血糖漂移、同型半胱氨酸对2型糖尿病患者尿蛋白排泄量的影响

Effect of blood glucose fluctuation and homocysteine on type 2 diabetic urinary protein excretion

目的探讨血糖漂移、同型半胱氨酸对2型糖尿病患者尿蛋白排泄量的影响。方法对我院自2014年1月至2015年6月所收治的105例糖尿病患者根据尿白蛋白/肌酐(UACR)高低分为正常蛋白尿组、微量蛋白尿组和大量蛋白尿组;比较三组间年龄、糖尿病病程、收缩压(SBP)、舒张压(DBP)、体质量指数(BMI)、空腹血糖(FBG)、甘油三酯(TG)、综胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(HCY)、糖化血红蛋白(Hb A1c)的水平。同时对三组患者进行连续72 h的动态血糖监测,观察三组间平均血糖水平(MBG)及日内平均血糖漂移幅度(MAGE)的差异。多组间比较采用单因素方差分析,组间两两比较采用LSD法。用Spearman法进行相关分析,多因素分析采用多元逐步回归分析法。结果微量蛋白尿组、大量蛋白尿组病程[(12.85±6.3)年vs.(16.06±6.86)年vs.(8.42±4.17)年]、SBP[(143.21±22.51)mm Hg vs.(157.78±18.41)mm Hg vs.(131.73±20.95)mm Hg]、DBP[(80.12±11.66)mm Hg vs.(86.50±13.30)mm Hg vs.(72.73±12.76)mm Hg]、TG[(2.38±0.98)mmol/L vs.(3.11±2.06)mmol/L vs.(1.75±0.81)mmol/L]、HCY[(7.74±1.40)mmol/L vs.(9.55±1.46)mmol/L vs.(9.94±4.07)mmol/L]、MBG[(8.45±1.68)mmol/L vs.10.65±2.38)mmol/L vs.14.41±5.40)mmol/L]、MAGE[(9.30±1.47)mmol/L vs.(11.73±2.58)mmol/L vs.(25.15±18.45)mmol/L]均高于正常蛋白尿组(P<0.05);微量蛋白尿组病程[(12.85±6.3)年vs.(16.06±6.86)年]、SBP[(143.21±22.51)mm Hg vs.(157.78±18.41)mm Hg]、DBP[(80.12±11.66)mm Hg vs.(86.50±13.30)mm Hg]、TG[(2.38±0.98)mmol/L vs.(3.11±2.06)mmol/L]、HCY[(7.74±1.40)mmol/L vs.(9.55±1.46)mmol/L]、MBG[(8.45±1.68)mmol/L vs.(10.65±2.38)mmol/L]、MAGE[(9.30±1.47)mmol/L vs.(11.73±2.58)mmol/L]均低于大量蛋白尿组(P<0.05)。UACR与糖尿病病程、SBP、DBP、TG、HCY、MBG、MAGE呈明显正相关(P均<0.05)。逐步回归分析表明糖尿病病程(x1)、SBP(x2)、MBG(x3)及HCY(x4)是UACR的影响因素,回归方程为?y=-1.044+0.027x1+0.011x2+1.04x3+1.02x4。结论糖尿病肾病患者血糖漂移、HCY与尿蛋白排泄量之间存在相关性,糖尿病肾病患者血糖漂移偏大、HCY升高将会引起尿蛋白排泄量的增加。

Objective To investigate the effect of blood glucose fluctuation and homocysteine on urinary protein excretion in type 2 diabetic patients. Methods A total 105 patients with diabetic from January 2014 to June 2015 in our hospital. According to urine albumin/creatinine(UACR) levels were divided into normal proteinuria group, micro protein urine group and a large amount of proteinuria group. The age, duration of diabetes, systolic blood pressure(SBP), diastolic blood pressure(DBP), body mass index(BMI), fasting blood glucose(FBG), triglyceride(TG), cholesterol(TC), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), homocysteine(HCY), glycosylated hemoglobin(Hb A1c) were compared. At the same time, the three groups of patients for continuous 72 hours of dynamic blood glucose monitoring, observed the difference between the three groups of the average blood glucose level(MBG) and the daily average blood glucose excursion amplitude(MAGE). More comparison using single factor analysis of variance between groups, between two groups to compare the LSD method. Spearman method was used for correlation analysis, multiple factor analysis using multiple stepwise regression analysis. Results The diabetic duration[(12.85±6.3) years vs.(16.06±6.86) years vs.(8.42±4.17) years], SBP[(143.21±22.51) mm Hg vs.(157.78±18.41) mm Hg vs.(131.73±20.95) mm Hg], DBP[(80.12±11.66) mm Hg vs.(86.50±13.30) mm Hg vs.(72.73±12.76) mm Hg], TG[(2.38±0.98) mmol/L vs.(3.11±2.06) mmol/L vs.(1.75±0.81) mmol/L], HCY[(7.74±1.40) mmol/L vs.(9.55±1.46) mmol/L vs.(9.94±4.07) mmol/L], MBG[(8.45±1.68) mmol/L vs.(10.65±2.38) mmol/L vs.(14.41±5.40) mmol/L], MAGE[(9.30±1.47) mmol/L vs.(11.73±2.58) mmol/L vs.(25.15±18.45) mmol/L] of micro protein urine group and a large amount of proteinuria group were higher than those of normal proteinuria group(P<0.05). The diabetic duration[(12.85±6.3) years vs.(16.06±6.86) years], SBP[(143.21±22.51) mm Hg vs.(157.78±18.41) mm Hg], DBP[(80.12±11.66) mm Hg vs.(86.50±13.30) mm Hg], TG[(2.38±0.98) mmol/L vs.(3.11±2.06) mmol/L], HCY[(7.74±1.40) mmol/L vs.(9.55±1.46) mmol/L], MBG[(8.45±1.68) mmol/L vs.(10.65±2.38) mmol/L, MAGE[(9.30±1.47) mmol/L vs.(11.73±2.58) mmol/L] of micro protein urine group were lower than those of a large amount of proteinuria group(P<0.05). The Spearman correlation analysis showed that UACR was positively associated with diabetic duration, SBP, DBP, TG, HCY, MBG, MAGE(all P<0.05). In multiple stepwise regression analysis, diabetes duration(x1), SBP(x2), MBG(x3) and HCY(x4) were independent risk factors of UACR. Regression equation: ?y=-1.044+ 0.027x1+0.011x2+1.04x3+1.02x4. Conclusion There is a correlation between blood glucose excursion, HCY and urine protein excretion in patients with diabetic nephropathy.