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目的探讨早期糖尿病慢性肾脏疾病(CKD)患者血清血管生成素样蛋白4(ANGPTL4)水平及吡格列酮(PGZ)对其影响。方法选取体检健康者92名为健康对照(NC)组、新诊断单纯T2DM患者89例为T2DM组和早期CKD患者90例为CKD组。将CKD组采用随机数字表法进一步分为联合吡格列酮治疗(PGZ)亚组45例和联合格列美脲治疗(GLI)亚组45例。采用ELISA检测血清ANGPTL4水平,观察治疗前后CKD患者血清ANGPTL4水平变化。结果 NC、T2DM、CKD组血清ANGPTL4水平逐渐降低[(34.8±4.75)vs(31.1±3.65)vs(27.1±3.52)ng/ml,P<0.05或P<0.01]。血清ANGPTL4水平与超氧化物岐化酶(SOD)、TG呈正相关(r=0.635、0.526,P<0.05或P<0.01),与BMI、FPG、HbA1c、高敏C反应蛋白(hsC-RP)、UAlb/Cr、VEGF、FIns、胰岛素抵抗指数(HOMA-IR)呈负相关(r=-0.502、-0.624、-0.542、-0.520、-0.538、-0.566、-0.576、-0.509,P<0.05或P<0.01)。治疗后PGZ亚组血清ANGPTL4水平较治疗前升高[(31.51±3.87)vs(27.60±3.58)ng/ml,P<0.05],UAlb/Cr降低[(88.50±8.90)vs(116.20±10.30)mg/24h,P<0.01]。治疗后GLI亚组UAlb/Cr较治疗前降低[(99.70±12.80)vs(122.40±13.10)mg/24h,P<0.05],血清ANGPTL4水平变化比较差异无统计学意义[(27.20±3.54)vs(26.60±3.48)ng/ml,P>0.05]。多元线性回归分析显示,HbA1c、FIns、UAlb/Cr是血清ANGPTL4水平的独立影响因素。结论 CKD患者血清ANGPTL4水平降低,吡格列酮通过增加血清ANGPTL4水平对CKD患者发挥治疗作用。
Objective To investigate the level of serum angiopoietin-like protein 4 (ANGPTL4) in patients with early diabetic chronic kidney disease (CKD) and the effect of pioglitazone (PGZ) on it. Methods Ninety-two healthy subjects were selected as healthy control (NC) group, 89 newly diagnosed T2DM patients as T2DM group and early CKD as CKD group. The CKD group was further divided into 45 cases with subgroup of combination pioglitazone (PGZ) and 45 cases with subgroup of glioma (GLI) by random number table. Serum levels of ANGPTL4 were detected by ELISA, and serum ANGPTL4 levels in CKD patients before and after treatment were observed. Results The level of serum ANGPTL4 in NC, T2DM and CKD groups decreased gradually ([(34.8 ± 4.75) vs (31.1 ± 3.65) vs (27.1 ± 3.52) ng / ml, P <0.05 or P <0.01]. The level of serum ANGPTL4 was positively correlated with superoxide dismutase (SOD) and TG (r = 0.635,0.526, P <0.05 or P <0.01), but not with the levels of BMI, FPG, HbA1c, hsC-RP, UAb / Cr, VEGF, FIns and HOMA-IR were negative correlation (r = -0.502, -0.624, -0.542, -0.520, -0.538, -0.566, -0.576, -0.509, P <0.05 or P <0.01). The level of serum ANGPTL4 in PGZ subgroup was significantly higher than that before treatment [(31.51 ± 3.87) vs (27.60 ± 3.58) ng / ml, P <0.05] and decreased UAlb / Cr [(88.50 ± 8.90) vs (116.20 ± 10.30) mg / 24h, P <0.01]. After treatment, the levels of UAlb / Cr in GLI subgroup were significantly lower than those before treatment [(99.70 ± 12.80) vs (122.40 ± 13.10) mg / 24h, P <0.05], but there was no significant difference in serum ANGPTL4 level (26.60 ± 3.48) ng / ml, P> 0.05]. Multiple linear regression analysis showed that HbA1c, FIns and UAlb / Cr were independent influencing factors of serum ANGPTL4 level. Conclusions The level of ANGPTL4 in serum of CKD patients is decreased, and pioglitazone exerts a therapeutic effect on CKD patients by increasing serum levels of ANGPTL4.