2021 年第 5 期 第 16 卷

血浆钙调神经磷酸酶与糖尿病肾病患者左心室舒张功能不全的相关性

Correlation between plasma calcineurin and left ventricular diastolic dysfunction in patients with diabetic nephropathy

作者：唐炯1陆春梅2

英文作者：Tang Jiong1 Lu Chunmei2

单位：1南通大学第四附属医院盐城市第一人民医院肾内科224000；2南通大学第四附属医院盐城市第一人民医院门诊部224000

英文单位：Yancheng No.1 People′s Hospital Jiangsu Province Yancheng 224000 China; 2Department of Outpatient the Fourth Affiliated Hospital of Nantong University Yancheng No.1 People′s Hospital Jiangsu Province Yancheng 224000 China

关键词：糖尿病肾病；钙调神经磷酸酶；左心室舒张功能不全

英文关键词：Diabeticnephropathy；Calcineurin；Leftventriculardiastolicdysfunction

• 摘要：

• 目的 探讨血浆钙调神经磷酸酶（CaN）水平与糖尿病肾病患者并发左心室舒张功能不全（LVDD）的关系。方法 选择2018年1月至2020年4月江苏省盐城市第一人民医院收治的104例糖尿病肾病患者，其中慢性肾脏病（CKD）3期45例、CKD4期32例、CKD5期27例。所有患者检测血浆CaN水平，进行超声心动图检测获得左心室结构和功能相关参数［左心室射血分数，舒张末期室间隔厚度(IVST)、左心室舒张末期内径、左心室后壁厚度(LVPWT)、左心室舒张末期容积（LVEDV）、左心室舒张早期充盈峰最大充盈速度（E值）/舒张晚期充盈峰最大峰值速度（A值）比值、左心室充盈压（LVFP）］。根据LVFP将患者分为LVDD组［LVFP＞15 mmHg（1 mmHg=0.133 kPa），43例］和无LVDD（NLVDD）组（LVFP≤15 mmHg，61例）。收集患者临床资料，二元Logistic回归分析糖尿病肾病患者并发LVDD的危险因素。结果 LVDD组血浆CaN水平高于NLVDD组［（2.31±0.42）μg/L比（1.35±0.28）μg/L］，CKD5期患者血浆CaN水平高于CKD4、CKD3期患者，CKD4期高于CKD3期患者（均P＜0.05）。Pearson相关性分析显示CaN 与IVST、LVPWT、LVFP呈正相关（r=0.531、0.643、0.712，均P＜0.05），与LVEDV、E/A比值呈负相关（r=-0.501、-0.613，均P＜0.05）。二元Logistic回归分析结果显示高体重指数、收缩压、CaN水平是糖尿病肾病患者并发LVDD的危险因素（均P＜0.01）。结论 糖尿病肾病并发LVDD患者血浆CaN水平显著升高，CaN水平与糖尿病肾病左心室舒张功能密切相关。

• Objective To investigate the relationship between plasma calcineurin (CaN) level and left ventricular diastolic dysfunction (LVDD) in patients with diabetic nephropathy. Methods From January 2018 to April 2020, 104 patients with diabetic nephropathy admitted to Yancheng No.1 People′s Hospital, Jiangsu Province were selected, including 45 cases of chronic kidney disease (CKD) stage 3, 32 cases of CKD stage 4 and 27 cases of CKD stage 5. Plasma CaN level was measured in all patients, and echocardiography was performed to obtain parameters related to left ventricular structure and function［left ventricular ejection fraction, end-diastolic interventricular septal thickness (IVST), left ventricular end-diastolic dimension, left ventricular posterior wall thickness (LVPWT), left ventricular end-diastolic volume(LVEDV), the ratio of maximum filling velocity (E value) of early diastolic filling peak to maximum peak velocity of late diastolic filling peak (A value) and left ventricular filling pressure(LVFP)］. According to LVFP, patients were divided into LVDD group (LVFP＞15 mmHg, 43 cases) and non-LVDD (NLVDD) group (LVFP≤15 mmHg, 61 cases). The clinical data of the patients were collected, and the risk factors of LVDD in patients with diabetic nephropathy were analyzed by binary Logistic regression. Results Plasma CaN level in LVDD group was higher than that in NLVDD group［（2.31±0.42）μg/L vs （1.35±0.28）μg/L］, plasma CaN level in CKD stage 5 patients was higher than that in CKD stage 4 and CKD stage 3 patients, and plasma CaN level in CKD stage 4 patients was higher than that in CKD stage 3 patients (all P＜0.05). Pearson correlation analysis showed that CaN was positively correlated with IVST, LVPWT and LVFP (r=0.531, 0.643 and 0.712, all P＜0.05) and negatively correlated with LVEDV and E/A ratio (r=-0.501 and -0.613, both P＜0.05). Binary Logistic regression analysis showed that high body mass index, systolic blood pressure and CaN level were the risk factors for LVDD in diabetic nephropathy patients (all P＜0.01). Conclusions The plasma CaN level of patients with diabetic nephropathy complicated with LVDD increases significantly. CaN level is closely related to the left ventricular diastolic function in patients with diabetic nephropathy.