·糖尿病肾脏疾病·

　　【摘要】 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组和早期糖尿病慢性肾脏疾病(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)、UAER 、UAlb/Cr 、VEGF、FIns、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/24 h，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/24 h，P<0.05]，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。

　　【关键词】血管生成素样蛋白4;吡格列酮;糖尿病慢性肾脏疾病

　　【Abstract】 Objective To explore the level of angiopoietin-like protein 4 (ANGPTL4) in patients with early chronic kidney disease (CKD) in diabetes and the influence of pioglitazone on the level. Methods 92 healthy people with normal glucose tolerance were selected as the controls (NC group). 89 newly diagnosed T2DM were selected (T2DM group). 90 cases of CKD group were divided into pioglitazone (PGZ) and glimepiride (GLI) treated subgroups, 45 cases in each subgroup. After treatment, serum ANGPTL4 levels were observed in CKD group. Results There were significant differences in serum ANGPTL4 levels among NC, T2DM and CKD groups [(34.8±4.75) vs (31.1±3.65) vs (27.1±3.52)ng/ml，P<0.05 or P<0.01]. ANGPTL4 level was positively correlated with SOD, TG (r=0.635, 0.526, P<0.05 or P<0.01), and negatively correlated with BMI, FPG, HbA1c, hsC-RP, UAlb/Cr, VEGF, FIns, HOMA-IR (r=﹣0.502, ﹣0.624, ﹣0.542, ﹣0.520, ﹣0.538, ﹣0.566, ﹣0.576, ﹣0.509, P<0.05 or P<0.01). In PGZ subgroup after treatment, ANGPTL4 levels were significantly increased and UAlb/Cr significantly decreased [(31.51±3.87) vs (27.60±3.58)ng/ml，P<0.05;(88.50±8.90) vs (116.20±10.30)mg/24 h，P<0.01]. In GLI subgroup after treatment, there were no significant difference in FPG and HbA1c as compared with PGZ subgroup but ANGPTL4 levels have no significant differences after treatment, and UAlb/Cr decreased [(27.20±3.54) vs (26.60±3.48)ng/ml，P>0.05;(99.70±12.80) vs (122.40±13.10)mg/24 h，P<0.05]. HbA1c, FIns, UAlb/Cr were the independent related factors influencing ANGPTL4 of CKD patients. Conclusion Serum ANGPTL4 has a lower level in CKD patients. PGZ is effective in treating CKD. This role is associated with the increase of serum ANGPTL4.

　　【Key words】 Angiopoietin-like protein 4 (ANGPTL4);Pioglitazone;Chronic kidney disease (CKD) in diabetes