.333）。
蛋白尿与OPG或胎球蛋白-A之间发现的差异可能是由于患者接受的药物剂量和种类不同，以及遗传和种族因素。到目前为止，在我国，与OPG和胎球蛋白-A相关的多态性尚未明确。关于多态性的进一步详细研究将具有额外的价值。
