| Objective:To investigate the relationship among the 24 h ambulatory blood pressure,the level of chemerin and microalbuminuria in type 2 diabetic nephropathy. Currently, we know that diabetic nephropathy is bound to be the end-stage renal disease if it is not to be trested in time. so that, it has become the fist cause of end-stage renal disease. So far, the treatment of end-stage renal disease is extremely difficult. Early detection, early treatment is especially important for patient with diabetic nephropathy. Now we know that rennin-an-giotensin system plays a very important role in the development of diabetic nephropathy. Activation of the rennin angiotensin system not only can cause the damage of glomerular filtration barrier, and can affect the blood pressure. It is a question that whether the diabetic nephropathy is related with the blood pressure. Before the presentence of abnomrmal microalbuminuria, the 24 h ambulatory blood pressure of the patients with diabetic nephropathy are already exist on the form of change. Chemerin as a newly discovered fat facror, is intimately related with the body inflammation and metabolic syndeome. It is a question that whether the diabetic nephropathy is related with the level of chemerin. The relationships among the level of chemerin, the blood pressure, the plasma lipid, the body mass index, the renal function are unknown yet. The study analyse the relationship among the 24 h ambulatory blood pressure,the level of chemerin and microalbuminuria in diabetes to find a strong evidence which can earlily prevent and treat the diabetic nephropathy.Methods:88 in-ward patients with diaetes in the Second Hospital of Hebei Medical University from January 2014 to December 2014, 41 males and 47 females, 22-87 years old,mean age is 57.1±14.4 years. All of them are divided into 4 groupes according to Mogensen stage: Group A: the diabetes with normal albuminuria [U-Alb?20ug/min and e GFR>60m L/(min·1.73m2),n=24], 11 males and 13 females, mean age is 53.26 ± 13.53 years. Group B: microabuminuria [20ug/min< U-Alb <200ug/min and e GFR>60m L/(min·1.73m2),n=21], 10 males and 11 females, mean age is 60.27±13.82 years. Group C: Mass albuminuria [U-Alb?200ug/min and e GFR>60m L/(min·1.73m2),n=22], 9males and 13 females, mean age is 52.57±15.67 years. Group D: Kidney function insufficiency [e GFR ? 60 m L/(min·1.73m2),n=21],11 males and 10 females, mean age is 62.86±13.03 years. Group N : the normals for health, 20 cases, 9 males and 11 females, mean age is 49.05±9.82 years. All subjects are detected, including 24 h ambulatory blood pressure,the level of chemerin, total cholesrerol(TC), triglyceride(TG), low-density lipoprotein cholesterol(LDL-C), body mass index( BMI), creatinine and other clinical indicators.All data are used by SPSS 13.0 Statistical Package for the treatment.Results:1 The gender and age of diabetic nephropathy patients have not statistical differences with the healthy person(P>0.05). With the progress of the diabetic nephropathy, the level of creatinine and cystatin-C will be increased. At the same time, the glomerular filtration rate will be decreased. The level of blood-glucose and blood-lipoid with diabetic nephropathy are not increased. The patients of V term DKD have low level of blood-glucose and blood-lipoid, they also have a low body mass index.2 The level of blood pressure between the diabetic nephropathy in early stage and the healthy person have not statistical differences(P>0.05). Along with the development of diabetic nephropathy, their blood pressure rising. The level of urinary albumin excretion rate of patients with diabetic nephropathy and the level of the systolic blood pressure, the systolic blood pressure in the daytime, the systolic blood pressure at night, the diastolic blood pressure, the diastolic blood pressure at night and pulse pressure were positively correlated. The coefficient index are 0.351(P<0.01), 0.345(P<0.01), 0.356(P<0.01), 0.196(P<0.05), 0.237(P<0.05), 0.322(P<0.01). When the patients with diabetic nephropathy have normal urinary albumin excretion rate, their blood pressure value is normal too. But, the rhythm of their blood pressure is unnormal.3 The level of chemerin of patients with diabetic nephropathy and the level of creatinine, cystain-C, BMI, Hb A1 c, the systolic blood pressure, the diastolic blood pressure were positively correlated. The coefficient index are 0.427(P<0.01)?0.420(P<0.01)?0.218(P<0.05)?0.208(P<0.05)?0.678(P<0.01)?0.442(P<0.01)?0.577(P<0.01). The level of chemerin of patients with diabetic nephropathy, the level of glomerular filtration rate, the declined rate of the night mean systolic pressure are negative correlation, the coefficient index are-0.522(P<0.01),-3.1(P<0.01).Conclusions:1 With the progress of the diabetic nephropathy, the level of creatinine and cystatin-C will be increased. At the same time, the glomerular filtration rate will be decreased. The level of blood-glucose and blood-lipoid with diabetic nephropathy are not increased. The patients of V term DKD have low level of blood-glucose and blood-lipoid, they also have a low body mass index.2 Along with the development of diabetic nephropathy, their blood pressure rising. When the patients with diabetic nephropathy have normal urinary albumin excretion rate, their blood pressure value is normal too. But, the rhythm of their blood pressure is unnormal.3 The level of chemerin of patients with diabetic nephropathy and the level of creatinine, cystain-C, the blood pressure, Hb A1 c were positively correlated. Chemerin may pass to participate in the body's glucolipid metabolism to participate the development of the diabetic nephropathy. |
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