早期糖尿病肾病与胰岛素抵抗及微炎症状态之间关系的研究

A study on the relationship of insulin resistance and microinflammatory state on early diabetic nephropathy

目的探讨早期糖尿病。肾病与胰岛素抵抗及微炎症状态之间的关系。方法收集我院2012年1月-2014年12月治疗的早期糖尿病肾病患者112例作为观察组，并选择同期单纯糖尿病患者114例作为对照组，比较两组胰岛素抵抗指数（HOMA—IR）、超敏C反应蛋白（hs—CRP）、血清白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α水平，分析其与糖尿病肾病的关系。结果观察组患者HOMA—IR、hs—CRP、IL-6及TNF-α水平分别为（5．62±2．11）mg／L、（7．12±2．23）mg／L、（58．56±10．23）ng／L、（21．23±5．79）ng／L，对照组患者分别为（2．56±1．18）mg／L、（3．21±1．43）mg／L、（38．13±9．36）ng／L、（15．37±4．37）ng／L，观察组水平明显高于对照组，差异均具有统计学意义（P均〈0．05）。以两组患者作为研究对象，将年龄、性别、病程、糖化血红蛋白（HbAlc）、HOMA—IR、hs—CRP、IL-6、TNF-α等指标纳入多因素Logistic回归分析结果表明，病程、HOMA—IR、IL-6及TNF-α均可作为早期糖尿病肾病的预测指标。结论早期糖尿病。肾病发展过程中胰岛素抵抗及微炎症状态可能发挥重要作用，值得临床进一步研究。

Objective To explore the relationship of insulin resistance and microinflainmatory state on early diabetic nephropathy patients. Methods From January 2012 to December 2014,112 cases of early diabetic nephropathy were recruited as the observation group, while 114 cases of diabetes without early complications were recruited as the control group. Indexes of insulin resistance（ HOMA-IR）, hypersensitive C-reactive protein （hs-CRP） and serum interleukin （ IL）-6, tumor necrosis factor （ TNF）-α indicators of two groups were compared and the relationship with diabetic nephropathy was analyzed. Results The average levels of HOMA-IR, hs-CRP, IL-6 ,TNF-α of the observation group were （5.62 ± 2. 11 ） mg/L, （7.12 ± 2.23 ） mg/L, （58. 56 ± 10. 23 ） ng/L, （21. 23 ± 5. 79 ） ng/L respectively, while in the control group they were （2.56 ± 1.18 ） mg/L, （3.21 ± 1.43 ） mg/L, （ 38.13 ± 9.36） ng/L and （ 15.37 ± 4. 37 ） ng/L respectively. The HOMA-IR,hs-CRP, IL-6, TNF-α in the observation group were significantly higher than the control group, and the difference was statistically significant （ P 〈 0.05）. Among the age, sex, duration, glycosylated hemoglobin （ HbAlc）, HOMA-IR, hs-CRP, IL-6 and TNF-α involved into the Logistic regression analysis, the results showed that the duration, HOMA-IR, IL-6, and TNF-α could predict early diabetic nephropathy independently. Conclusion Insulin resistance and microinflammatory state may play an important role in the development of early diabetic nephropathy,which deserves further studies.