何宴清 杨萍 文莉 郑雪松 肖丽

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何宴清 杨萍 文莉 郑雪松 肖丽

目的分析CD+34细胞与糖尿病肾病代谢参数的相关性及其与糖尿病肾病发病的关系。方法选择终末期肾病患者100例，根据是否合并2型糖尿病分为合并糖尿病的终末期肾病组(n=55)，为终末期肾病组(n=45)。糖尿病组(n=50)。同时选取体检中心健康体检者作为健康对照组(n=60)。比较4组三酰甘油(TG)、胆固醇(TC)、空腹血糖(FPG)、餐后2 h血糖(2 hFPG)、糖化血红蛋白(HbA1c)、CD+34细胞/单核细胞值，尿微量白蛋白、肌酐(Cr)水平测定，肾小球滤过率的差异，以及各指标间的相关性。结果与阴性健康对照组比较，3个试验组CD+34细胞在单核细胞中的比值降低(P<0.05)；糖尿病组高于终末期肾病组、糖尿病合并终末期肾病组(P<0.05)。糖尿病合并终末期肾病组外周血 CD+34/单核细胞值与HBA1c、Cr、FPG、微量白蛋白、2 hFPG呈负相关(r值分别为-0.439、-0.241、-0.298、-0.342、-0.447，P<0.05)。结论CD+34细胞可能是肾病患者的危险因素，参与肾病的发生，监测 CD+34细胞水平变化也许能用来预测 2 型糖尿病患者合并终末期肾病的发生发展，其中糖尿病可能进一步导致CD+34细胞数量的下降。

CD34+细胞；2型糖尿病；终末期肾病

1 资料与方法

1.1 一般资料 选择2012年1月至2013年1月在我院肾病内科住院的终末期肾病患者100例，根据是否合并糖尿病分为2组:糖尿病合并终末期肾病组55例，男30例，女25例；终末期肾病组45例，男23例，女22例，为终末期肾病无糖尿病病史。糖尿病组为50例2型糖尿病患者无肾病病史。同时选取体检中心的60例健康体检者作为健康对照组。4组一般资料比较有可比性。见表1。

表1 4组一般资料比较 ±s

2 结果

组别CD+34/PMNC健康对照组(n=60)0．094±0．032糖尿病组(n=50)0．075±0．022∗终末期肾病组(n=45)0．038±0．020∗#糖尿病合并终末期肾病组(n=55)0．035±0．020∗#

注：与健康对照组比较，*P<0.05；与糖尿病组比较，#P<0.05

2.2 4组FPG、2 hFPG、HbA1c水平比较 健康对照组与糖尿病组、糖尿病合并终末期肾病组比较差异有统计学意义(P<0.05)，与终末期肾病组比较差异无统计学意义(P>0.05)；糖尿病组与终末期肾病组、糖尿病合并终末期肾病组比较有统计学意义(P<0.05)；终末期肾病组与糖尿病合并终末期肾病组比较差异有统计学意义(P<0.05)。见表3。

组别FPG(mmol/L)2hFPG(mmol/L)HbA1c(%)健康对照组(n=60)4．3±0．87．2±0．64．9±0．5糖尿病组(n=50)8．0±2．19．8±2．38．5±0．6终末期肾病组(n=45)5．7±1．2#8．3±2．4#5．6±0．9#糖尿病合并终末期肾病组(n=55)9．5±3．0∗#△13．6±3．6∗#△10．5±0．7∗#△

注：与健康对照组比较，*P<0.05；与糖尿病组比较，#P<0.05；与终末期肾病组比较，△P<0.05

2.3 4组患者微量白蛋白、Cr、eGFR比较 终末期肾病组及糖尿病合并终末期肾病组微量白蛋白、Cr、eGFR与健康组比较差异有统计学意义(P<0.05)。糖尿病组与健康对照组比较差异无统计学意义(P>0.05)，糖尿病组与终末期肾病组及2型糖尿病合并终末期肾病组微量白蛋白、Cr、eGFR差异有统计学意义(P<0.05)。终末期肾病组及糖尿病合并终末期肾病组比较，差异无统计学意义(P>0.05)。见表4。

组别Cr(μmol/L)微量白蛋白(mg/L)eGFR(%)健康对照组(n=60)60±65．4±2．998±7∗糖尿病组(n=50)80±86．9±3．295±8∗终末期肾病组(n=45)795±8∗1014．3±50．2∗9．0±0．8∗糖尿病合并终末期肾病组(n=55)804±10∗986．1±40．0∗9．5±1．2∗

注：与健康对照组比较，*P<0.05

表5 CD34+细胞与各指标相关分析

3 讨论

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ClinicalstudyonthechangesofCD+34cellsinpatientswithtype2diabetesmellituscomplicatedbyterminalstagenephropathy

HEYanqing,YANGPing,WENLi,etal.

DepartmentofDermatology,TaiheHospitalAffiliatedtoHubeiMedicalCollage,Hubei,Shiyan442000,China

ObjectiveTo analyze the correlation between CD+34cells and the parameters of diabetic nephropathy as well as the pathogenesis of diabetic nephropathy.MethodsOne hundred patients with terminal stage nephropathy were divided terminal stage nephropathy A group (with diabetes,n=55) and terminal stage nephropathy B group (without diabetes,n=45),simple diabetes group (n=50),at the same time,60 healthy subjects were enrolled as control group.The TG,TC,FPG,2 hFPG,HbA1c,ratio of CD+34cells/monocytes,urine microcontent albumin,muscle anhydride levels,glomerular filtration rate were detected and comparted in the four groups.ResultsAs compard with that in control group,the ratio of CD+34cells/monocytes in three experimental groups were obviously decreased (P<0.05),which in diabetes group was significantly higher than that in terminal stage nephropathy A group and terminal stage nephropathy B group (P<0.05).The ratio of CD+34cells/monocytes was negatively correlated to HbA1c,Cr,FPG in terminal stage nephropathy A group (r=-0.439,-0.241,-0.241,-0.342,-0.298,respectively,P<0.05).ConclusionCD+34cells may be risk factors for patients with diabetic nephropathy,which may be involved in the pathiogenesis of diabetic nephropathy,so monitoring the changes of CD+34cells may predict the pathogenesis and development of type 2 diabetes mellitus complicated by terminal stage nephropathy,in which diabetes mellitus may result in further decrease of CD+34cells.

CD+34 cells;type 2 diabetes mellitus;terminal stage nephropathy

10.3969/j.issn.1002-7386.2014.23.003

442000 湖北省十堰市，湖北医药学院附属太和医院皮肤科

R 587.1

A

1002-7386(2014)23-3531-04

2014-05-13)