Abd-Allha Essam, Hassan Basma Badr, Abduo Mohamad, Omar Seham Ahmed, Sliem Hamdy
Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Indian J Endocrinol Metab. 2014 Jan;18(1):94-8. doi: 10.4103/2230-8210.126585.
The risk for diabetic nephropathy in type 2 diabetes is about 30-40%, and it is considered the leading cause of end-stage renal disease. Small dense low-density lipoprotein (sdLDL) particles are believed to be atherogenic, and its predominance has been accepted as an emerging cardiovascular risk factor. This study aimed to assess small dense LDL as a potential risk factor and a possible predictor for diabetic nephropathy in type 2 diabetic patients.
According to microalbuminuria test, 40 diabetic patients were categorized into two groups: Diabetic patients without nephropathy (microalbuminuria negative group) and diabetic patients with nephropathy (microalbuminuria positive group), each group consists of 20 patients and all were non-obese and normotensive. The patients were re-classified into three sub-groups depending on the glomerular filtration rate (GFR).
The mean of small dense LDL level in the microalbuminuria positive group was higher than that in the microalbuminuria negative group, but without statistical significance. It was significantly higher in patients with either mild or moderate decrease in estimated GFR than in patients with normal estimated GFR. There was statistically significant correlation between small dense LDL and albuminuria and significant inverse correlation between small dense LDL and estimated GFR in all patients in the study. Based on microalbuminuria, the sensitivity and specificity of small dense LDL in the diagnosis of diabetic nephropathy was 40% and 80%, respectively, with cutoff values of small dense LDL >55.14 mg/dl. On the other hand, based on GFR, the sensitivity and specificity were 88.24% and 73.91% respectively, with cutoff values of small dense LDL >41.89 mg/dl.
Small dense LDL is correlated with the incidence and severity of diabetic nephropathy in type 2 diabetic patients. It should be considered as a potential risk factor and as a diagnostic biomarker to be used in conjunction with other biochemical markers for early diagnosis, assessment, and follow-up of diabetic nephropathy.
2型糖尿病患者发生糖尿病肾病的风险约为30%-40%，糖尿病肾病被认为是终末期肾病的主要病因。小而密的低密度脂蛋白（sdLDL）颗粒被认为具有致动脉粥样硬化性，其占优势已被公认为一种新出现的心血管危险因素。本研究旨在评估小而密的低密度脂蛋白作为2型糖尿病患者糖尿病肾病的潜在危险因素和可能的预测指标。
根据微量白蛋白尿检测，将40例糖尿病患者分为两组：无肾病的糖尿病患者（微量白蛋白尿阴性组）和有肾病的糖尿病患者（微量白蛋白尿阳性组），每组20例，均为非肥胖且血压正常。根据肾小球滤过率（GFR）将患者重新分为三个亚组。
微量白蛋白尿阳性组的小而密的低密度脂蛋白水平均值高于微量白蛋白尿阴性组，但无统计学意义。估算肾小球滤过率轻度或中度降低的患者的小而密的低密度脂蛋白水平显著高于估算肾小球滤过率正常的患者。在本研究的所有患者中，小而密的低密度脂蛋白与蛋白尿之间存在统计学显著相关性，与估算肾小球滤过率之间存在显著负相关性。基于微量白蛋白尿，小而密的低密度脂蛋白诊断糖尿病肾病的敏感性和特异性分别为40%和80%，小而密的低密度脂蛋白的截断值>55.14mg/dl。另一方面，基于肾小球滤过率，敏感性和特异性分别为88.24%和73.91%，小而密的低密度脂蛋白的截断值>41.89mg/dl。
小而密的低密度脂蛋白与2型糖尿病患者糖尿病肾病的发生率和严重程度相关。应将其视为潜在危险因素和诊断生物标志物，与其他生化标志物联合用于糖尿病肾病的早期诊断、评估和随访。
