胰岛素样生长因子1与2型糖尿病尿白蛋白排泄率关系的临床研究

The clinical study on the relationship of the levels of insulin-like growth factor-1 with urinary albumin excretion rate in patients with type 2 diabetes

目的探讨尿和血胰岛素样生长因子1(IGF-1)水平与2型糖尿病(T2DM)尿白蛋白排泄率的关系。方法根据尿白蛋白排泄率(UAER)将80例T2DM患者分为正常白蛋白尿组(N-UAlb)32例,微量白蛋白尿组(M-UAlb)28例和大量白蛋白尿组(L-UAlb)20例。另设对照(NC)组20名。检测4组尿和血IGF-1水平。结果 (1)与NC组比较,T2DM三组血IGF 1明显降低,三组间血1GF-1水平无明显差异;(2)N-UAlb组尿IGF 1与NC组相比无明显差异;M-UAlb组和L-UAlb组尿IGF-1排泄较N-UAlb组显著增高;(3)尿IGF-1排泄与UAER和尿视黄醇结合蛋白排泄率呈正相关; 结论 2型糖尿病肾病尿IGF-1排泄的增加,提示可能有肾组织局部合成和分泌IGF 1的增加,后者可能是2型糖尿病肾病的发病机制之一。

Objective To evaluate the relationship between the level of insulin like growth factor -1 （IGF -1）in serum and urine and urinary albun, in excretion rate in patients with type 2 diabetes. Methods IGF-1 level in serum and urine was determined in 20 healthy subjects （ control） , and 80 type 2 diabetic patients. Three subgroups included group N UAlb with UAER〈20ug/min（n 32） ,group M-UAlb with UAER 20-200ug/min（n= 28） and group L-UAlb with UAER〉200ug/min（n=20）. Results Serum IGF-1 in group N UAlh,M UAlb,L -UAlb significantly decreased in comparison with control（P〈0.01）, however, there were no significant difference in serum IGFI among group N-UAlb, M-UAlb and L-UAlb. Urinary IGF -1 in group N UAlb did not differ from that in controls（n=20,P〉0.05）. Urinary IFG-1 level in group M-UAlh and L- UAlb significantly increased in comparison with group N-UAlb（P〈0.01）. Urinary IGF- 1 level was correlated positively with UAER（r=0.519,P〈0.01） and RBP（r= 0.884,P〈 0.01）. Conclusions Urinary IGF-1 increment may suggest the increase of renal tissue IGF -1 synthesis and secretion,this may be involved in the pathogenesis of diabetic nephropathy in type 2 diabetes.