糖尿病是我国发病率最高的慢性疾病之一,作为一种代谢性疾病,其会导致一系列机体病变造成严重的健康问题。糖尿病对患者的影响主要是由并发症导致。其中糖尿病肾病是糖尿病常见严重并发症中的一种,肾脏部位的微血管发生病变累及肾脏出现蛋白尿是导致糖尿病患者死亡的主要因素之一。研究发现在糖尿病肾病患者中动脉粥样硬化的发生几率也高于健康人群,然而其发生机理尚未有定论。近年来的研究显示,遗传因素、胰岛素抵抗、免疫功能和炎症反应都可能是导致并发动脉粥样硬化的原因,其中胰岛素抵抗、炎症反应在糖尿病肾病患者并发动脉粥样硬化的过程中可能起到最为关键的作用。因此,本综述拟探讨糖尿病肾病患者血清中炎症因子指标SAA水平与胰岛素抵抗并考察其预测糖尿病肾病患者并发动脉粥样硬化的效果。
Diabetes is one of the chronic diseases with the highest incidence in China. As a metabolic disease, it will lead to a series of body lesions and cause serious health problems. The impact of diabetes on patients is mainly caused by complications. Among them, diabetic nephropathy is one of the common serious complications of diabetes. The microangiopathy in the kidney and proteinuria is one of the main factors leading to the death of diabetic patients. Studies have found that the inci-dence of atherosclerosis in diabetic nephropathy patients is also higher than that in healthy people, but the mechanism of its occurrence has not been determined. Recent studies have shown that genetic factors, insulin resistance, immune function and inflammatory response may be the causes of atherosclerosis, among which insulin resistance and inflammatory response may play the most critical role in the process of atherosclerosis in diabetic nephropathy patients. Therefore, this re-view aims to investigate the relationship between serum inflammatory factor SAA level and insulin resistance in diabetic nephropathy patients and its effect on predicting atherosclerosis in diabetic nephropathy patients.
Study on the Correlation between TyG, SAA and Atherosclerosis in Diabetic Nephropathy Patients
Wenju Zhu1, Xiaoqin Zuo2
1Qinghai University, Xining Qinghai
2Department of Geriatrics, Affiliated Hospital of Qinghai University, Xining Qinghai
Received: Mar. 6th, 2022; accepted: Mar. 29th, 2022; published: Apr. 11th, 2022
ABSTRACT
Diabetes is one of the chronic diseases with the highest incidence in China. As a metabolic disease, it will lead to a series of body lesions and cause serious health problems. The impact of diabetes on patients is mainly caused by complications. Among them, diabetic nephropathy is one of the common serious complications of diabetes. The microangiopathy in the kidney and proteinuria is one of the main factors leading to the death of diabetic patients. Studies have found that the incidence of atherosclerosis in diabetic nephropathy patients is also higher than that in healthy people, but the mechanism of its occurrence has not been determined. Recent studies have shown that genetic factors, insulin resistance, immune function and inflammatory response may be the causes of atherosclerosis, among which insulin resistance and inflammatory response may play the most critical role in the process of atherosclerosis in diabetic nephropathy patients. Therefore, this review aims to investigate the relationship between serum inflammatory factor SAA level and insulin resistance in diabetic nephropathy patients and its effect on predicting atherosclerosis in diabetic nephropathy patients.
Keywords:Diabetic Nephropathy, Atherosclerosis, TyG, SAA
朱文举,左小芹. 糖尿病肾病患者TyG、SAA与动脉粥样硬化的相关性研究Study on the Correlation between TyG, SAA and Atherosclerosis in Diabetic Nephropathy Patients[J]. 临床医学进展, 2022, 12(04): 2535-2540. https://doi.org/10.12677/ACM.2022.124365
参考文献ReferencesSaran, R., Robinson, B., Abbott, K.C., et al. (2019) US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. American Journal of Kidney Diseases, 73, A7-A8.Fioretto, P. and Mauer, M. (2007) Histopathology of Diabetic Nephropathy. Seminars in Nephrology, 27, 195-207.
<br>https://doi.org/10.1016/j.semnephrol.2007.01.012Chronic Kidney Disease Prognosis Consortium, Matsushita, K., van der Velde, M., et al. (2010) Association of Estimated Glomerular Filtration Rate and Albuminuria with All-Cause and Cardiovascular Mortality in General Population Cohorts: A Collaborative Meta-Analysis. The Lancet, 375, 2073-2081.
<br>https://doi.org/10.1016/S0140-6736(10)60674-5Nathan, D.M. and DCCT/EDIC Research Group (2014) The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: Overview. Diabetes Care, 37, 9-16.
