2型糖尿病肾脏病患者血清胆汁酸谱变化分析

Changes in bile acid profile in type 2 diabetes mellitus patients complicated with diabetic kidney disease

关键词:  糖尿病肾脏病  胆汁酸谱  尿白蛋白/肌酐比值  估算的肾小球滤过率

Key words:  diabetic kidney disease  bile acid profiles  UACR  eGFR

摘要:

目的探究2型糖尿病（type 2 diabetes mellitus, T2DM）合并糖尿病肾脏病（diabetic kidney disease, DKD）的患者胆汁酸（bile acid, BA）谱的变化，分析BA谱成分与DKD的相互联系。方法对80例T2DM患者进行BA谱检测，根据尿白蛋白/肌酐比值（urinary albumin-to-creatinine ratio, UACR）将患者分为单纯T2DM组和T2DM合并DKD组，比较两组间BA谱的差异，分析影响UACR和估算的肾小球滤过率（estimated glomerular filtration rate, eGFR）的因素。结果两组胆汁酸差异无统计学意义。UACR与胆汁酸无显著相关，但eGFR与鹅脱氧胆酸(chenodeoxycholic acid, CDCA)（rs=-0.374，P＜0.01）、胆酸(cholic acid, CA)（rs=-0.285，P＜0.01）、甘氨胆酸(glycocholic acid, GCA)（rs=-0.224，P＜0.05）、牛磺胆酸(taurocholic acid, TCA)（rs=-0.275，P＜0.05）、牛磺鹅脱氧胆酸(taurochenodeoxycholic acid, TCDCA)（rs=-0.26，P＜0.05）、总初级BA（rs=-0.26，P＜0.05）、总游离初级BA（rs=-0.376，P＜0.01）呈显著负相关，与甘氨熊脱氧胆酸(glycine ursodeoxycholic acid, GUDCA)（rs=0.255，P＜0.05）呈显著正相关。多元线性逐步回归分析显示，CDCA（β=-0.271，P=0.01）和GUDCA（β=0.228，P=0.023）是eGFR的影响因素。结论2型糖尿病肾脏病患者血胆汁酸虽然与尿蛋白无相关性，但明显地影响到肾功能的变化。

Abstract:

ObjectiveTo investigate the changes in bile acid(BA) profile in type 2 diabetes mellitus(T2DM) patients and T2DM with diabetic kidney disease(DKD). MethodsAccording to urinary albumin-to-creatinine ratio(UACR), 80 T2DM patients were divided into T2DM group and T2DM with DKD group. The BA profile between the two groups was compared and the factors influencing UACR and estimated glomerular filtration rate(eGFR) were analyzed. ResultsThere were no significant differences in bile acid profile between the two groups. There were no significant correlations between UACR and bile acid components. The eGFR was negatively correlated with CDCA（rs=-0.374，P＜0.01）, CA （rs=-0.285，P＜0.01）, GCA （rs=-0.224，P＜0.05）, TCA（rs=-0.275，P＜0.05）, TCDCA（rs=-0.26，P＜0.05）, total primary BA（rs=-0.26，P＜0.05）and total primary free BA（rs=-0.376，P＜0.01）; and positively correlated with GUDCA（rs=0.255，P＜0.05）. Multiple linear stepwise regression analysis showed that the CDCA（β=-0.271，P=0.01） and GUDCA（β=0.228，P=0.023）were independent risk factors of eGFR. ConclusionIn patients with type 2 diabetic kidney disease the bile acid profile is not correlated with UACR, but it affects renal function significantly.