Article(id=1211268824494633164, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268819788632695, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.01.14, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1591891200000, receivedDateStr=2020-06-12, revisedDate=1603296000000, revisedDateStr=2020-10-22, acceptedDate=null, acceptedDateStr=null, onlineDate=1766718592046, onlineDateStr=2025-12-26, pubDate=1611763200000, pubDateStr=2021-01-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766718592046, onlineIssueDateStr=2025-12-26, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766718592046, creator=13701087609, updateTime=1766718592046, updator=13701087609, issue=Issue{id=1211268819788632695, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='1', pageStart='1', pageEnd='100', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766718590924, creator=13701087609, updateTime=1766718828068, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1211269814484594852, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268819788632695, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1211269814484594853, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268819788632695, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=84, endPage=88, ext={EN=ArticleExt(id=1211268824813400282, articleId=1211268824494633164, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Research progress on the relationship between haptoglobin and diabetic kidney disease, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Haptoglobin (HP) is a kind of plasma glycoprotein with genetic polymorphism, secreted mainly in liver and has two alleles of HP1 and HP2, can form three potential genotypes: HP1-1, HP2-1 and HP2-2, which has the function of binding to free hemoglobin and antioxidation. At present, many studies have shown that HP may be a potential biomarker of diabetic kidney disease. Because of the special structure and function of HP, it has certain advantages in early diagnosis and prognosis prediction of diabetic nephropathy. The relationship has been mainly reviewed in present paper between the expression level of HP and its genotypes in the occurrence, development, diagnosis and prognosis prediction of diabetic nephropathy.

, correspAuthors=Xiang-Mei Chen, authorNote=null, correspAuthorsNote=
*E-mail:
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触珠蛋白(HP)是一种具有遗传多态性的血浆糖蛋白,主要在肝脏分泌,有HP1和HP2两种等位基因,可形成3种潜在的基因型:HP1-1、HP2-1和HP2-2,具有结合游离血红蛋白及抗氧化等功能。HP由于特殊的结构及功能,在糖尿病肾病早期诊断及预后预测中均具有一定的优势,可能是糖尿病肾病的潜在生物标志物。该文主要综述HP表达水平及其基因型与糖尿病肾病发生、发展、诊断及预后之间的关系。

, correspAuthors=陈香美, authorNote=null, correspAuthorsNote=
陈香美,E-mail:
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柯雨景,硕士研究生,主要从事糖尿病合并肾脏疾病相关研究。E-mail:

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触珠蛋白与糖尿病肾病的关系研究进展
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柯雨景 1, 2 , 董哲毅 2 , 陈香美 1, 2, *
解放军医学杂志 | 综述 2021,46(1): 84-88
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解放军医学杂志 | 综述 2021, 46(1): 84-88
触珠蛋白与糖尿病肾病的关系研究进展
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柯雨景1, 2 , 董哲毅2, 陈香美1, 2, *
作者信息
  • 1广东药科大学临床医学院,广州 510006
  • 2解放军总医院肾脏病科/解放军肾脏病研究所/肾脏疾病国家重点实验室/国家慢性肾病临床医学研究中心/肾脏疾病研究北京市重点实验室,北京 100853
  • 柯雨景,硕士研究生,主要从事糖尿病合并肾脏疾病相关研究。E-mail:

通讯作者:

陈香美,E-mail:
Research progress on the relationship between haptoglobin and diabetic kidney disease
Yu-Jing Ke1, 2 , Zhe-Yi Dong2, Xiang-Mei Chen1, 2, *
Affiliations
  • 1School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
  • 2Department of Nephrology, General Hospital of Chinese PLA/Institute of Nephrology of PLA/State Key Laboratory of Kidney Diseases/National Chronic Nephropathy Clinical Research Center/Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
出版时间: 2021-01-28 doi: 10.11855/j.issn.0577-7402.2021.01.14
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触珠蛋白(HP)是一种具有遗传多态性的血浆糖蛋白,主要在肝脏分泌,有HP1和HP2两种等位基因,可形成3种潜在的基因型:HP1-1、HP2-1和HP2-2,具有结合游离血红蛋白及抗氧化等功能。HP由于特殊的结构及功能,在糖尿病肾病早期诊断及预后预测中均具有一定的优势,可能是糖尿病肾病的潜在生物标志物。该文主要综述HP表达水平及其基因型与糖尿病肾病发生、发展、诊断及预后之间的关系。

