2型糖尿病患者血糖变异性对肾小管损伤的影响

Effect of Blood Glucose Variability on Renal Tubular Injury in Type 2 Diabetic Patients

目的 分析2型糖尿病患者血糖变异性参数与肾小管损伤标志物之间的关系,探讨血糖变异性对肾小管损伤的影响。方法 选取2023年1月至2024年3月在我院住院的2型糖尿病患者100例。根据尿视黄醇结合蛋白(URBP)水平分为URBP正常组42例和URBP升高组58例,同时选取健康人群50名作为对照组。检测肌酐、空腹血糖、糖化血红蛋白、URBP等,并进行连续动态血糖监测。对比分析各组平均血糖波动幅度(MAGE)、血糖水平标准差(SDBG)、最大血糖波动幅度(LAGE)、日间血糖平均绝对差(MODD)的变化,并进行相关性分析。结果 URBP升高组与URBP正常组之间空腹血糖、糖化血红蛋白、肌酐差异有统计学意义(P <0.05)。URBP正常组与健康对照组之间MAGE、SDBG、LAGE、MODD差异均有统计学意义(P <0.05),URBP升高组与URBP之间差异更显著(P <0.01)。URBP与MAGE呈显著正相关(P <0.01),与SDBG、LAGE、MODD均呈正相关(P <0.05)。结论 血糖变异性过大会加重肾小管损伤,平稳控制血糖,减少血糖波动幅度,有利于延缓糖尿病肾病的进展。

Objective To analyze the relationship between the parameters of blood glucose variability and the markers of renal tubular injury in type 2 diabetic patients,and to explore the effect of blood glucose variability on renal tubular injury.Methods One hundred patients with type 2 diabetes mellitus hospitalized in our hospital from January 2023 to march 2024 were selected.Urinary retinol-binding protein(URBP) levels were divided into normal URBP group(42 cases) and elevated URBP group(58 cases),and 50 healthy people were selected as control group.Creatinine,fasting blood glucose,glycated hemoglobin and URBP were measured.Continuous glucose monitoring was also carried out.The changes of mean blood glucose fluctuation amplitude(MAGE),standard deviation of blood glucose level(SDBG),maximum blood glucose fluctuation amplitude(LAGE) and mean absolute difference of daily blood glucose(MODD) in each group were compared and analyzed,and the correlation analysis was conducted.Results There were significant differences in fasting blood glucose,hemoglobin A1c and creatinine between elevated URBP group and normal URBP group(P<0.05).There were significant differences in MAGE,SDBG,LAGE and MODD between the normal URBP group and the healthy control group(P<0.05).The difference between elevated URBP group and normal URBP was more significant(P<0.01).URBP was a significant positive correlation with MAGE(P<0.01),and was a positive correlation with SDBG,LAGE and MODD(P<0.05).Conclusion Excessive blood glucose variability can aggravate renal tubular injury.Smooth control of blood glucose and reduce the amplitude of blood glucose fluctuations is conducive to delay the progress of diabetic nephropathy.