Griffin T P, Wall D, Browne G A, Dennedy M C, O'Shea P M
1 Centre for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland.
2 School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland.
Ann Clin Biochem. 2018 May;55(3):373-384. doi: 10.1177/0004563217728964. Epub 2017 Dec 21.
Introduction Hyperglycaemia increases succinate concentrations and succinate receptor activation in the kidney resulting in renin release. The aim of our study was to determine if there is an association between glycaemic control as evidenced by glycated haemoglobin values and activation of the renin-angiotensin-aldosterone system in patients with type 2 diabetes mellitus and hypertension. Methods A cross-sectional study was conducted at Galway University Hospitals between December 2014 and March 2015. Participants ( n = 66) were identified following interrogation of the electronic database for patients with type 2 diabetes mellitus. Baseline clinical demographics, aldosterone, plasma renin activity, direct renin concentration, urea and electrolytes, glycated haemoglobin, cholesterol, urine sodium and albumin creatinine ratio were recorded. Results There was a significant positive linear correlation between glycated haemoglobin and renin (both plasma renin activity [ P = 0.002] and direct renin concentration [ P = 0.008]) and between serum creatinine and aldosterone measured using both radioimmunoassay ( P = 0.008) and immunochemiluminometric assay ( P = 0.008). A significant negative linear correlation was demonstrated between serum sodium and plasma renin activity ( P = 0.005) and direct renin concentration ( P = 0.015) and between estimated glomerular filtration rate and aldosterone measured using radioimmunoassay ( P = 0.02) and immunochemiluminometric assay ( P = 0.016). A significant negative linear correlation existed between urine sodium and plasma renin activity ( P = 0.04) and aldosterone measured using radioimmunoassay ( P = 0.045). Conclusions There is a direct positive association between glycaemic control and renin. We advocate for renin measurement to be part of the diabetologist's armamentarium to assess, guide and optimize therapeutic strategies in patients with diabetes.
引言 高血糖会增加肾脏中琥珀酸盐的浓度并激活琥珀酸盐受体，从而导致肾素释放。我们研究的目的是确定糖化血红蛋白值所反映的血糖控制与2型糖尿病合并高血压患者肾素-血管紧张素-醛固酮系统激活之间是否存在关联。方法 2014年12月至2015年3月在戈尔韦大学医院进行了一项横断面研究。通过查询2型糖尿病患者的电子数据库确定参与者（n = 66）。记录基线临床人口统计学数据、醛固酮、血浆肾素活性、直接肾素浓度、尿素和电解质、糖化血红蛋白、胆固醇、尿钠和尿白蛋白肌酐比值。结果 糖化血红蛋白与肾素（血浆肾素活性[P = 0.002]和直接肾素浓度[P = 0.008]）之间、血清肌酐与使用放射免疫分析法（P = 0.008）和免疫化学发光分析法（P = 0.008）测量的醛固酮之间存在显著的正线性相关性。血清钠与血浆肾素活性（P = 0.005）和直接肾素浓度（P = 0.015）之间、估算肾小球滤过率与使用放射免疫分析法（P = 0.02）和免疫化学发光分析法（P = 0.016）测量的醛固酮之间存在显著的负线性相关性。尿钠与血浆肾素活性（P = 0.04）和使用放射免疫分析法测量的醛固酮（P = 0.045）之间存在显著的负线性相关性。结论 血糖控制与肾素之间存在直接的正相关。我们主张将肾素测量作为糖尿病专家评估、指导和优化糖尿病患者治疗策略的手段之一。
