Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea.
J Diabetes Complications. 2017 Oct;31(10):1499-1505. doi: 10.1016/j.jdiacomp.2017.07.002. Epub 2017 Jul 6.
The relationship between the renin-angiotensin system (RAS) and diabetes has been studied for many years. However, studies that assessed RAS components comprehensively were limited. We hypothesized that serum RAS components, especially the effector peptide angiotensin-II, might be closely associated with glucose metabolism status and diabetic complications.
We investigated the association of individual RAS component with albuminuria in 407 subjects with normal glucose metabolism (NGM), prediabetes, or type 2 diabetes mellitus (T2DM). Anthropometric and biochemical parameters, including glucose homeostasis, albuminuria, and RAS-related parameters such as plasma renin activity (PRA), aldosterone, angiotensin-converting enzyme (ACE), and angiotensin-II levels, were measured.
The mean±standard deviation (SD) age and body mass index were 57.1±11.1years and 24.7±3.3kg/m, respectively. There were 54 subjects with NGM, 102 with prediabetes, and 251 with T2DM. The mean±SD angiotensin-II levels in these groups were 9.32±6.89, 12.89±10.39, and 17.00±15.28pg/mL, and the respective urinary albumin-to-creatinine ratios (ACRs) were 8.1±5.3, 13.3±17.3, and 30.7±51.9mg/g, which were significantly different among the groups. The serum angiotensin-II levels were correlated with levels of PRA, insulin resistance, C-reactive protein, and urinary ACR. Among RAS-related parameters, only the angiotensin-II level was significantly associated with urinary ACR after adjusting for relevant risk factors.
Angiotensin-II may play an important role in the development of albuminuria, particularly in subjects with impaired glucose metabolism.
肾素-血管紧张素系统（RAS）与糖尿病的关系已研究多年。然而，综合评估 RAS 成分的研究有限。我们假设血清 RAS 成分，特别是效应肽血管紧张素 II，可能与葡萄糖代谢状态和糖尿病并发症密切相关。
我们调查了 407 例血糖正常（NGM）、糖尿病前期或 2 型糖尿病（T2DM）患者的单个 RAS 成分与白蛋白尿的关系。测量了包括葡萄糖稳态、白蛋白尿和 RAS 相关参数（如血浆肾素活性（PRA）、醛固酮、血管紧张素转换酶（ACE）和血管紧张素 II 水平）在内的人体测量和生化参数。
平均年龄±标准差（SD）为 57.1±11.1 岁，平均体重指数（BMI）为 24.7±3.3kg/m。NGM 组有 54 例，糖尿病前期组有 102 例，T2DM 组有 251 例。这些组的平均±SD 血管紧张素 II 水平分别为 9.32±6.89、12.89±10.39 和 17.00±15.28pg/mL，相应的尿白蛋白/肌酐比值（ACR）分别为 8.1±5.3、13.3±17.3 和 30.7±51.9mg/g，组间差异有统计学意义。血清血管紧张素 II 水平与 PRA、胰岛素抵抗、C 反应蛋白和尿 ACR 水平相关。在 RAS 相关参数中，只有血管紧张素 II 水平在调整相关危险因素后与尿 ACR 显著相关。
血管紧张素 II 可能在白蛋白尿的发生发展中起重要作用，特别是在糖代谢受损的患者中。