触珠蛋白  /  糖尿病肾病  /  基因型  /  早期诊断  /  预后

Haptoglobin (HP) is a kind of plasma glycoprotein with genetic polymorphism, secreted mainly in liver and has two alleles of HP1 and HP2, can form three potential genotypes: HP1-1, HP2-1 and HP2-2, which has the function of binding to free hemoglobin and antioxidation. At present, many studies have shown that HP may be a potential biomarker of diabetic kidney disease. Because of the special structure and function of HP, it has certain advantages in early diagnosis and prognosis prediction of diabetic nephropathy. The relationship has been mainly reviewed in present paper between the expression level of HP and its genotypes in the occurrence, development, diagnosis and prognosis prediction of diabetic nephropathy.

haptoglobin  /  diabetic kidney disease  /  genotype  /  early diagnosis  /  prognosis
柯雨景, 董哲毅, 陈香美. 触珠蛋白与糖尿病肾病的关系研究进展. 解放军医学杂志, 2021 , 46 (1) : 84 -88 . DOI: 10.11855/j.issn.0577-7402.2021.01.14
Yu-Jing Ke, Zhe-Yi Dong, Xiang-Mei Chen. Research progress on the relationship between haptoglobin and diabetic kidney disease[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (1) : 84 -88 . DOI: 10.11855/j.issn.0577-7402.2021.01.14
糖尿病肾病(diabetic kidney disease,DKD)是糖尿病患者的主要并发症[1],也是导致全球糖尿病患者病死率升高和社会医疗资源消耗的重要原因之一[2]。此外,DKD也是世界范围内引起终末期肾病(ESRD)的最常见原因。DKD的早期检测有助于早期干预,延缓其进展为ESRD的速度。肾活检病理学检查是诊断DKD的金标准,但创伤程度高,不利于早期诊断。蛋白尿、血肌酐及估算肾小球滤过率(eGFR)等是临床诊断及预测DKD进展的常用标志物,但在敏感性和特异性方面无明显优势。近年来,触珠蛋白(haptoglobin,HP)、α2-巨球蛋白、A-L-岩藻糖苷酶、视黄醇结合蛋白等生物标志物在预测DKD的发生及预后评估方面备受关注,其中HP由于特殊的结构和功能,在DKD早期诊断及预后预测方面均具有一定优势,且HP基因型(HP1-1、HP1-2、HP2-2)与DKD的发生发展密切相关。本文主要围绕HP在DKD中的研究现状进行综述。
HP也称为结合珠蛋白,于1946年由Jayle等[3]发现,是一种在人体血浆中循环的糖蛋白。其基因位于16号染色体的长臂上(16q22),有两个主要的等位基因HP1和HP2。后来研究发现,HP1等位基因存在于所有动物中,而HP2等位基因仅存在于人类。在人类进化早期,等位基因差异来自于第3与第4外显子的交叉重复,显示为具有5个外显子的HP1等位基因(无重复)和具有7个外显子的HP2等位基因[4],但这种变异很可能是HP2等位基因的反复缺失产生了新的HP1等位基因[5],即HP2可能是人类祖先的等位基因。HP1和HP2两种等位基因可形成3种主要基因型:HP1-1(HP1等位基因纯合)、HP2-2(HP2等位基因纯合)及HP2-1(杂合子)。这3种基因型表现出不同结构的多聚体,进而产生结合游离血红蛋白(hemoglobin,Hb)、抗氧化活性、促进血管生成、调节免疫功能等不同的生物学效应。在过去几十年中,对超过10万人的HP分型进行分析显示,这两个等位基因频率在地理和种族上存在较大差异。在北美洲,HP1-1、HP2-1、HP2-2的分布概率分别为18%、49%、37%,在欧洲分别为13%、50%、36%,而在亚洲分别为3%、13%、84%[6]
可被切割成亚基α链和β链,由二硫键连接,具体结构为重链(β链)和轻链(α链)组成的二聚体或多聚体,其中β链相同,但α链有两种,即HPα1和HPα2。由于HP等位基因不同导致HP1(单价)和HP2(二价)蛋白产物的价态不同,这些价态差异的结果导致HP1-1基因型的个体是二聚体,HP2-1基因型的个体是线性聚合物,而HP2-2基因型的个体则为环状聚合物[7-8]
