胰岛素抵抗、PAI-1与糖尿病肾病的相关性研究

Relationship between insulin r`esistance,type-1 plasminogen activator inhibitor and diabetic nephropathy

目的探讨胰岛素抵抗(IR)程度、血浆组织纤溶酶原激活物抑制剂-1(PAI-1)水平与2型糖尿病肾病(DN)患者病情严重程度的相关性。方法连续收集2010年1月至2012年11月在我院肾内科病区及内分泌科病区住院并诊断为DN的患者122例,按尿蛋白排泄率(UAER)水平分为微量白蛋白尿组(60例)和大量白蛋白尿组(62例)两组,检测DN患者血浆空腹胰岛素(Fins)、PAI-1水平并计算胰岛素抵抗指数(HOMA-IR),比较两组患者上述指标的差异,采用多因素Logistic回归分析方法分析HOMA-IR、PAI-1水平、低密度脂蛋白、总胆固醇、高血压、性别等多个自变量与DN患者病情严重程度(UAER>200μg/min)的相关性。结果大量白蛋白尿组DN患者血浆Fins、PAI-1水平及HOMA-IR均明显高于微量白蛋白组(P<0.01),Spearman相关分析显示DN患者HOMA-IR与PAI-1呈正相关(r=0.495,P<0.05),多因素Logistic回归分析显示HOMA-IR,PAI-1与糖尿病病程均是DN严重程度的独立预测因子。结论胰岛素抵抗、PAI-1是DN形成和发展的重要因素,两者相互作用加重DN的病情。

Objective To investigate the relationship between insulin resistance,type-1 plasminogen activator inhibitor（PAI-1） and the severity of diabetic nephropathy（DN）.Methods 122 DN patients hospitalized in our urology department or endocrinology department from January,2010 to November,2012 were selected and divided into two groups according to patients＇ urinary albumin excretion rate（UAER） levels： microalbuminuria group including 60 cases and massive albuminuria group including 62 cases.DN patients＇ plasma fasting insulin（Fins） and PAI-1 levels were measured after admission,Homeostasis Model Assessment（HOMA） were used to calculate insulin resistance index（HOMA-IR）.Multiple factor Logistic regression analysis were used to measure the predictive value of PAI-1,HOMA-IR to the severity of DN.Results HOMA-IR,Plasma levels of PAI-1 and Fins in massive albuminuria group were significantly higher than microalbuminuria group（P0.01）.Spearman correlation analysis indicated that HOMA-IR had a positive correlation with PAI-1 level（r=0.495,P0.05）.Multiple factor Logistic regression analysis indicated that PAI-1,HOMA-IR and course of type-2 diabetes mellitus were independent factors relevant to the severity of DN.Conclusions Both insulin resistance and PAI-1 were crucial factors in DN＇s development and progression.The interactions between IR and PAI-1 aggravated DN patients＇ condition.