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目的观察1型糖尿病患儿血管内皮损害标志物—内皮素(ET)和血管性假血友病因子(von Wille-brand因子,vWF)的变化,分析其与尿白蛋白排泄率(UAER)的关系,从而筛查出更敏感的早期诊断糖尿病肾病(DN)的指标。方法收集1998-06—2005-06在山东省立医院就诊的4~18岁1型糖尿病患儿40例,根据UAER分为正常白蛋白尿组(A组)25例和微量白蛋白尿组(B组)15例,同时以年龄、性别、身高1∶1匹配的健康儿童作为对照组,分别检测其血糖(FBG)、糖化血红蛋白(HbA1c)、血浆ET和vWF的变化,并分析其相关性。结果与正常对照组比较,1型糖尿病患者血浆ET-1和vWF、HbA1c明显增高,尤其是微量白蛋白尿组升高更明显(均P<0·01),血浆ET-1和vWF与UAER、HbA1c均呈正相关。结论1型糖尿病患儿在出现白蛋白尿前已存在血管内皮功能异常,其白蛋白排泄与血管内皮功能障碍程度有一定相关性。血浆ET-1、vWF检测可作为早期筛查糖尿病肾病的可靠指标。
Objective To investigate the changes of endothelins (ET) and von Wille-brand (vWF) markers in children with type 1 diabetes mellitus (DM), and to investigate their relationship with urinary albumin excretion rate (UAER) The relationship was thus screened for more sensitive indicators of early diagnosis of diabetic nephropathy (DN). Methods Forty children aged 4-18 years old with type 1 diabetes who were treated in Shandong Provincial Hospital from June 1998 to June 2005 were collected and divided into 25 cases of normal albuminuria group (A group) and microalbuminuria group Group B). Fifteen healthy children of age, sex and height 1: 1 were used as control group. The changes of FBG, HbA1c, ET and vWF in plasma were detected and their correlations were analyzed . Results Compared with the normal control group, the plasma levels of ET-1, vWF and HbA1c were significantly increased in type 1 diabetic patients, especially in patients with microalbuminuria (all P <0.01). The levels of ET-1, vWF and UAER , HbA1c were positively correlated. Conclusion There is a dysfunction of vascular endothelial dysfunction in children with type 1 diabetes before albuminuria, and the albumin excretion has some correlation with the degree of vascular endothelial dysfunction. Plasma ET-1, vWF test can be used as a reliable indicator of early screening of diabetic nephropathy.