HP主要由肝脏分泌,但肝脏并不是唯一场所[9]。巨噬细胞及中性粒细胞中也可检测到有HP的合成,但合成量明显低于肝细胞[10],提示炎症反应与HP的分泌存在密切联系。HP的降解也主要在肝脏,与游离Hb形成触珠蛋白-血红蛋白(HP-Hb)复合物[11],通过网状细胞系统或CD163受体介导的胞吞作用进行降解[12-13],二聚体降解最快,环状聚合物降解最慢[14-15]
HP作为急性期蛋白,其最主要的功能是与血浆中的游离Hb结合形成HP-Hb复合物并被清除。HP1-1编码的蛋白较HP2-2编码的蛋白结合游离Hb的能力更强。Hb从红细胞释放至血浆中时可发生一系列氧化反应,生成游离血红素及游离铁[16],并出现一氧化氮(NO)耗竭、氧化应激及血管功能障碍等[17]。研究表明,HP与Hb结合可减弱铁诱导的氧化反应[18]。HP的抗氧化保护功能具有基因型依赖性,HP1蛋白在结合游离Hb及抗氧化潜能方面优于HP2蛋白[19],在糖尿病患者中这种差异更明显,其中HP1-1型的抗氧化作用最强,HP2-2型最弱[20-21]
HP与DKD关系的早期研究主要集中在基因多态性方面,大多数研究在西方人群中进行,在亚洲人群中缺乏确凿的证据。基因型研究表明,HP2-2基因型与1型及2型DKD易感性相关。初期对以色列110例血压正常的糖尿病患者进行研究发现,DKD的患病率及严重程度与HP2-2基因型明显相关,HP2-2基因型可能是DKD发生的主要易感基因[22]。随后,在约旦[23]、爱尔兰[24]及埃及[25]开展的研究证实HP2-2基因型与DKD发生风险亦存在相关性。对糖尿病模型的肾脏活检证实HP2-2基因型小鼠较HP1-1基因型小鼠的肾近曲小管细胞(PCT)溶酶体铁沉积量明显增加,并可进一步导致溶酶体膜损伤及氧化应激所致的肾细胞损伤[26-27]。HP2-2基因型中PCT过量铁的来源为Hb,且氧化应激增加是DKD潜在的致病机制。在HP2-2基因型中,HP-Hb复合物的CD163受体的正常清除机制严重受损,其半衰期约增加5倍[28]。因此,铁沉积介导的氧化应激和肾脏肥大急剧增加,进而增加了HP2-2基因型人群罹患DKD的风险。
然而,并非所有HP2-2基因型与DKD的研究均发现这种相关性。巴西265例HP基因型队列研究[29]及西班牙114例糖尿病人群研究[30]中并未发现HP2-2基因型与DKD风险相关。以上矛盾的观点可能与种族、病例选择标准、样本量、代谢控制或其他可能影响DKD演变的混杂因素(如吸烟、高血压、经济状况等)有关。值得注意的是,ESRD在亚洲人群中的发病率高于西方人群,且DKD在中国的2型糖尿病(T2DM)患者中患病率高达52.2%[31]。因此,继续扩大亚洲人群的HP基因型研究可为进一步探讨DKD的发病机制提供依据。同时,评估糖尿病患者的HP基因型有助于提高DKD的预测及管理水平。
近年来,尿HP被认为是中国人群肾脏损害的生物标志物。有研究对增殖性糖尿病视网膜病变(PDR)队列随访5.3年后发现,PDR组的尿HP水平是正常对照组的8.7倍,基线尿HP≥20 ng/min的患者慢性肾功能不全的发生率高于基线尿HP<20 ng/min的患者(RR=3.27,95%CI 1.41~7.58),表明尿HP是PDR的特异性标志物,可作为尿白蛋白的补充预测T2DM患者的肾损害[32]。Bhensdadia等[33]对30例T2DM患者尿中7种标志物[聚集蛋白、HP、甘露聚糖结合凝集素丝氨酸蛋白、溶酶体膜蛋白2、血管紧张素原、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及尿调蛋白]的研究显示,尿HP是早期肾功能减退(ERFD)的最佳预测因子。有研究在204例尚未出现严重肾脏疾病的T2DM患者中验证了尿HP对ERFD的预测作用,结果显示,使用尿HP/肌酐比值(HCR)预测早期肾功能下降的OR值为2.70(95%CI 1.15~6.32),而使用白蛋白/肌酐比值(ACR)预测早期肾功能下降的OR值为2.50(95%CI 1.14~5.48),表明HCR可预测早期肾功能下降,且早于白蛋白尿[34]。另一项研究发现,T2DM患者的HCR与ACR呈正相关,与eGFR呈负相关,且ROC曲线分析显示HCR对早期DKD的诊断具有较高的敏感性和特异性[35]
目前大多数研究均集中在HP基因型、尿HP与DKD的相关性或血HP与糖尿病的相关性方面,而关于血HP与DKD的研究较少。Huang等[36]发现,在中国汉族人群中T2DM合并DKD的患者血清HP水平明显高于无DKD者,且血清HP水平与对数转换后的血肌酐(r=0.166,P=0.011)、蛋白尿(r=0.179,P=0.006)均呈正相关,与对数转换后的eGFR(r=–0.148,P=0.024)呈负相关,提示血清HP水平可作为T2DM患者DKD早期诊断和监测的潜在生物标志物。但此研究缺乏患者的HP基因型信息,不能排除DKD组与对照组之间HP基因型分布的差异,而这很可能影响DKD患者的血清HP水平,以及DKD发展过程中的炎症及氧化应激状态。
