Clodi M, Oberbauer R, Waldhäusl W, Maurer G, Kostner G M, Kostner K
Third Department of Medicine, University of Vienna, Austria.
Diabetologia. 1997 Dec;40(12):1455-60. doi: 10.1007/s001250050849.
Lp(a), one of the most atherogenic lipoproteins, is believed to contribute significantly to vascular diseases in non-insulin-dependent diabetic (NIDDM) patients. Contradictive data have been published on these patients concerning plasma concentrations of Lp(a) and their relation to renal function. Since apo(a) fragments appear in urine, we measured urinary apo(a) in 134 NIDDM patients and 100 matched controls and related urinary apo(a) concentrations to plasma Lp(a) levels and kidney function. Plasma Lp(a) values were found to be significantly higher in NIDDM patients. NIDDM patients also secreted significantly more apo(a) into their urine as compared to control subjects. There was no correlation between creatinine clearance or albumin excretion and urinary apo(a) concentrations. Patients with macroalbuminuria exhibited a twofold higher apparent fractional excretion of apo(a) in comparison to patients with normal renal function. Urinary apo(a) values in both patients and control subjects were highly correlated to plasma Lp(a), yet no correlation was found with HbA1c or serum lipoproteins. It is concluded that urinary apo(a) excretion is correlated to plasma Lp(a) levels but not to creatinine clearance in patients suffering from NIDDM.
脂蛋白(a)是最具致动脉粥样硬化性的脂蛋白之一，被认为在非胰岛素依赖型糖尿病（NIDDM）患者的血管疾病中起重要作用。关于这些患者的脂蛋白(a)血浆浓度及其与肾功能的关系，已发表了相互矛盾的数据。由于载脂蛋白(a)片段出现在尿液中，我们检测了134例NIDDM患者和100例匹配对照者的尿载脂蛋白(a)，并将尿载脂蛋白(a)浓度与血浆脂蛋白(a)水平及肾功能相关联。发现NIDDM患者的血浆脂蛋白(a)值显著更高。与对照受试者相比，NIDDM患者向尿液中分泌的载脂蛋白(a)也显著更多。肌酐清除率或白蛋白排泄与尿载脂蛋白(a)浓度之间无相关性。与肾功能正常的患者相比，大量白蛋白尿患者的载脂蛋白(a)表观分数排泄高出两倍。患者和对照受试者的尿载脂蛋白(a)值均与血浆脂蛋白(a)高度相关，但与糖化血红蛋白或血清脂蛋白无相关性。结论是，NIDDM患者的尿载脂蛋白(a)排泄与血浆脂蛋白(a)水平相关，但与肌酐清除率无关。
