代谢综合征肾损害发病情况分析

Analysis of related factors of metabolic syndrome associated nephropathy

目的探讨代谢综合征肾损害发病情况的相关因素。方法选取常规肾功能检测的肥胖患者86例(失访1例),依据检测结果分为肾功能正常组(A组)31例,肾功能异常组(B组)54例;对全部入选患者进行治疗,并于12周后依据治疗效果将B组分为B1组31例(肾功能明显好转组)和B2组23例(肾功能未见好转组)。分别于患者体检时和治疗12周后复诊时检测各组患者的血脂、血流变学、肾功能、血压、空腹血糖(fasting blood glucose,FBG)及餐后2 h血糖(2-hour postprandial glucose,2 h PBG)。结果体检时B组总胆固醇(total cholesterol,TC)、三酯甘油(triglyceride,TG)、FBG、2 h PBG、空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数(homeostasis model assessment-insulin resistance index,HOMA-IR)水平明显高于A组,高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平明显低于A组,差异均有统计学意义(P<0.05),2组低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)水平差异无统计学意义(P>0.05);24 h尿蛋白定量(24-hour urinary protein excretion,24 h UP)、血尿素氮(blood urea nitrogen,BUN)及平均动脉压(mean arterial pressure,MAP)水平明显高于A组,肾小球滤过率(estimated glomerular filtration rate,e GFR)水平明显低于A组(P<0.05);B1组TC、TG、24 h UP、BUN、FBG、HOMA-IR、MAP水平均低于B2组,e GFR水平明显高于B2组(P<0.05)。治疗前A、B组血液流变学指标差异均无统计学意义(P>0.05);治疗后A、B 2组血液流变学指标明显低于治疗前,且B组血液流变学指标明显低于A组,差异均有统计学意义(P<0.05)。结论 HOMA-IR及MAP的升高与代谢综合征肾损害的发病相关,可为疾病的预防和治疗指明新的研究方向。

Objective To explore the related factors of metabolic syndrome associated nephropathy. Methods Eighty-six obese patients（ 1 lost） for routine renal function detection in our hospital from March 2010 to March 2014 were selected,who were divided into two groups,31 patients with normal renal function as group A,and 54 patients with renal injury as group B according to the testing results. All selected patients were treated,and the group B was divided into group B1（ renal function were significantly improved,31 cases） and group B2（ renal function did not improved,23 cases）according to the result of 12 weeks treatment. The lipids,blood rheology,renal function,blood pressure and glucose of the two groups were detected first came to medical examination and after 12 weeks treatment. Results The total cholesterol（ TC）,triglyceride（ TG）,fasting blood glucose（ FBG）,2-hour postprandial glucose（ 2 h PBG）,fasting insulin（ FINS）,and homeostasis model assessment-insulin resistance index（ HOMA-IR） of group B were higher than that of the group A,high density lipoprotein cholesterol（ HDL-C） was significantly lower that that in group A, the difference was statisticallysignificant（ P〈0. 05）. The difference of low density lipoprotein cholesterol（ LDL-C） levels in 2 groups were not statistically significant（ P〈0. 05）. 24-hour urinary protein excretion（ 24 h UP）,blood urea nitrogen（ BUN） and mean arterial pressure（ MAP） level were significantly higher than that in group A,e GFR level was significantly lower than that in group A（ P〈0. 05）. The TC,TG,24 h UP,BUN,FBG,HOMA-IR and MAP of group B1 were lower than that in group A,the e GFR of group B1 was significantly higher than that in group B2,the difference was statistically significant（ P〈0. 05）. Before treatment the blood rheology index of both A,B groups had no significant difference（ P〈0. 05）; after the treatment the blood rheology index of both A,B groups were significantly lower than that before treatment,blood rheology index of B group were significantly lower than that in group A,the difference was statistically significant（ P〈0. 05）. Conclusion HOMA-IR and MAP were important cause of the rise of metabolic syndrome associated nephropathy,and can be pointed out for the prevention and treatment of disease.