<br>https://doi.org/10.2337/dc13-2112UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive Blood-Glucose Control with Sulphonylureas or Insulin Compared with Conventional Treatment and Risk of Complica-tions in Patients with Type 2 Diabetes (UKPDS 33). The Lancet, 352, 837-853. <br>https://doi.org/10.1016/S0140-6736(98)07019-6Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein, H.C., Miller, M.E., et al. (2008) Effects of Intensive Glucose Lowering in Type 2 Diabetes. The New England Journal of Medicine, 358, 2545-2559.
<br>https://doi.org/10.1056/NEJMoa0802743ADVANCE Collaborative Group, Patel, A., MacMahon, S., et al. (2008) Intensive Blood Glucose Control and Vascular Outcomes Inpatients with Type 2 Diabetes. The New England Journal of Medicine, 358, 2560-2572.
<br>https://doi.org/10.1056/NEJMoa0802987Duckworth, W., Abraira, C., Moritz, T., et al. (2009) Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. The New England Journal of Medicine, 360, 129-139. <br>https://doi.org/10.1056/NEJMoa0808431Chen, S.C. and Tseng, C.H. (2013) Dyslipidemia, Kidney Disease, and Cardiovascular Disease in Diabetic Patients. The Review of Diabetic Studies, 10, 88-100. <br>https://doi.org/10.1900/RDS.2013.10.88Hirano, T. (2014) Abnormal Lipoprotein Metabolism in Diabetic Nephropathy. Clinical and Experimental Nephrology, 18, 206-209. <br>https://doi.org/10.1007/s10157-013-0880-yHayashi, T., Hirano, T., Taira, T., et al. (2008) Remarkable In-crease of Apolipoprotein B48 Level in Diabetic Patients with End-Stage Renal Disease. Atherosclerosis, 197, 154-158. <br>https://doi.org/10.1016/j.atherosclerosis.2007.03.015Kuwabara, T., Mori, K., Mukoyama, M., et al. (2012) Exacerbation of Diabetic Nephropathy by Hyperlipidaemia Is Mediated by Toll-Like Receptor 4 in Mice. Diabetologia, 55, 2256-2266. <br>https://doi.org/10.1007/s00125-012-2578-1Kuwabara, T., Mori, K., Mukoyama, M., et al. (2014) Macrophage-Mediated Glucolipotoxicity via Myeloid-Related Protein 8/Toll-Like Receptor 4 Signaling in Diabetic Nephropathy. Clinical and Experimental Nephrology, 18, 584-592. <br>https://doi.org/10.1007/s10157-013-0922-5De Cosmo, S., Menzaghi, C., Prudente, S., et al. (2013) Role of Insulin Resistance in Kidney Dysfunction: Insights into the Mechanism and Epidemiological Evidence. Nephrology Dialysis Transplantation, 28, 29-36.
<br>https://doi.org/10.1093/ndt/gfs290Jauregui, A., Mintz, D.H., Mundel, P., et al. (2009) Role of Altered Insulin Signaling Pathways in the Pathogenesis of Podocyte Malfunction and Microalbuminuria. Current Opinion in Nephrology and Hypertension, 18, 539-545.
<br>https://doi.org/10.1097/MNH.0b013e32832f7002徐诣芝, 王乐, 张凤, 等. 非酒精性脂肪性肝病男性患者的冠心病发病风险与血管紧张素II水平的相关性研究[J]. 重庆医科大学学报, 2013, 38(1): 68-72.Matsuzawa, Y., Funahashi, T., Kihara, S., et al. (2004) Adiponectin and Metabolie Syndrome. Arteriosclerosis, Thrombosis, and Vascular Biology, 24, 29-33. <br>https://doi.org/10.1161/01.ATV.0000099786.99623.EFHamaguchi, M., Kojima, T. and Takeda, N. (2007) Nonalcoholic Fatty Liver Disease Is a Novel Predictor of Cardiovascular Disease. World Journal of Gastroenterology, 13, 1579-1584. <br>https://doi.org/10.3748/wjg.v13.i10.1579Simental-Mendia, L.E., Rodriguez-Moran, M. and Guerrero-Romero, F. (2008) The Product of Fasting Glucose and Triglycerides as Surrogate for Identifying Insulin Resistance in Apparently Healthy Subjects. Metabolic Syndrome and Related Disorders, 6, 299-304. <br>https://doi.org/10.1089/met.2008.0034Du, T., Yuan, G., Zhang, M., et al. (2014) Clinical Usefulness of Lipid Ratios, Visceral Adiposity Indicators, and the Triglycerides and Glucose Index as Risk Markers of Insulin Resistance. Cardiovascular Diabetology, 13, 146.
