血压昼夜节律失衡对糖尿病患者尿肾小管相关损伤指标的影响

Influence of blood pressure circadian rhythm imbalance on urinary renal tubule-related injury indexes in diabetic patients

目的通过对血压昼夜节律失衡且无高血压、肾脏损害的2型糖尿病(T2DM)患者尿肾小管相关损伤指标的观察,探讨血压昼夜节律失衡对糖尿病患者肾小管的影响。方法选取2022年1月至2023年10月寿光和信医院肾内科和山东省潍坊内分泌与代谢病医院内科收治的100例符合标准的T2DM患者作为研究对象,根据患者24 h动态血压监测的结果分为杓型血压组(45例)和非杓型血压组(55例),比较两组患者的尿β_(2)微球蛋白(β_(2)-MG)、视黄醇结合蛋白(RBP)、N-乙酰-β-D氨基葡萄糖苷酶(NAG)与尿肌酐(UCr)比值和两组患者的昼夜尿量比值及尿比重。结果非杓型血压组尿β_(2)-MG、RBP、NAG与UCr比值均高于杓型血压组,差异有统计学意义(P<0.05)。两组患者昼夜尿量比值及尿比重比较,差异无统计学意义(P>0.05)。结论血压昼夜节律失衡对T2DM患者的近端肾小管有一定损伤,而对远端肾小管没有明显的影响。血压昼夜失衡节律变化可作为糖尿病患者早期肾损伤的参考指标。

Objective To investigate the effect of circadian rhythm imbalance of blood pressure on renal tubules in type 2 diabetes mellitus(T2DM)patients without hypertension or renal damage by observing the indexes of urinary renal tubule-related injury.Methods A total of 100 T2DM patients admitted to the Department of Nephrology,Hexin Hospital and Weifang Endocrinology and Metabolic Disease Hospital from January 2022 to October 2023 were selected as research subjects.According to the results of 24 h ambulate blood pressure monitoring,they were divided into arytenotype blood pressure group(45 cases)and non-arytenotype blood pressure group(55 cases).Urinaryβ_(2)-microglobulin(β_(2)-MG),retinol-binding protein(RBP),N-acetyl-β-D-glucosidase(NAG)to urine creatinine(UCr)ratio,the ratio of diurnal urine volume and urinary specific gravity between the two groups were compared.Results The urinary ratios ofβ_(2)-MG,RBP,NAG and UCr in non-arytenotype blood pressure group were higher than those in arytenotype blood pressure group,and the differences were statistically significant(P<0.05).There were no significant differences in the ratio of diurnal urine volume and urinary specific gravity between the two groups(P>0.05).Conclusion The circadian rhythm imbalance of blood pressure can damage the proximal renal tubules in T2DM patients,but has no significant effect on the distal renal tubules.The circadian rhythm imbalance of blood pressure can be used as a reference index of early kidney injury in diabetic patients.