肥胖2型糖尿病肾病患者微量白蛋白排泄率与胰岛素抵抗及血浆纤溶系统相关性研究  

Relationship between insulin sensitivity and fibrinolysis system in patients of obese type 2 diabetic nephropathy

作　　者：唐宽晓[1] 任建民[1] 朱媛媛[1] 王德全[1] 

机构地区：[1]山东大学齐鲁医院内分泌科,山东济南250012

出　　处：《中国老年学杂志》2005年第1期25-27,共3页Chinese Journal of Gerontology

基　　金：山东省卫生厅青年基金资助课题(编号:JZ30)

摘　　要：目的探讨肥胖2型糖尿病(T2DM)肾病患者胰岛素敏感性与血浆纤溶系统相关性。方法对108例肥胖T2DM患者及31例健康体检者进行体格检查,采用生物电阻抗法测定其体脂含量,测定其24h尿白蛋白排泄量、血脂、空腹血糖、糖基化血红蛋白(HbA1c)及胰岛素水平、血浆组织型纤溶酶原激活物(tPA)及其抑制物1(PAI1)活性和D二聚体(DD)水平。结果大量白蛋白尿组肥胖度、HbA1c和胰岛素敏感性指数(ISI)分别大于和小于微量白蛋白尿组和尿白蛋白正常组(均P<005)。与正常对照者比较,肥胖T2DM患者血浆PAI1活性明显升高(均P<005),大量白蛋白尿组更明显;糖尿病肾病患者血浆tPA活性及大量白蛋白尿组DD水平大于正常对照者(P<005,P<001)。多因素逐步回归分析显示,PAI1活性与BMI、腰围及血清TG水平呈正相关,与ISI呈负相关。结论肥胖T2DM肾病患者尤其是向心性者血浆PAI1活性及DD水平明显增加,而tPA活性减低,并随着肾病的加重而增加,与肥胖程度呈正相关、与ISI呈负相关。Objective To investigate the relationship between insulin sensitivity and fibrinolysis system in patients with obese type 2 diabetic (OBDM) nephropathy.Methods 108 patients with OBDM and 31 cases of healthy control were accepted physical examination. Total excretion of urine albumin of all day (24 h UAE), fast serum glucose, blood lipid, GHbA1c levels, plasma tissue plasminogen activator (t-PA) activity, plasminogen activator inhibitor-1 (PAI-1) activity and D-dimer (D-D) concentration were assayed in all the cases. Results The degree of obesity (especially central obesity), concentration of GhbA1c and insulin sensitivity index (ISI) in OBDM nephropathy patients with mass-excretion of urine albumin were more and less than those in OBDM nephropathy patients with a little and normal excretion of urine albumin (P< 0.05, respectively). Plasma PAI-1 activity in patients with OBDM was more than that in normal control group (P<0.05, respectively), especially in group with mass-excretion of urine albumin. Plasma t-PA activity of OBDM patients and D-D levels of patients with mass-excretion of urine albumin were higher than normal control group (P<0.05～0.01). Stepwise multivariate analysis showed that plasma PAI-1 activity was correlated positively with body mass index (BMI), waistline and serum triglyceride levels, negatively with ISI respectively. Conclusions PAI-1 activity and D-D levels increase but t-PA activity decrease significantly in patients with OBDM, especially in the central OBDM, and the tendency parallel with the course of diabetic nephropathy and the degree of central obesity, but plasma PAI-1 activity correlates negatively with ISI.

关 键 词：肥胖症 2型糖尿病 糖尿病肾病 纤维蛋白溶解 

分 类 号：R587.1[医药卫生—内分泌]