Abstract:

Objective　To explore the clinical relationship between vascular endothelial function and ischemic cardiovascular and cerebrovascular diseases in patients with diabetic nephropathy (DN). Methods　Three hundred and thirty-seven patients with DN, 150 patients with type 2 diabetes mellitus, and 150 healthy examinees admitted to Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from January 2020 to January 2023 were set as a DN group, a diabetes group, and a healthy group, respectively. There were 173 males and 164 females in the DN group; they were (60.89±10.78) years old. There were 80 males and 70 females in the diabetes group; they were (60.82±10.63) years old. There are 79 males and 71 females in the healthy group; they were (60.85±10.39) years old. Their vascular endothelial function indicators [endothelin (ET), nitric oxide (NO), endothelium-dependent hyperpolarizing factor (EDHF), von Willebrand factor (vWF), and vascular endothelial growth factor (VEGF)] were detected and compared. The incidence rate of ischemic cardiovascular and cerebrovascular diseases in the patients with DN was calculated. The patients with DN were divided into an occurrence group and a non-occurrence group according to whether they complicated with ischemic cardiovascular and cerebrovascular diseases, and the levels of vascular endothelial function indicators and other clinical data were compared between the two groups. χ² and t tests were used for the statistical analysis. The correlation between vascular endothelial function indicators and ischemic cardiovascular and cerebrovascular diseases in the patients with DN was analyzed by the Pearson correlation analysis. The multivariate logistic regression model was used to analyze the influencing factors of ischemic cardiovascular and cerebrovascular diseases in the patients with DN. Results　The levels of ET, vWF, and VEGF in the DN group were higher than those in the diabetes group and the healthy group [(62.15±7.59) pg/L vs. (51.58±6.88) pg/L and (40.82±5.97) pg/L, (728.35±95.48) U/L vs. (511.58±67.17) U/L and (179.99±22.48) U/L, and (174.96±20.18) ng/L vs. (138.65±18.23) ng/L and (106.78±15.47) ng/L; F=490.30, 2 618.32, and 727.35; all P<0.05], and the levels of NO and EDHF were lower [(51.27±7.02) μmol/L vs. (62.96±8.32) μmol/L and (70.45±9.58) μmol/L and (12.63±2.59) μmol/L vs. (17.56±3.35) μmol/L and (25.14±4.78) μmol/L; F=328.51 and 708.23; both P<0.05]; the levels of ET, vWF, and VEGF in the diabetes group were higher than those in the healthy group (all P<0.05), and the levels of NO and EDHF were lower (both P<0.05). The incidence rate of ischemic cardiovascular and cerebrovascular diseases in the patients with DN was 32.94% (111/337). The age and levels of glycosylated hemoglobin (HbA1c), serum creatinine (SCr), ET, vWF, and VEGF in the occurrence group were higher than those in the non-occurrence group [(70.93±10.05) years vs. (55.96±9.24) years, (12.66±2.67)% vs. (9.03±2.05)%, (120.56±15.98) μmol/L vs. (93.57±13.55) μmol/L, (67.95±8.89) pg/L vs. (59.31±7.45) pg/L, (789.15±80.85) U/L vs. (698.49±77.66) U/L, and (191.36±20.64) ng/L vs. (166.91±19.75) ng/L; t=13.576, 13.783, 16.179, 9.375, 9.936, and 10.523; all P<0.05], the course of DN was longer [(6.34±1.26) years vs. (4.15±1.03) years; t=17.010; P<0.05], and the glomerular filtration rate (GFR) and levels of NO and EDHF were lower [(77.12±10.68) ml/(min·173 m²) vs. 96.22±11.48) ml/(min·173 m²), (44.66±6.82) μmol/L vs. (54.52±6.24) μmol/L, and (9.15±1.78) μmol/L vs. (14.34±1.85) μmol/L; t=14.683, 13.217, and 24.505; all P<0.05]. ET, vWF and VEGF in the patients with DN were positively correlated with the occurrence of ischemic cardiovascular and cerebrovascular diseases (t=5.152, 7.052, and 6.975; all P<0.001), while NO and EDHF were negatively correlated with the occurrence of ischemic cardiovascular and cerebrovascular diseases (t=-5.564 and -6.272; both P<0.001). Age, course of DN, HbA1c, ET, vWF, and VEGF were the risk factors of the DN patients complicated with ischemic cardiovascular and cerebrovascular diseases (all P<0.05), while GFR, NO, and EDHF were the protective factors (all P<0.05). Conclusion　Endothelial function indicators, such as ET, NO, EDHF, vWF, and VEGF, are correlated with ischemic cardiovascular and cerebrovascular diseases in patients with DN, and are all influencing factors of ischemic cardiovascular and cerebrovascular diseases in patients with DN.

