2型糖尿病伴H型高血压对肾脏损伤的临床观察

Observation of renal damage in type 2 diabetic patients with high level of homocysteine associated hypertension

目的探讨H型高血压对T2DM患者肾脏损伤的作用。方法选择尿蛋白阴性T2DM患者528例,分为单纯T2DM组、T2DM伴高血压组、T2DM伴高同型半胱氨酸(Hcy)组和T2DM伴H型高血压组。观察各组尿白蛋白/肌酐(UAlb/Cr)、eGFR、血肌酐(Scr)、胱抑素C(Cys-C)等指标。结果单纯T2DM组、T2DM伴高血压组、T2DM伴高Hcy组和T2DM伴H型高血压组UAlb/Cr水平分别为8.00(4.78,23.25)、10.09(5.51,45.78)、11.48(6.38,51.67)和14.06(7.92,54.21)mg/g;eGFR为(94.28±18.01)、(84.86±18.74)、(85.90±18.09)和(75.64±19.43)ml/(min·1.73m2);Scr为(76.16±17.64)、(78.73±14.75)、(84.74±17.17)和(97.35±64.17)μmol/L;Cys-C为(0.93±0.26)、(0.98±0.17)、(1.10±0.29)和(1.16±0.33)mg/L。Logistic分析显示,Hcy是UAlb/Cr和eGFR的危险因素。结论 H型高血压增加了T2DM患者的肾脏损伤。

Objective To investigate the renal damagein type 2diabetic patients with high level of homocysteineassociated hypertension. Methods A total of 528 type 2diabetic patients with negative urinary protein by routine examination were recruited in this study.All the subjects were divided into four group saccording to their blood pressure and homocysteine：T2DM group,T2DM＋hypertension group,T2DM＋high level of homocysteine group,and T2DM＋hypertension＋high level of homocysteine group.UAlb/Cr,eGFR,Scr and Cys-C were measured in all the participants. Results The levels of UAlb/Cr were 8.00（4.78,23.25）,10.09（5.51,45.78）,11.48（6.38,51.67）,14.06（7.92,54.21）mg/g;eGFR were（94.28±18.01）,（84.86±18.74）,（85.90±18.09）,（75.64±19.43）ml/（min·1.73 m2）;Scr were（76.16±17.64）,（78.73±14.75）,（84.74±17.17）,（97.35±64.17）μmol/L;Cys-C were（0.93±0.26）,（0.98±0.17）,（1.10±0.29）,（1.16±0.33）mg/L in T2 DM,T2DM＋hypertension,T2DM＋high level of homocysteine,and T2 DM ＋ hypertension＋ high level of homocysteine group respectively.Logistic regression analysis showed that Hcy was a risk factor for UAlb/Cr and eGFR. Conclusion High level of homocysteine aggravates renal damage in patients with type 2diabetes.