糖尿病肾病患者血清脑利钠肽,同型半胱氨酸水平的变化及其意义

Relationship Between Serum Levels of Brain Natriuretic Peptide and Homocysteine and Blood Glucose in Patients with Type 2 Diabetic Nephropathy

[目的]探讨糖尿病（DN）肾病血清脑利钠肽（BNP）,同型半胱氨酸（Hcy）水平与DN病变程度的关系及强化血糖治疗后二者的变化.[方法]随机选择DN 88例,按24小时尿微量白蛋白（Umalb）及血清肌酐分为正常蛋白尿组（SDM组,Umalb〈30 mg,28例）,早期肾病组（EDM组,30 mg300 mg,Cr〉110 μmol/L,14例）.另选健康成人28例作为对照组（NC组）,应用双抗夹心免疫荧光法检测BNP,用HT-Ⅱ型酶联法检测Hcy水平并进行比较.[结果]EDM组,CDM组,CRF组BNP明显高于SDM组及NC组（P〈0.05）,且与Umalb（r=0.42,P〈0.05）,Cr（r=0.56,P〈0.05）呈明显正相关.EDM组,CDM组,CRF组Hcy明显高于SDM组及NC组（P〈0.05）,且与Umalb（r=0.28,P〈0.05）,Cr（r=0.46,P〈0.05）呈明显正相关.强化血糖控制后BNP,Hcy明显低于治疗前（P〈0.05）.[结论]DN患者BNP和Hcy水平显著升高,血清BNP和Hcy水平对预测DN的发生发展,病程有较好的价值.

[Objective] To explore the relationship between serum levels of brain natriuretic peptide（BNP）, homocysteine（Hcy） and the degree of diabetic nephropathy（DN）, and to analyze the changes of BNP and Hey after intensive glucose control. [Methods] Totally 88 DN patients were randomly chosen. According to 24h-urinary albumin（Umalb） and serum creatine（Cr）, all patients were divided into normal proteinuria group（SDN group, umalbG30mg, n =28）, early DN group（EDN group, 30mg〈umalb〈300mg, n =24）, clinical DN group（CDN group, umalb≥300mg, n =22） and chronic renal failure group（CRF group, umalb〉300mg,Cr〉110μmol/L, n = 14）. Other 28 healthy adults were selected as the control group（NC group）. Double antibody sandwich immunofluorescence was used to detect BNP and HT- Ⅱ enzyme-linked assay was used to measure the Hcy level. [Results] The BNP level in EDN group, CDN group and CRF group was obviously higher than that in SDN group and NC group（ P G0.05）. The level of BNP was positively correlated with umalb（r=0.42, P G0.05） and Cr（r=0.56, P G0.05）. The Hcy level in EDN group, CDN group and CRF group was obviously higher than that in SDN group and NC group（ P G0.05）. The level of BNP was positively correlated with umalb（r=0.28, P G0.05） and Cr（r=0.46, P G0.05）. The levels of BNP and Hey after intensive glucose control were significantly lower than those before treatment（ P G0.05）. [Conclusion] The levels of BNP and Hey significantly increase in DN patients. Serum levels of BNP and Hcy have good value for predicting the occurrence, development and course of DN.