摘要目的 研究2型糖尿病患者血浆脂联素水平及脂联素基因启动子区-11377位点单核苷酸多态性(SNP)与尿白蛋白排泄率(UAER)之间的关系.方法 按1999年世界卫生组织制定的糖尿病诊断标准,自2006年4月至2009年4月选取福建医科大学附属第二医院内分泌科2型糖尿病患者403例,根据24 h UAER分为正常组(UAER<30 mg/24 h,NAU组)201例、微量白蛋白尿组(30 mg/24 h≤UAER<300 mg/24 h,MiAU组)134例和大量白蛋白尿组(UAER≥300 mg/24 h,MaAU组)68例.采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术,检测脂联素基因启动子区SNP-11377C→G多态性.同时检测血浆脂联素、血脂、血糖、空腹胰岛素、血肌酐和内生肌酐清除率.脂联素水平与临床指标的相关性采用简单相关分析和偏相关分析.结果 脂联素水平随UAER增高呈递增趋势[NAU、MiAU、MaAU组分别为6.33(0.10～24.32)mg/L,6.97(0.25～20.12)mg/L,9.38(1.88～26.99)mg/L],MaAU组显著高于NAU和MiAU组(P<0.01).脂联素水平与血浆肌酐呈正相关(r=0.212,P<0.01),与肌酐清除率呈负相关(r=-0.157,P<0.05),与稳态模型胰岛素抵抗指数(HOMA-IR)呈负相关(r=-0.215,P<0.01).脂联素基因启动子SNP-11377C→G的基因型(CC型、CG型和GG型)和等位基因频率分布在NAU组、AU组间的差异无统计学意义(P>0.05).未发现启动子区SNP-11377C→G与脂联素水平有关.结论 2型糖尿病患者血脂联素随糖尿病肾病进展白蛋白尿加重而增高.未发现福建地区2型糖尿病患者脂联素基因启动子区-11377C→G多态性与UAER明显相关.

abstractsObjective To explore the association of adiponectin level, adiponectin gene-11377 polymorphism and urinary albumin excretion rate (UAER) in patients with type 2 diabetes mellitus.Methods Adiponectin gene SNP-11377C→G was identified in 403 patients with type 2 diabetes mellitus,including 201 patients with normal albuminuria (NAU group,UAER < 30 mg/24 h), 134 patients with microalbuminuria ( MiAU group, 30 mg/24 h ≤ UAER < 300 mg/24 h ) and 68 patients with macrolalbuminuria (MaAU group,UAER≥300 mg/24 h) by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Plasma adipanectin, blood lipid, fasting plasma glucose, fasting insulin serum creatinine and creatinine clearance rate were also measured. Results Plasma adiponectin levels showed an increasing tendency in groups of NAU, MiAU and MaAU (6. 33 mg/L(0.10 -24.32) ,6. 97 mg/L(0.25 -20. 12) ,9. 38mg/L(1.88 -26. 99)). Plasma adiponectin level was significant higher in MaAU group than in NAU and MiAU groups (P<0.01). Plasma adiponectin level was positive correlated with Scr (r=0.212, P <0.01), negative correlated with Ccr (r = -0. 157, P <0.05) and HOMA-IR (r =-0.215, P < 0.01 ). The frequencies of adiponectin gene genotype and allele showed no significant difference between the NAU group and the AU group(P>0.05). Significant difference in groups of different genotypes of SNP-11377C→G ( CC/CG/GG ) was not found. Conclusions Aggravation of diabetic nepbropathy and albuminuria accompany increasing adiponectin level in patients with type 2 diabetes mellitus. There is no significant association of SNP-11377C→G in the promoter region of adiponectin gene and albuminuria in patients with type 2 diabetes mellitus of in a population Fujian Province.