血清瘦素和NGAL在2型糖尿病合并不同分级高血压患者中的变化及其与左心结构和功能的关系-现代医学

血清瘦素和NGAL在2型糖尿病合并不同分级高血压患者中的变化及其与左心结构和功能的关系

作者：李宝新¹ 2 郭淑芹¹ 张鑫¹ 常文龙¹ 李立琴¹ 王翯¹ 马爽¹ 张云良¹

单位：1. 保定市第一中心医院内分泌科, 河北省, 保定市 071000;
2. 河北医科大学, 河北石家庄 050017

分类号：R587.1

出版年·卷·期（页码）：2018·46·第二期（106-111）

摘要：

目的：研究不同血压分级的2型糖尿病患者血清瘦素和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）的变化，并分析其与左心结构和功能的关系。方法：收集住院的2型糖尿病患者208例，包括单纯糖尿病患者（DM组，50例），2型糖尿病合并高血压患者158例，依据血压水平又分为糖尿病高血压1级组（DH1组，53例），糖尿病高血压2级组（DH2组，51例），糖尿病高血压3级组（DH3组，54例），同期体检健康对照组（NC组，50例），ELISA检测血清瘦素和NGAL的水平，测量所有受试者超声心动图参数。对比受试者各项指标的差异，并分析其相关性。结果：与正常对照组和单纯糖尿病组相比，糖尿病合并高血压组随着血压分级的增加，超声心动图参数IVST、LVEDD、LVPWT、LAD、LVMI、血清LPN和NGAL水平均明显升高，且以DH3组最高（P<0.05）；而参数LVEF和E/A随着血压分级的增加而显著降低，以DH3组最低（P<0.05）。多元逐步回归分析结果显示参数LVMI和收缩压均为LPN和NGAL的独立危险因素。结论：2型糖尿病患者随着血压分级的增高出现左心肥厚程度相应增加，而左心收缩功能随之降低，血清LPN和NGAL水平逐渐升高，表明LPN和NGAL均可能参与2型糖尿病合并高血压的发生并对其左心结构和功能产生影响。

Objective: To study the levels of serum leptin(LPN) and NGAL and its correlation with left cardiac morphology and function in type 2 diabetes with different grades of hypertension patients. Methods: We chose two hundred and eight resident type 2 diabetes patients, including type 2 diabetes alone patients(DM group,n=50),and one hundred fifty-eight type 2 diabetes with hypertension patients (DH1 group,n=53;DH2 group,n=51;DH3 group,n=54),then fifty healthy people as NC group were enrolled in this study.The levels of serum leptin and NGAL were detected by ELISA, and the cardiac structure and function were examined. Compared the difference of each index in the groups,and index about the correlation between leptin and NGAL were analyzed. Results: The levels of IVST, LVEDD, LVPWT,LAD,LVMI,leptin and NGAL in DH1,DH2 and DH3 group were higher than those in the NC and DM groups(P<0.05),and those in the DH3 group were the highest(P<0.05), LVEF and E/A were decreased with the rising grade of hypertension, and in the DH3 group were the lowest(P<0.05).Correlation analyses showed that LPN and NGAL were positively correlated with SBP and LVMI. Further multiple linear regression analysis showed that SBP and LVMI were independent risk factors for serum LPN and NGAL levels. Conclusion: The left ventricular systolic function was decreased and left ventricular hypertrophy was increased with the rising grade of blood pressure. With the rise of blood pressure, the levels of serum LPN and NGAL were increased. LPN and NGAL might play important roles in the changes of left cardiac structure and function in T2DM patients with hypertension.

参考文献：

[1] YU B,CAI D.Neural Programmatic Role of Leptin,TNFα,melanocortin,and glutamate in blood pressure regulation vs obesity-related hypertension in male C57BL/6 mice[J].Endocrinology,2017,158(6):1766-1775.
[2] SIDDIQI Z,KAROLI R,KAUL A,et al.Evaluation of neutrophil gelatinase-associated lipocalin and cystatin C as early markers of diabetic nephropathy[J].Ann Afr Med,2017,16(3):101-106.
[3] AVCI C E,ROTA S,DURSUN B,et al.Evaluation of serum NGAL and hepcidin levels in chronic kidney disease patients[J].Ren Fail,2016,38(1):35-39.
[4] 殷俏,张云良,郭淑芹,等.视黄醇结合蛋白4、超敏C反应蛋白与糖尿病视网膜病变的关系[J].国际内分泌代谢杂志,2016,36(3):149-156.
[5] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):579-616.
[6] 中华医学会超声医学分会超声心动图学组.中国成年人超声心动图检查测量指南[J].中华超声影像学杂志,2016,25(8):645-666.
[7] MAJUMDAR J,CHAKRABORTY P,MITRA A,et al.Fenugreek,A Potent hypoglycaemic herb can cause central hypothyroidism via leptin-a threat to diabetes phytotherapy[J].Exp Clin Endocrinol Diabetes,2017,125(7):441-448.
[8] PODZOLKOV V I,BRAGINA A E,MURASHKO N F.Stable nitric oxide metabolites levels in hypertensive patients with obesity and high leptin level[J].Kardiologiia,2016,56(7):14-19.
[9] SHI Z,MADDEN C J,BROOKS V L.Arcuate neuropeptide Y inhibits sympathetic nerve activity via multiple neuropathways[J].J Clin Invest,2017,127(7):2868-2880.
[10] MAHFOUZ M H,ASSIRI A M,MUKHTAR M H.Assessment of neutrophil gelatinase-associated lipocalin (NGAL) and retinol-binding protein 4(RBP4) in type 2 diabetic patients with nephropathy[J].Biomark Insights,2016,11(11):31-40.
[11] ABDOLLAHI M,NG T S,REZAEIZADEH A,et al.Insulin treatment prevents wounding associated changes in tissue and circulating neutrophil MMP-9 and NGAL in diabetic rats[J].PLoS One,2017,12(2):e0170951.
[12] EILENBERG W,STOJKOVIC S,PIETHOTA-POLANCZYK A,et al.Neutrophil gelatinase associated lipocalin (NGAL) is elevated in type 2 diabetics with carotid artery stenosis and reduced under metformin treatment[J].Cardiovasc Diabetol,2017,16(1):98.
[13] AHMAD F S,NING H,RICH J D,et al.Hypertension,obesity,diabetes,and heart failure-free survival:The cardiovascular disease lifetime risk pooling project[J].JACC Heart Fail,2016,4(12):911-919.
[14] AYUBI E,SANI M.Carotid atherosclerosis is associated with left ventricular diastolic function[J].J Echocardiogr,2016,14(3):120-129.
[15] RITTER A M,dE FARIA A P,BARBARO N,et al.Crosstalk between obesity a-nd MMP-9 in cardiac remodelling -across-sectional study in apparent treatment-resistant hypertension[J].Blood Press,2017,26(2):122-129.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录