<br>https://doi.org/10.1186/s12933-014-0146-3Guerrero-Romero, F., Simental-Mendia, L.E., Gonzalez-Ortiz, M., et al. (2010) The Product of Triglycerides and Glucose, a Simple Measure of Insulin Sensitivity. Comparison with the Euglycemic-Hyperinsulinemic Clamp. The Journal of Clinical Endocrinology & Metabolism, 95, 3347-3351. <br>https://doi.org/10.1210/jc.2010-0288Lee, E.Y., Yang, H.K., Lee, J., et al. (2016) Triglyceride Glucose Index, a Marker of Insulin Resistance, Is Associated with Coronary Artery Stenosis in Asymptomatic Subjects with Type 2 Diabetes. Lipids in Health and Disease, 15, 155.
<br>https://doi.org/10.1186/s12944-016-0324-2Pham, H., Robinson-Cohen, C., Biggs, M.L., et al. (2012) Chronic Kidney Disease, Insulin Resistance, and Incident Diabetes in Older Adults. Clinical Journal of the American Society of Nephrology, 7, 588-594.
<br>https://doi.org/10.2215/CJN.11861111Cho, Y., Ann, S.H., Won, K., et al. (2019) Association between Insu-lin Resistance, Hyperglycemia, and Coronary Artery Disease According to the Presence of Diabetes. Scientific Reports, 9, Article No. 6129.
<br>https://doi.org/10.1038/s41598-019-42700-1Budoff, M. (2016) Triglycerides and Triglyceride-Rich Lipo-proteins in the Causal Pathway of Cardiovascular Disease. The American Journal of Cardiology, 118, 138-145. <br>https://doi.org/10.1016/j.amjcard.2016.04.004Hansen, T., Ahlstrom, H., Soderberg, S., et al. (2009) Visceral Adipose Tissue, Adiponectin Levels and Insulin Resistance Are Related to Atherosclerosis as Assessed by Whole-Body Magnetic Resonance Angiography in an Elderly Population. Atherosclerosis, 205, 163-167. <br>https://doi.org/10.1016/j.atherosclerosis.2008.11.007孙卫平, 廖利珍. 胰岛素对新诊断2型糖尿病炎症脂肪因子的影响[J]. 中国现代医学杂志, 2015, 25(22): 55-58.谭曦舒, 李立群, 胡玲玲, 等. OSAHS患者HCY、SAA水平与认知功能的关系研究[J]. 中国现代医学杂志, 2017, 27(1): 82-85.穆云. 血清淀粉样蛋白A在类风湿关节炎患者体内的表达及其受体与血管形成关系的研究[D]: [硕士学位论文]. 天津: 天津医科大学, 2012.盛秀芝, 蔡溢, 王涛. 血清淀粉样蛋白A在糖尿病肾病早期诊断中的价值[J]. 中国实验诊断学, 2010, 14(5): 728.白伟, 刘建凤, 王艳霞, 等. 2型糖尿病肾病患者血清淀粉样蛋白A水平[J]. 中国中西医结合肾病杂志, 2011, 12(4): 337-338.吴云, 展秀君, 王艳荣. 血清同型半胱氨酸、胱抑素C及尿微量白蛋白联合检测在糖尿病早期肾病中的意义[J]. 中国现代医生, 2019, 57(32): 119-122.Trakaki, A., Scharnagl, H., Trieb, M., et al. (2020) Prolonged Bed Rest Reduces Plasma High-Density Lipoprotein Levels Linked to Markedly Suppressed Cholesterol Efflux Capacity. Scientific Reports, 10, Article No. 15001.
<br>https://doi.org/10.1038/s41598-020-71921-yMakinen, S., Nguyen, Y.H., Skrobuk, P., et al. (2013) Mecha-nisms of Insulin Resistance. Duodecim, 129, 2115-2122.Xiang, M., Wang, P.X., Wang, A.B., et al. (2016) Tar-geting Hepatic TRAF1-ASK1 Signaling to Improve Inflammation, Insulin Resistance, and Hepatic Steatosis. Journal of Hepatology, 64, 1365-1377.
<br>https://doi.org/10.1016/j.jhep.2016.02.002Son, J.W., Jang, E.H., Kim, M.K., et al. (2011) Diabetic Reti-nopathy Is Associated with Subclinical Atherosclerosis in Newly Diagnosed Type 2 Diabetes Mellitus. Diabetes Re-search and Clinical Practice, 91, 253-259.
<br>https://doi.org/10.1016/j.diabres.2010.11.005Avogaro, A., Giorda, C., Maggini, M., et al. (2007) Incidence of Coronary Heart Disease in Type 2 Diabetic Men and Women: Impact of Microvascular Complications, Treatment, and Geographic Location. Diabetes Care, 30, 1241-1247.
<br>https://doi.org/10.2337/dc06-2558Brownrigg, J.R., Hughes, C.O., Burleigh, D., et al. (2016) Microvascular Disease and Risk of Cardiovascular Events among Individuals with Type 2 Diabetes: A Population-Level Cohort Study. The Lancet Diabetes & Endocrinology, 4, 588-597. <br>https://doi.org/10.1016/S2213-8587(16)30057-2