胰岛素强化治疗对糖尿病肾病患者色素上皮衍生因子及血管内皮生长因子水平的影响

摘要

Objective To observe the differences of serum pigment epithelium derived factor (PEDF), vascular endothe-lial growth factor (VEGF) levels of patients with diabetic nephropathy in different periods and to explore the impact of intensive insulin therapy on patients' levels of serum PEDF, VEGF. Methods 85 cases of type 2 diabetes inpatients (comply with the 1999 WHO diagnostic criteria for diabetes) treated in the Department of Endocrinology of Beijing Military General Hospital from December 2012 to December 2013 were selected, and the subjects were divided into three groups according to the urine albumin creatinine ratio (UACR):30 cases with normal albuminuria (UACR<30 mg/g) in group A;28 cases with light albuminuria (30 mg/g≤UACR<300 mg/g) in group B and 27 cases with macroalbumin-uria (UACR≥300 mg/g) in group C. The subjects in each group were given 14-days treatment of intensive insulin therapy. FPG, 2hPBG, GSP, PEDF, VEGF, UACR before and after treatment were measured and each indicator was analyzed. Results①The levels of PEDF, VEGF before treatment in group B and C were higher than those of group A (P< 0.01), and group C was obviously higher than group B (P<0.01).②FPG, 2hPBG, GSP, PEDF, VEGF were obviously declined after intensive insulin treatment in three groups (P<0.05 or P<0.01). Conclusion①PEDF, VEGF levels of diabetic nephropathy are significantly higher than those with normal albuminuria, and with the increase in albuminuria, PEDF, VEGF levels increase significantly. ②Whether diabetes combines with nephropathy or not, intensive insulin therapy can improve the PEDF and VEGF levels while lowering blood glucose.%目的：观察不同时期糖尿病肾病患者血清色素上皮衍生因子（PEDF）、血管内皮生长因子（VEGF）水平的差异，并探讨胰岛素强化治疗对其血清PEDF及VEGF水平的影响。方法选取2012年12月~2013年12月在北京军区总医院住院的2型糖尿病患者（符合1999年WHO糖尿病诊断标准）85例，根据尿白蛋白/肌酐比值（UACR）分为三组院正常白蛋白尿组（A组）30例（UACR约30 mg/g）；微量白蛋白尿组（B组）28例（30 mg/g≤UACR约300 mg/g）；大量白蛋白尿组（C组）27例（UACR≥300 mg/g）。分别给予14 d的胰岛素强化治疗，于治疗前后测定空腹血糖（FPG）、餐后2 h血糖（2hPBG）、糖化血清蛋白（GSP）、PEDF、VEGF、UACR，并对各指标进行分析。结果①治疗前B、C组PEDF、VEGF明显高于A组（P<0.01），且C组明显高于B组（P<0.01）。②胰岛素强化治疗后，三组FPG、2hPBG、GSP、PEDF和VEGF均较治疗前明显下降（P<0.05或P<0.01）。结论①糖尿病肾病患者的PEDF、VEGF水平明显高于正常蛋白尿的糖尿病患者，随着白蛋白尿的增加，PEDF、VEGF水平明显升高。②无论是否合并糖尿病肾病，胰岛素强化治疗均可以在降血糖的同时，改善其PEDF、VEGF水平。