CAJ | 학술논문

目的探讨糖尿病肾病(diabetic nephropathy，DN)病人血清脂质代谢异常与肾脏损害间的关系。方法 64例2型糖尿病(diabetes mellitus，DM)病人，按尿清蛋白排泄率(urinary albumin excretion rate，UAER)分组，并设对照组，分别测定血清总胆固醇(to tal cholesterol，TC)、甘油三脂(triglycerides，TG)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol，HDL-C)、低密度脂蛋白胆固醇(1ow density lipoprotein-cho1esterol，LDL-C)、载脂蛋白A1(apolipoprotein-A1，Apo-A1)及载脂蛋白B(apolipoprotein-B，Apo-B)，比较组间差异及与UAER的关系；同时比较血脂与血糖间的关系。结果正常清蛋白尿组仅Apo-A1显著降低(P＜0．01)；微量清蛋白尿组Apo-A1显著降低，Apo-B显著升高(P＜0．05)；临床期DN组Apo-A1显著降低(P＜0．05)，Apo-B、TC、LDL-C显著升高(P＜0．05，0．01)，Apo-A1／Apo-B在DM三组均显著降低(P＜0．01，0．05)；TG、LDL-C及Apo B与UAER呈显著正相关(P＜0．01，0．001)；TC、TG及LDH-C与血糖呈显著正相关。结论 DN病人存在明显的脂质代谢异常，与血糖控制不良有关，且随肾脏损害程度加重而加重，其中TG、HDL-C及Apo-B的异常增高与肾脏损害程度密切相关，推测脂质代谢异常可能是DN诱发或(和)加重因素之一；控制血糖有助于预防血脂代谢紊乱．而控制血脂代谢异常有助于廷缓DN发展，有重要临床意义。
목적탐토당뇨병신병(diabetic nephropathy，DN)병인혈청지질대사이상여신장손해간적관계。방법 64례2형당뇨병(diabetes mellitus，DM)병인，안뇨청단백배설솔(urinary albumin excretion rate，UAER)분조，병설대조조，분별측정혈청총담고순(to tal cholesterol，TC)、감유삼지(triglycerides，TG)、고밀도지단백담고순(high density lipoprotein-cholesterol，HDL-C)、저밀도지단백담고순(1ow density lipoprotein-cho1esterol，LDL-C)、재지단백A1(apolipoprotein-A1，Apo-A1)급재지단백B(apolipoprotein-B，Apo-B)，비교조간차이급여UAER적관계；동시비교혈지여혈당간적관계。결과정상청단백뇨조부Apo-A1현저강저(P＜0．01)；미량청단백뇨조Apo-A1현저강저，Apo-B현저승고(P＜0．05)；림상기DN조Apo-A1현저강저(P＜0．05)，Apo-B、TC、LDL-C현저승고(P＜0．05，0．01)，Apo-A1／Apo-B재DM삼조균현저강저(P＜0．01，0．05)；TG、LDL-C급Apo B여UAER정현저정상관(P＜0．01，0．001)；TC、TG급LDH-C여혈당정현저정상관。결론 DN병인존재명현적지질대사이상，여혈당공제불량유관，차수신장손해정도가중이가중，기중TG、HDL-C급Apo-B적이상증고여신장손해정도밀절상관，추측지질대사이상가능시DN유발혹(화)가중인소지일；공제혈당유조우예방혈지대사문란．이공제혈지대사이상유조우정완DN발전，유중요림상의의。
Objective To investigate the relation between abnormal metabolism of serum lipids and renal damage in patients with diabetic nephropathy(DN). Methods 64 patients with type 2 diabetes mellitus were divided into three groups according to urinary albumin excretion rate (UAER), and another control group was established. The serum concentrations of total cholesterol (TC), triglycerides (TG), high-density lipoprotein -cholesterol (HDL-C), low-density lipoprotein-eholesterol (LDL-C), apolipoprotein-A 1 (ApoA1 ) and apolipoprotein-B (Apo-B) were measured. Their differences in between above groups were observed. Results The level of Apo-A1 in normal albuminuria group decreased significantly (P＜0.01). In the microalbuminuria group,the level of Apo-A1 decreased significantly and the Apo-B increased significantly (P＜0.05). For DN patients in clinical phase,the Apo-A1 level decreased significantly (P＜0.05) yet the Apo-B,TC and LDL-C increased significantly (P＜0.01,0. 05). The ratio of Apo-A1 and Apo-B decreased significantly in all three groups of DN (P＜0. 01,0. 05). Conclusion Patients with DN have a significant abnormal lipid metabolism which aggravates gradually alongwith the progression of renal damage. Abnormal lipid metabolism might be one of the factors that causes inducement and progression of DN.To notice this metabolic disorder and give a correct treatment will be important in delaying the process of DN.