老年早期糖尿病肾病患者尿白蛋白排泄率相关因素分析

摘要

目的：探讨2型糖尿病早期肾病的危险因素与防治策略。方法以2型糖尿病早期肾病老年患者（DN 组）73例，2型糖尿病无肾病患者（DM 组）35例为研究对象，测定炎症指标血清炎症因子超敏 C 反应蛋白（hs－CRP）、肿瘤坏死因子α（TNF－α）、白细胞介素－6（IL－6）、白细胞介素－1β（IL－1β）水平、生化指标空腹血糖（FBG）、餐后2 h 血糖（PBG）、糖化血红蛋白（HbA1c）、血脂[总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）]、尿酸（UA）、空腹胰岛素（FINS）。计算胰岛素抵抗指数（HOMA－IR）、尿白蛋白排泄率（UAER）；测量身高、体重、血压。结果DN 组血清炎症因子 hs－CRP、TNF－α、IL－6、IL－1β水平及LDL、UA、HbA1c、FINS、HOMA－IR 比 DM 组升高（P ＜0.05）。相关分析显示，UAER 与 TNF－α、IL－6、HOMA－IR呈正相关（r ＝0.549、0.584、0.894，P ＜0.01）。结论早期2型糖尿病肾病患者尿白蛋白排泄率与炎症状态、胰岛素抵抗相关。%Objective To observe the risk factors and prevention strategies for the treatment of early type 2 diabetic nephropathy.Methods Seventy-three elderly patients with early type-2 diabetic nephropathy were taken as the research objects(DN group) and other matched 35 cases with diabetic but without nephropathy as the controls (DM group).The inflammation factors(hs-CRP, TNF-α, IL-6, IL-1β), fasting blood-glucose(FBG), 2-hour post-prandial blood glucose(PBG), glycosylated hemoglobin(HbA1c), blood lipid levels(TC, TG, HDL, LDL), Uric acid (UA), fasting insulin(FINS) and the insulin resistance index(HOMA-IR) were detected.Urinary albumin ex-cretion rate(UAER) was tested in DN group.The data of height, weight and blood pressure were also collected.Re-sults The levels of inflammation factors hs-CRP, TNF-α, IL-6, IL-1βand LDL, UA, HbA1c, FINS and HOMA-IR were significantly more elevated in DN group than those in DM group(P <0.05).The levels of UAER were posi-tively related to TNF-α, IL-6 and HOMA-IR(r =0.549, 0.584, 0.894, P <0.01).Conclusion UAER is associ-ated with the levels of inflammatory and HOMA-IR in the elderly patients with early type-2 diabetic nephropathy.