血糖稳定性对新诊断2型糖尿病患者早期糖尿病慢性肾脏疾病的影响

Influence of glycemic stability on early diabetic chronic kindey disease in newly diagnosed type 2 diabetes mellitus

目的探讨血糖稳定性对新诊断T2DM患者早期糖尿病慢性肾脏疾病(CKD)的影响。方法对105例新诊断T2DM患者采用99mTc-DTPA肾动态显像法检测肾小球滤过率(GFR),并结合UAlb检测结果分为高GFR无UAlb(HG)组、高GFR伴UAlb(HG+UAlb)组、正常GFR伴UAlb(Con+UAlb)组及正常GFR无UAlb(Con)组,检测各组相关指标并比较。结果 (1)Con+UAlb组DBP高于其他各组(P<0.05);HbA1c在Con、Con+UAlb、HG、HG+UAlb组逐渐升高(P<0.05);HOMA-IR在Con、Con+UAlb、HG+UAlb、HG组逐渐升高(P<0.05);血糖水平标准差(SDBG)、日内平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)在Con、HG、HG+UAlb、Con+UAlb组逐渐升高(P<0.05)。(2)相关分析显示,CKD患者GFR与HOMA-IR、HbA1c呈正相关(r=0.541、0.472,P<0.05),与SDBG、MAGE、MODD呈负相关(r=-0.600、-0.913、-0.850,P<0.05)。(3)回归分析显示,CKD患者GFR的影响因素是HOMA-IR、HbA1c、MAGE、MODD(β=0.425、0.242、-0.252、-0.217,P=0.001、0.001、0.004、0.030)。结论早期CKD患者中HbA1c、HOMA-IR与GFR呈正相关,而MAGE、MODD与GFR呈负相关。

Objective To discuss the effect of glycemic stability on early status of diabetic chronic kindey disease （CKD） in newly diagnosed type 2 diabetes mellitus.Methods Glomerular filtration rate （GFR） were measured by 99mTc-DTPA,renal dynamic imaging,and urinary albumin（UAlb） were also tested.105 newly diagnosed T2DM were categorized into Con,HG,HG＋UAlb and Con＋UAlb group,with 28 cases,25 cases,20 cases,32 cases respectively.The detective values of relevant indicators were compared.Result （DAfter comparison,there were no differences in age,SBP,BMI,TC,TG,HDL-C,LDL-C among four groups （P 〉 0.05）,but DBP was highest in Con＋ UAlb group than in any othor groups （P〈0.05） ; HbA1c was increased progressively from Con to Con＋UAlb to HG to HG＋UAlb group（P〈0.05） ; HOMA-IR was increased progressively from Con to Con＋ UAlb to HG＋ UAlb to HG group（P 〈 0.05） ; SDBG、MAGE、MODD were increased progressively from Con to HG to HG＋ UAlb to Con＋UAlb group（P〈0.05）,but SDBG between group HG＋ UAlb and Con had no difference.（2）The correlation analysis indicated that HOMA-IR and HbA1c were positively correlated with GFR of CKD patients （P 〈 0.05）,and SDBG、MAGE、MODD were negatively related with GFR （P 〈 0.05） ;（3） Stepwise multivariable regression analysis showed that HOMA-IR、HbA1c、MAGE、MODD were independent correlation factors of GFR in CKD （β=0.425,0.242,-0.252,-0.217,P =0.001,0.001,0.004,0.030）,respectively.Conclusion In early CKD patients,HbA1c and HOMA-IR have positive correlation with GFR,but MAGE and MODD are negatively related to GFR.