Key words: Diabetic nephropathy,  , Vascular endothelial function,  , Ischemic cardiovascular and cerebrovascular diseases,  , Correlation,  , Influencing factors

摘要：

目的　探讨血管内皮功能与糖尿病肾病（diabetic nephropathy，DN）患者并发缺血性心脑血管病的临床关系。方法　将2020年1月至2023年1月陕西中医药大学附属医院收治的337例DN患者、150例单纯2型糖尿病患者和150例健康体检者依次归入DN组、糖尿病组和健康组。DN组男173例，女164例，年龄（60.89±10.78）岁。糖尿病组男80例，女70例，年龄（60.82±10.63）岁。健康组男79例，女71例，年龄（60.85±10.39）岁。检测其血管内皮功能指标［内皮素（endothelin，ET）、一氧化氮（nitricoxide，NO）、内皮超极化因子（endothelium-dependent hyperpolarizing factor，EDHF）、血管性血友病因子（von Willebrand factor，vWF）、血管内皮生长因子（vascular endothelial growth factor，VEGF）］并进行比较。统计DN患者缺血性心脑血管病发生率。按是否并发缺血性心脑血管病将DN患者分为发生组、未发生组，比较两组血管内皮功能指标与其他临床资料。采用χ²检验、t检验进行统计分析。采用Pearson相关性分析DN患者血管内皮功能指标与缺血性心脑血管病相关性。采用多因素logistic回归模型分析DN患者并发缺血性心脑血管病的影响因素。结果　DN组ET、vWF、VEGF高于糖尿病组、健康组［（62.15±7.59）pg/L比（51.58±6.88）pg/L、（40.82±5.97）pg/L，（728.35±95.48）U/L比（511.58±67.17）U/L、（179.99±22.48）U/L，（174.96±20.18）ng/L比（138.65±18.23）ng/L、（106.78±15.47）ng/L；F=490.30、2 618.32、727.35，均P<0.05］，NO、EDHF低于糖尿病组、健康组［（51.27±7.02）μmol/L比（62.96±8.32）μmol/L、（70.45±9.58）μmol/L，（12.63±2.59）μmol/L比（17.56±3.35）μmol/L、（25.14±4.78）μmol/L；F=328.51、708.23，均P<0.05］；糖尿病组ET、vWF、VEGF高于健康组（均P<0.05），NO、EDHF低于健康组（均P<0.05）。DN患者缺血性心脑血管病发生率为32.94%（111/337）。与未发生组比较，发生组年龄和糖化血红蛋白（glycosylated hemoglobin Alc，HbA1c）、血肌酐（serum creatinine，SCr）、ET、vWF、VEGF水平较高［（70.93±10.05）岁比（55.96±9.24）岁、（12.66±2.67）%比（9.03±2.05）%、（120.56±15.98）μmol/L比（93.57±13.55）μmol/L、（67.95±8.89）pg/L比（59.31±7.45）pg/L、（789.15±80.85）U/L比（698.49±77.66）U/L、（191.36±20.64）ng/L比（166.91±19.75）ng/L；t=13.576、13.783、16.179、9.375、9.936、10.523，均P<0.05］，DN病程较长［（6.34±1.26）年比（4.15±1.03）年；t=17.010，P<0.05］，肾小球滤过率（glomerular filtration rate，GFR）和NO、EDHF水平较低［（77.12±10.68）ml/（min·173 m²）比（96.22±11.48）ml/（min·173 m²）、（44.66±6.82）μmol/L比（54.52±6.24）μmol/L、（9.15±1.78）μmol/L比（14.34±1.85）μmol/L；t=14.683、13.217、24.505，均P<0.05］。DN患者ET、vWF、VEGF与缺血性心脑血管病的发生呈正相关（t=5.152、7.052、6.975，均P<0.001），NO、EDHF与缺血性心脑血管病的发生呈负相关（t=-5.564、-6.272，均P<0.001）；年龄、DN病程、HbA1c、ET、vWF、VEGF是DN患者并发缺血性心脑血管病的危险因素（均P<0.05），GFR、NO、EDHF是保护因素（均P<0.05）。结论　血管内皮功能指标ET、NO、EDHF、vWF、VEGF与DN患者并发缺血性心脑血管病存在相关性，均是DN患者并发缺血性心脑血管病的影响因素。

关键词:

糖尿病肾病, 血管内皮功能, 缺血性心脑血管病, 相关性, 影响因素