糖尿病肾病患者血清电解质水平变化的研究

Changes of serum electrolytes in patients with diabetic nephropathy

目的探讨糖尿病肾病（DN）患者血清电解质变化，及与尿微量白蛋白的相关性。方法选取2013年4月至2014年10月在天津中医药大学第二附属医院内科住院的2型糖尿病患者450例，按尿微量白蛋白排泄率（UAER）结果分为3组，〈20μg/min为无DN组（176例），20～200μg/min为微量白蛋白尿组（182例），≥200μg/min为大量白蛋白尿组（92例）。同时检测患者血清电解质钾、钠、氯、磷、镁、钙水平，并留取患者一般资料，分析各种电解质变化与DN的关系。结果3组间的钾、磷、钙、镁水平有差异，大量白蛋白尿组的钾（F=11．139，P〈0．01）、磷（F=3．115，P〈0．05）水平最高，镁（F=7．251，P〈0．05）、钙（F=5．721，P〈0．01）水平最低。微量白蛋白尿组与大量白蛋白尿组患者的钾、磷水平均高于无DN组，镁水平低于无DN组（P〈0．05或P〈0．01）。大量白蛋白尿组钙水平低于无DN组（P〈0．01）。与微量白蛋白尿组相比，大量白蛋白尿组钾、磷水平升高，而钙、镁水平降低（P〈0．05或P〈0．01）。直线相关分析显示，磷、钾水平与24h尿微量白蛋白呈正相关（r=0．348，0．258，P〈0．001）。钙、镁水平与24h尿微量白蛋白呈负相关（r=-0．360，-0．374，P〈0．001）。结论DN患者随着尿微量白蛋白的增多，钾、磷水平逐渐升高，镁、钙水平逐渐降低。

Objective To explore the changes of serum electrolytes in patients with diabetic nephropathy （DN）, and the correlation between electrolytes and urinary microalbumin. Methods A total of 450 patients with type 2 diabetes were included from April 2013 to October 2014 in the Department of Inter- nal Medicine of the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine. Accord- ing to urinary albumin excretion rate（ UAER）, all patients were divided into three groups： normal albuminu- ria group （ UAER 〈 20 μg/min, n = 176 ）, microalbuminuria group （ 20 μg/min ≤ UAER 〈 200 μg/min, n = 182） ,macroalbuminuria group （ UAER ≥ 200 μg/min, n = 92 ）. The levels of serum electrolytes including potassium（K）, sodium （Na）, chlorine （C1）, phosphorus （P）, magnesium （ng）, and calcium （Ca） were detected. The clinical characteristics were recorded. The relationship between various electrolytes and DN was analyzed. Results K,P, Ca,and Mg were significantly different among the three groups. In macroalbu- minutia group, the levels of K （ F = 11. 139, P 〈 0.01 ） and P （ F = 3.115, P 〈 0.05 ） were higher, while the levels of Mg（ F = 7.251,P 〈 0.05 ） and Ca（ F = 5. 721, P 〈 0.01 ） were lower than those of other groups. The levels of K and P in microalbuminuria group and macroalbuminuria group were significantly higher than those of normal albuminuria group, and Mg was lower than that of normal albuminuria group （ P 〈 0.05 or P 〈 0.01 ）. The level of Ca in macroalbuminuria group was lower than that of normal albuminuria group（ P 〈 0.01 ）. Compared with microalbuminuria group,the levels of K and P in macroalbuminuria group were high- er, while the levels of Ca and Mg were lower （P 〈 0.05 or P 〈 0.01 ）. Linear correlation analysis showed that there was a positive correlation between P, K and 24 h urine mieroalbumin（ r = 0. 348,0.258 ,P 〈 0.001 ） ,and a negative correlation between Ca, Mg and 24 h urine microalbumin （r = -0.360, -0. 374, P 〈 0.001 ）. Conclusion With the increase of urinary albumin excretion, the levels of K and P gradually in- crease ,while the levels of Ca and Mg gradually decrease.