不同程度糖尿病肾病患者血清胰岛素样生长因子1的变化

Change of serum insulin like growth factor 1 in diabetic nephropathy patients

目的观察胰岛素样生长因子1（IGF-1）在不同程度糖尿病肾病患者血清中的变化。方法选取2013年3月至2014年3月河北联合大学附属医院确诊的2型糖尿病患者120例作为研究对象，另选取同期30例健康体检者作为对照组；根据尿白蛋白排泄率将2型糖尿病患者分为4组：2型糖尿病非肾病组（DM组，31例）、早期糖尿病肾病组（DN1组，35例）、临床糖尿病肾病组（DN2组，32例）和终末期糖尿病肾病组（DN3组，22例）。测定所有患者及健康体检者血清中IGF-1浓度，采用放射免疫法测定尿微量白蛋白，计算尿微量白蛋白排泄率（UAER），分别测定糖化血红蛋白（HbA1c）、空腹血糖、生长激素、血脂、血压及肾小球滤过率（GFR），比较各组间上述指标差异。结果①DN1组患者血清IGF-1水平高于DM组及对照组[（228±30）μg/L比（192±41）、（198±20）μg／L]（P〈0．05），DN2组IGF-1水平高于DN1组[（364±26）μg/L比（228±30）μg／L]（P〈0．05），DN3组血清IGF-1水平[（388±30）μg／L]高于DN2组（P〈0．05）。各组患者血清生长激素水平无明显差异（P〉0．05）。②2型糖尿病各组UAER、HbA1c、空腹血糖均高于对照组，糖尿病肾病各组UAER、HbA1c、空腹血糖水平均高于DM组，差异均有统计学意义（均P〈0．05）。DM组GFR高于对照组[（147±20）m]／min比（100±18）ml／min，P〈0．05]，DN1，DN2和DN3组GFR均低于对照组和DM组（均P〈0．05），且依次降低[（140±24）、（68±10）、（10±3）m1]，3组间差异有统计学意义（均P〈0．05）。③DN2组、DN3组患者病程长于DM组和DNI组（均P〈0．05）。总胆固醇、三酰甘油、收缩压2型糖尿病各组均高于对照组，糖尿病肾病各组均高于DM组，差异有统计学意义（均P〈0．05）。④血清IGF-1水平与UAER、HbA1c、空腹血糖、总胆固醇、三酰甘油、收缩压、病程呈正相关，与GFR呈负相关。结论血清IGF-1增高的水平与糖尿病肾病的严重程度呈正相关。

Objective To observe the changes of insulin like growth factor 1 （ IGF-1 ） in serum of patients with different degrees of diabetic nephropathy. Methods Totally 30 healthy control （control group） and 120 patients with type 2 diabetes were enrolled. According to the urinary albumin excretion rate, the patients with type 2 diabetes were divided into 4 groups：type 2 diabetes non-nephropathy group （DM group, 31 cases） , early diabetic nephropathy group （DN1 group 35 cases）, clinical diabetic nephropathy group （DN2 group, 32 cases） and end stage diabetic nephropathy group （DN3 group,22 cases） . The IGF-1 concentration in serum was measured, the urine trace albumin was determined by radioimmunoassay method and the urinary albumin excretion rate （UAER） was then calculated. The glycosylated hemoglobin （HbAlc）, fasting plasma glucose （FPG）, growth hormone （GH） , blood lipid, blood pressure and glomerular filtration rate （GFR） were measured and compared between the two groups. Results （1） The level of serum IGF-1 in DN1 group was higher than that in DM group and in control group [ （228 ±30） μg/L vs （ 192 ±41 ） , （ 198 ±20） μg/L] （P 〈0.05 ） ; DN2 group was higher than DN1 group （364 ±26） μg/L vs （228 ±30） μg/L] （P 〈 0. 05 ） ; DN3 group was the highest [ （388 ± 30） μg/L] . The GH level had no significant differences among all the five groups （all P 〉 0. 05 ）. （2）The level of UAER, HbAlc and FPG in type 2 diabetes groups were all significantly higher than those in control group, and in diabetic nephropathy groups were all higher than those in DM group（ all P 〉 0. 05 ）. The GFR level in DM group was lower than that in control group [ （147 ± 20）ml/min vs （100 ± 18）ml/min, P 〈 0.05 ] , and the GFR level in DN1, DN2 and DN3 group decreased in sequence [ （ 140 ± 24 ）, （ 68 ± 10）, （ 10 ± 3 ） ml] with significantly differences （ P 〈 0.05 ）, all being lower than that in DM group （ all P 〈 0.05 ）. （3）The level of total cholesterol （TC） , triglyceride （TG） and systolic blood pressure in type 2 diabetes groups were all significantly higher than those in control group, and in diabetic nephropathy groups were all higher than those in DM group （ all P 〈 0.05 ）. （4）Serum level of IGF 1 was positively correlated with UAER, HbA1c, FPG, TC, TG, systolic blood pressure and duration ; it was negatively correlated with GFR. Conclusions Increase of serum IGF-1 level is associated with the severity of diabetic nephropathy .