血清和肽素对2型糖尿病肾功能损害的诊断及预后判断的临床意义

Prognostic significance and clinical diagnosis of Serum Copeptin in type 2 diabetes patientson with renal damage

目的探讨血清和肽素(Copeptin)对2型糖尿病(T2DM)肾功能损害的诊断及预后判断的临床意义。方法选取2014年3月至2015年8月在淮安市第二人民医院内分泌科住院,根据世界卫生组织糖尿病诊断标准确诊为T2DM 143例,完善基线资料,并检测血清Copeptin、24 h尿白蛋白定量,眼底检查,肾动脉多普勒超声及核素肾动态显像GFR测定。结果 (1)随着GFR水平不断降低,体质量指数(BMI)、空腹血浆葡萄糖(FPG)、胱抑素-c、尿素氮、血尿酸、胆固醇、甘油三酯、低密度胆固醇、胰岛素抵抗指数(HOMA-IR)、尿白蛋白排泄率(UAE)和Copeptin水平逐渐升高,差异有统计学意义(P<0.05)。(2)血清Copeptin水平与高血压、糖化血红蛋白、甘油三酯、血尿酸、尿素氮、胱抑素-c、Scr、UAE、HOMA-IR呈正相关,而与核素GFR呈负相关(P<0.05)。(3)校正年龄、性别、BMI等多因素后,肾功能分期,TG、胰岛素抵抗指数进入线性回归方程,是影响Copeptin水平的独立因素;每肾功能进展1期,血清Copetin水平升高514.833 g·L-1。结论血清Copeptin作为垂体后叶加压素(AVP)检测的替代物,在2型糖尿病肾功能损害的临床诊断和判断预后中起着重要的作用;动态监测血清Copeptin对预测糖尿病肾病的预后也有一定提示价值。血清Copeptin有望成为糖尿病肾病治疗的新靶点。

Objective To investigateexplore the prognostic significance and clinical diagnosis of sSerum cCopeptin in type 2 diabetes （T2DM）patients with renal damage.Methods A total of 143 T2 DMinpatients were recruited from the Department of Endocrinology between March 2014 and August 2015.T2DMwas diagnosed according to the diagnostic criteria for DMof WHO.Patients’characteris-tics were collected and serum copeptin,24 h urine albumin excretion （UAE）and GFR （determined by dynamic radionuclide renal im-aging）were measured.Results （1 ）As GFR decreased,most factors such as body mass index （BMI）,fasting plasma glucose （FPG）,Cystatin-c,urea nitrogen,uric acid,cholesterol,triglyceride,low density cholesterol,homeostasis model assessment -iInsu-lin rResistance （HOMA-IR）,urinary albumin excretion rate （UAE）and cCopeptin increased （P 〈0.05）.（2）Serum cCopeptin wasere positively correlated with blood pressure,glycated hemoglobin A1 C （HbA1 C）,triglycerides,uric acid,urea nitrogen,Cystatin-c,Scr,UAE and HOMA-IR,;and wasere negatively correlated with GFR （P 〈0.05）.（3）MInmultiple linear regression analysis showed that ,the different renal stages were independently related with the cCopeptin levels adjusted by age,gender,BMI.Serum cCopeptin levels increased byhave 514.833 g·L -1 increase as renal stages altered.Conclusion Serum copeptin as AVP substitute plays an important role inon prognosticprognosissignificance and clinical diagnosis of SerumCopeptinin T2 DM with renal damage;The dynamic monitoring of serum Copeptin contributes to the prognosis of diabetic nephropathy （DN）.Serum Copeptin is expected to be-come a new target for treatment of DN.