2型糖尿病患者血清同型半胱氨酸与肾脏功能的相关性研究
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摘要
目的探讨2型糖尿病患者血清同型半胱氨酸(Hcy)与尿微量白蛋白/肌酐(UACR)的分布特点及与尿素(BUN),肌酐(SCr)和尿酸(UA)的相关性。方法分析550例2型糖尿病患者血清Hcy和尿UACR依性别及年龄分布特征,并将550=例糖尿病患者按UACR分为正常白蛋白尿组(UACR<30 mg/g),微量白蛋白尿组(UACR30～300 mg/g),大量白蛋白尿组(UACR>300 mg/g),另选取对应的790例健康对照组进行比较,探讨糖尿病病例Hcy及UACR与年龄、BUN、SCr及UA的相关性。结果糖尿病病例中,男性组Hcy明显高于女性组(P<0.05),≥50岁组Hcy明显高于<50岁组(P<0.05);健康对照组,糖尿病正常蛋白尿组,微量白蛋白尿组及大量白蛋白尿组Hcy比较差异有统计学意义(P<0.05);糖尿病病例Hcy与UACR、BUN、SCr、UA、年龄呈正相关(r值分别为0.185、0.384、0.527、0.233、0.138,P<0.05)。UACR与BUN、SCr、UA、Hcy呈正相关(r值分别为0.197、0.315、0.092、0.185,P<0.05)。结论 Hcy及UACR是重要的糖尿病肾病监测指标,联合检测值得临床推广应用。
Objective To investigate the correlation between the distribution characteristics of serum homocysteine(Hcy) and urinary microalbumin/creatinine(UACR) in patients with type 2 diabetes mellitus,and to explore their correlation with BUN,SCr and UA.Methods A total of 550 patients with type 2 diabetes mellitus were divided into normal albuminuria group(UACR<30 mg/g),microalbuminuria group(UACR 30 ～ 300 mg/g),large albuminuria group(UACR > 300 mg/g)according to UACR levels.And the other 790 healthy subjects were enrolled as contro group.The correlation between Hcy,UACR and patient's age,BUN,SCr,UA in patients with type 2 diabetes mellitus was analyzed.Results In patients with type2 diabetes mellitus,the Hcy levels in male group were significantly higher than those in female group(P<0.05),which in the group over 50 years were significantly higher than those in the group under 50 years(P<0.05).The median Hcy levels in healthy control group,diabetic normal albuminuria group,microalbuminuria group and large albuminuria group were 5.67,6.96,7.75 and 8.26μmol/L,respectively,and there were significant differences in Hcy levels among the four groups(P<0.05).Moreover there was a significant positive correlation between Hcy and UACR,BUN,SCr,UA in patients with diabetes mellitus(r=0.197,0.315,0.092,0.185,respectively,P<0.05).Conclusion Hcy and UACR are important indexes for monitoring diabetic nephropathy,moreover,the combination detection of the two indexes is worthy of clinical application and promotion.
Objective To investigate the correlation between the distribution characteristics of serum homocysteine(Hcy) and urinary microalbumin/creatinine(UACR) in patients with type 2 diabetes mellitus,and to explore their correlation with BUN,SCr and UA.Methods A total of 550 patients with type 2 diabetes mellitus were divided into normal albuminuria group(UACR<30 mg/g),microalbuminuria group(UACR 30 ～ 300 mg/g),large albuminuria group(UACR > 300 mg/g)according to UACR levels.And the other 790 healthy subjects were enrolled as contro group.The correlation between Hcy,UACR and patient's age,BUN,SCr,UA in patients with type 2 diabetes mellitus was analyzed.Results In patients with type2 diabetes mellitus,the Hcy levels in male group were significantly higher than those in female group(P<0.05),which in the group over 50 years were significantly higher than those in the group under 50 years(P<0.05).The median Hcy levels in healthy control group,diabetic normal albuminuria group,microalbuminuria group and large albuminuria group were 5.67,6.96,7.75 and 8.26μmol/L,respectively,and there were significant differences in Hcy levels among the four groups(P<0.05).Moreover there was a significant positive correlation between Hcy and UACR,BUN,SCr,UA in patients with diabetes mellitus(r=0.197,0.315,0.092,0.185,respectively,P<0.05).Conclusion Hcy and UACR are important indexes for monitoring diabetic nephropathy,moreover,the combination detection of the two indexes is worthy of clinical application and promotion.
引文
1陈涧杨,韩飞.糖尿病肾脏病的预防及治疗.中华全科医师杂志,2017,16:253-257.
2中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版).中华内分泌代谢杂志,2014,30:893-942.
3李静,梁田田,王文健.糖尿病肾病的早期诊断.中华肾脏病杂志,2017,33:470-475.
4 Zhang LX,Zhao MH,Wang HB.Trends in chronic kidney disease in China.N Engl J Med,2016,375:905-906.
5李洪.早期糖尿病肾损伤患者Hcy、HbA1c和U-mAlb的检测价值.河北医药,2018,40:1842-1844,1848.
6段建芳,王艳妮,金凤钟,等.糖尿病肾病和血糖控制的关系及相关危险因素分析.中华老年多器官疾病杂志,2018,17:34-38.
7刘媛,王永胜.胱抑素C,同型半胱氨酸及尿碱性磷酸酶在糖尿病肾病诊断中的临床价值.国际检验医学杂志,2018,39:1038-1040.
