目的 探讨血清Fractalkine(FKN)和超敏C反应蛋白(hs-CRP)在2型糖尿病正常清蛋白尿期及微量清蛋白尿期(即早期2型糖尿病肾病)的变化及二者与相关代谢指标的相关性.方法 选择2009年3月-2010年2月在江苏省中医院内分泌科就诊的139例2型糖尿病患者,根据尿清蛋白/肌酐(UACR)水平,将患者分为正常蛋白尿组(UACR＜30 mg/g)92例和微量清蛋白尿组(30 mg/g≤UACR＜300 mg/g)47例.收集两组患者的一般资料(包括性别、年龄、病程等);测定相关生化指标水平,计算UACR;采用双抗体夹心酶联免疫(ELISA)法检测血清FKN水平,免疫比浊法测定hs-CRP水平.比较两组患者的各项生化指标及血清FKN、hs-CRP水平,并采用Pearson相关分析和多元逐步回归分析探讨相关指标与血清FKN、hs-CRP水平的关系.结果 (1)正常蛋白尿组和微量清蛋白尿组患者空腹血糖(FBG)、糖化血红蛋白(HbA1c)、hs-CRP水平比较,差异有统计学意义(P＜0.01);而两组血脂、FKN水平及肾小球滤过率(eGFR)比较,差异均无统计学意义(P＞0.05).(2)Pearson相关分析显示,血清FKN水平与体质指数(BMI)、腰围、三酰甘油(TG)、hs-CRP均呈正相关(P＜0.05).血清hs-CRP水平与BMI、腰围、eGFR、TG、UACR均呈正相关(P＜0.01),与HDL-C呈负相关(P＜0.05).(3)多元逐步回归分析显示,血清FKN与BMI独立相关(β=0.32,P＜0.01,R2=0.40);血清hs-CRP与BMI(β=0.30,P＜0.01,R2=0.37)、UACR(β=0.17,P＜0.01,R2=0.27)独立相关.结论 血清FKN水平与早期2型糖尿病患者代谢指标及UACR水平无相关性,而hs-CRP水平与早期2型糖尿病肾病关系密切.%Objective To investigate serum fractalkine ( FKN ) and high sensitivity C - reactive protein ( hs - CRP ) levels in normoalbuminuria and microalbuminuria period of type 2 diabetes and analyze the association of fractalkine and hs - CRP with urinary microalbumin excretion. Methods According to urinary albumin - to - creatinine ratio ( UACR ), a total of 139 patients with type 2 diabetes in endocrinology department of Jiangsu province hospital of Traditional Chinese Medicine between March 2009 and February 2010 were divided into normoalbuminuria group ( UACR <30 mg/g, 92 cases ) and microalbuminuria group ( 30 mg/g ≤ UACR < 300 mg/g, 47 cases ) . The basic characteristics of all subjects ( including sex, age, courses, etc ) were collected. UACR and blood chemistries were determined. FKN and hs - CRP were measured by enzyme - linked immunosorbent assay ( ELISA ) and immune turbidimetry respectively. The blood biochemical indices, FKN and hs - CRP levels of the two groups were compared. The relationship of FKN and hs - CRP levels with biochemical indices were analysed using Pearson correlation and multiple stepwise regression methods. Results ( 1 ) Differences of FBG, HbA1c and hs - CRP level between the two groups were statistically significant ( P <0. 01 ), while blood lipids, FKN levels and eGFR had no significant differences ( P >0. 05 ) . ( 2 ) FKN was positively correlated with body mass index ( BMI ), waist circumference, serum triglyceride and hs - CRP level ( P <0. 05 ) . The level of hs - CRP was positively related to BMI, waist circumference, eGFR, serum triglyceride and UACR ( P <0. 01 ) and negatively related to HDL - C level ( P <0. 05 ). (3) Multiple stepwise linear regression analysis showed that BMI was independently associated with FKN (β = 0. 32, P < 0. 01, R2 = 0. 40 ); While BMI (β = 0. 30, P < 0. 01, R2 = 0. 37 ) and UACR ((3 = 0. 17, P < 0. 01, R2 = 0. 27 ) had independent positive correlation with hs - CRP. Conclusion FKN level is not significantly associated with UACR and metabolic index of patients in T2DM. While hs - CRP level is positively correlated with early diabetic nephropathy.
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