糖尿病患者肾功能快速下降及其进展为ESRD的风险与蛋白尿的进展密切相关。DKD微量蛋白尿期尚可逆,如果不加以干预,进展至大量蛋白尿期将不可逆地发展为ESRD。然而,蛋白尿既不特异也不敏感,并不能很好地预测DKD的进展,而且肾病的发生及进展并不一定伴随蛋白尿。尿HP是一种有前景的预测DKD进展风险的生物标志物。早期报道,在糖尿病合并CKD 1期及CKD 2期的患者中,尿HP及蛋白尿均可独立预测肾脏病的进展情况[31]。Liu等[37]发现,进展期DKD患者的尿HP水平是非进展期患者的11倍。Brosius等[38]发现,只有尿HP可独立预测DKD的进展风险,其预测价值优于蛋白尿。
如果以上发现能够得到前瞻性队列研究的验证,尿HP可能成为第一个优于蛋白尿的可预测肾脏疾病进展风险的生物标志物,为预测DKD进展提供更精准的方法。由于尿HP与蛋白尿具有协同作用,因此也有可能作为一种潜在的生物标志物用于筛选高ESRD风险的临床试验参与者,从而提高临床试验的效率和精准度[39]。尿HP与蛋白尿的联合诊断及预测作用可能是进一步研究的方向。
氧化应激是DKD的潜在致病机制。HP水平反映了机体对炎症状态的调节反应,也可能与DKD发展过程中严重的氧化应激状态有关。HP水平及其抗氧化能力都是由基因型决定的,HP基因型是影响DKD预后的决定因素之一。Costacou等[40]研究的658例1型糖尿病人群中HP2-2、HP2-1、HP1-1基因型比例分别为43.4%、44.4%、12.2%,随访18年后,eGFR下降、微量白蛋白尿、大量白蛋白尿和ESRD的总体发生率分别为42.0%、40.5%、16.7%、12.2%,与HP1-1基因型相比,HP2-2基因型人群eGFR下降(RR=1.79,95%CI 1.06~3.00)和发生ESRD(RR=2.74,95%CI 1.17~6.45)的风险明显增加。Orchard等[41]对1441例1型糖尿病患者随访22年,发现其HP基因型与eGFR<60 ml/(min·1.73 m2)及ESRD明显相关,HP2-2基因型eGFR下降及发生ESRD的危险性大于HP2-1及HP1-1基因型,表明HP基因型是进展至ESRD的影响因素。此外,HP2-2基因型除了能预测糖尿病患者心肾并发症的发生外,还能增加糖尿病患者心肾死亡的易感性[42]
DKD是引起ESRD的主要原因之一,但其起病隐匿,一旦进入大量蛋白尿期,进展至ESRD的风险约为其他肾病的14倍。因此,探寻敏感性及特异性高的生物标志物以识别早期DKD人群并给予相应的干预措施具有重要的临床意义。HP可能是糖尿病患者进行肾脏诊断及治疗分层的一种有用工具,有望作为一个潜在生物标志物用于监测DKD的治疗效果或优化药物剂量,从而早期干预以防止或延缓DKD的发生发展。
  • 国家重点研发计划(2018YFC1704203)
  • 国家科技重大专项(2019ZX09201-005)
  • 国家自然科学基金(81700629)
  • 北京市科技计划课题(D171100002817002)
  • 解放军总医院大数据项目(2019MBD-053)
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doi: 10.11855/j.issn.0577-7402.2021.01.14
  • 接收时间:2020-06-12
  • 首发时间:2025-12-26
  • 出版时间:2021-01-28
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  • 收稿日期:2020-06-12
  • 修回日期:2020-10-22
基金
National Key Research and Development Program(2018YFC1704203)
国家重点研发计划(2018YFC1704203)
Important National Science and Technology Specific Projects(2019ZX09201-005)
国家科技重大专项(2019ZX09201-005)
National Natural Science Foundation of China(81700629)
国家自然科学基金(81700629)
Science and Technology Project of Beijing(D171100002817002)
北京市科技计划课题(D171100002817002)
Big Data Program from Chinese PLA General Hospital(2019MBD-053)
解放军总医院大数据项目(2019MBD-053)
作者信息
    1广东药科大学临床医学院,广州 510006
    2解放军总医院肾脏病科/解放军肾脏病研究所/肾脏疾病国家重点实验室/国家慢性肾病临床医学研究中心/肾脏疾病研究北京市重点实验室,北京 100853

通讯作者:

陈香美,E-mail:
参考文献
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https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.2021.01.14
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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