Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC.
Diabetes. 2022 Aug 1;71(8):1795-1799. doi: 10.2337/db21-0920.
Apolipoprotein M (apoM), primarily carried by HDL, has been associated with several conditions, including cardiovascular disease and diabetic nephropathy. This study proposes to examine whether plasma apoM levels are associated with the development of diabetic kidney disease, assessed as progression to macroalbuminuria (MA) and chronic kidney disease (CKD). Plasma apoM was measured using an enzyme immunoassay in 386 subjects from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) cohort at DCCT entry and closeout and the concentrations used to determine the association with risk of progression to kidney dysfunction from the time of measurement through 18 years of EDIC follow-up. apoM levels, at DCCT baseline, were higher in patients who developed CKD than in those who retained normal renal function. At DCCT closeout, participants who progressed to MA, CKD, or both MA and CKD also had significantly higher apoM levels than those who remained normal, and increased levels of apoM were associated with increased risk of progression to both MA (risk ratio [RR] 1.30 [95% CI 1.01, 1.66]) and CKD (RR 1.69 [95% CI 1.18, 2.44]). Our results strongly suggest that alterations in apoM and therefore in the composition and function of HDL in type 1 diabetes are present early in the disease process and are associated with the development of nephropathy.
载脂蛋白 M（apoM）主要存在于高密度脂蛋白（HDL）中，与多种疾病相关，包括心血管疾病和糖尿病肾病。本研究旨在探讨血浆 apoM 水平是否与糖尿病肾病的发生有关，以评估其是否可作为向大量白蛋白尿（MA）和慢性肾脏病（CKD）进展的指标。在糖尿病控制和并发症试验（DCCT）/糖尿病干预和并发症流行病学（EDIC）队列的 386 名受试者中，采用酶联免疫吸附试验测定血浆 apoM。在 DCCT 入组和结束时以及 EDIC 随访 18 年期间，从测量时间开始到肾功能障碍进展的时间，用浓度来确定与进展为肾功能障碍的风险的关联。在 DCCT 基线时，发生 CKD 的患者的 apoM 水平高于保留正常肾功能的患者。在 DCCT 结束时，向 MA、CKD 或 MA 和 CKD 均进展的参与者的 apoM 水平也显著高于保持正常的参与者，apoM 水平的升高与向 MA（风险比 [RR] 1.30 [95% CI 1.01, 1.66]）和 CKD（RR 1.69 [95% CI 1.18, 2.44]）的进展风险增加相关。我们的结果强烈表明，1 型糖尿病中 apoM 以及 HDL 的组成和功能的改变在疾病早期就存在，并与肾病的发生有关。