8陈建娥,吴晓力,蒋银.血清同型半胱氨酸、C反应蛋白与颈动脉内膜中层厚度在老年2型糖尿病合并脑梗塞患者中的意义.中华危重症医学杂志:电子版,2017,10:343-345.
9杨舒羽,曾素根.Hcy,HbA1c和肾病指数联合检测对2型糖尿病早期肾损伤筛查的临床应用价值.国际检验医学杂志,2018,39:1329-1331.
10周腾达,柯小瑚,蔡丽容.糖尿病肾病患者血清同型半胱氨酸,胱抑素C,三酰甘油/高密度脂蛋白胆固醇比值的表达情况.中国当代医药,2016:29-31.
11许庭松,孙奕.超敏C反应蛋白、胱抑素C和同型半胱氨酸联合检测在糖尿病早期肾损害中的诊断价值.国际检验医学杂志,2017,38:553-554.
12时立新.从蛋白尿到特征组学.糖尿病肾病的个体化防治-第52届欧洲糖尿病研究协会年会述评.中华内分泌代谢杂志,2017,33:263-265.
13张翠平,陈璟.老年2型糖尿病肾病患者血清胱抑素C、脂蛋白(α)与尿微量清蛋白/肌酐的相关性研究.国际检验医学杂志,2017,38:1029-1031.
14汪志红,何慈江.糖尿病肾病早期生物标志物预测肾病进展的可靠性.中华糖尿病杂志,2018,10:251-255.
15 Von SBJ,Lajer M,Goetze JP,et al.Time course and mechanisms of the anti-hypertensive and renal effects of liraglutide treatment.Diabet Med,2015,32:343-352.
16 Kohagura K,Kochi M,Miyagi T,et al.An association between uric acid levels and renal arteriolopathy in chronic kidney disease:a biopsy-based study.Hypertens Res,2013,36:43-49.
17 Bartakova V,Kuricova K,Pacal L,et al.Hyperuricemia contributes to the faster progression of diabetic kidney disease in type 2 diabetes mellitus.J Diabetes Complications,2016,30:1300-1307.
18佘新平,朱丹丹,郑志.尿酸在糖尿病视网膜病变中的作用研究现状及进展.中华眼底病杂志,2018,34:401-404.
2中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版).中华内分泌代谢杂志,2014,30:893-942.
3李静,梁田田,王文健.糖尿病肾病的早期诊断.中华肾脏病杂志,2017,33:470-475.
4 Zhang LX,Zhao MH,Wang HB.Trends in chronic kidney disease in China.N Engl J Med,2016,375:905-906.
5李洪.早期糖尿病肾损伤患者Hcy、HbA1c和U-mAlb的检测价值.河北医药,2018,40:1842-1844,1848.
6段建芳,王艳妮,金凤钟,等.糖尿病肾病和血糖控制的关系及相关危险因素分析.中华老年多器官疾病杂志,2018,17:34-38.
7刘媛,王永胜.胱抑素C,同型半胱氨酸及尿碱性磷酸酶在糖尿病肾病诊断中的临床价值.国际检验医学杂志,2018,39:1038-1040.
8陈建娥,吴晓力,蒋银.血清同型半胱氨酸、C反应蛋白与颈动脉内膜中层厚度在老年2型糖尿病合并脑梗塞患者中的意义.中华危重症医学杂志:电子版,2017,10:343-345.
9杨舒羽,曾素根.Hcy,HbA1c和肾病指数联合检测对2型糖尿病早期肾损伤筛查的临床应用价值.国际检验医学杂志,2018,39:1329-1331.
10周腾达,柯小瑚,蔡丽容.糖尿病肾病患者血清同型半胱氨酸,胱抑素C,三酰甘油/高密度脂蛋白胆固醇比值的表达情况.中国当代医药,2016:29-31.
11许庭松,孙奕.超敏C反应蛋白、胱抑素C和同型半胱氨酸联合检测在糖尿病早期肾损害中的诊断价值.国际检验医学杂志,2017,38:553-554.
12时立新.从蛋白尿到特征组学.糖尿病肾病的个体化防治-第52届欧洲糖尿病研究协会年会述评.中华内分泌代谢杂志,2017,33:263-265.
13张翠平,陈璟.老年2型糖尿病肾病患者血清胱抑素C、脂蛋白(α)与尿微量清蛋白/肌酐的相关性研究.国际检验医学杂志,2017,38:1029-1031.
14汪志红,何慈江.糖尿病肾病早期生物标志物预测肾病进展的可靠性.中华糖尿病杂志,2018,10:251-255.
15 Von SBJ,Lajer M,Goetze JP,et al.Time course and mechanisms of the anti-hypertensive and renal effects of liraglutide treatment.Diabet Med,2015,32:343-352.
16 Kohagura K,Kochi M,Miyagi T,et al.An association between uric acid levels and renal arteriolopathy in chronic kidney disease:a biopsy-based study.Hypertens Res,2013,36:43-49.
17 Bartakova V,Kuricova K,Pacal L,et al.Hyperuricemia contributes to the faster progression of diabetic kidney disease in type 2 diabetes mellitus.J Diabetes Complications,2016,30:1300-1307.
18佘新平,朱丹丹,郑志.尿酸在糖尿病视网膜病变中的作用研究现状及进展.中华眼底病杂志,2018,34:401-404.