伴微量白蛋白尿的初诊2型糖尿病患者胰岛分泌功能改变及肾内皮功能障碍的研究  

Endothelial dysfunction of kidney and change of islet excretal function in newly diagnosed type 2 diabetic patients with microalbuminuria

作　　者：吕以培[1] 张素华[2] 李舒敏[1] 黄永婵[1] 符春晖[3] 李媛[1] 罗文意[1] 梁红如[1] 黄中莹[1] 

机构地区：[1]钦州市第二人民医院内分泌科,广西钦州535000 [2]钦州市第二人民医院检验科,广西钦州535000 [3]钦州市第二人民医院心内科,广西钦州535000

出　　处：《临床荟萃》2006年第23期1701-1704,共4页Clinical Focus

基　　金：广西科学基金项目(桂科基0342062)

摘　　要：目的探讨初诊伴微量白蛋白尿(MU)的2型糖尿病患者内皮功能障碍与胰岛功能改变的关系。方法选择符合1999年WHO糖尿病诊断标准且尿白蛋白排泄率(UAER)≥20μg/min、<200μg/min,除外其他MU的原因且空腹血糖(FBS)>10 mmol/L与餐后2小时血糖(2 hBS)>15 mmol/L的初诊2型糖尿病患者32例,观察体质量指数(BMI)、腰臀比(WHR)、FBS、空腹胰岛素(FINS)、空腹C肽(FCP)、果糖胺(FA)、UAER、尿内皮素(UET-1)、血内皮素(SET-1),计算稳态模型(HOMA)模型β细胞功能指数(HOMA-Is),对应用胰岛素强化治疗前与血糖下降(避免低血糖反应且FBS<7 mmol/L与2 hBS<9 mmol/L)平稳2周后上述指标进行对比。结果治疗前后FBS(15.01±3.15)mmol/L vs(6.81±0.86)mmol/L,FA(3.90±0.38)mmol/L vs(2.41±0.29)mmol/L,HOMA-Is(2.79±0.89 vs 4.32±0.5),UAER(53.07±19.83)μg/min vs(21.65±8.16)μg/min,UET-1(244.56±19.30)pg/min vs(142.12±27.95)pg/min,SET-1(153.34±31.52)ng/L vs(103.55±20.77)ng/L,相互比较差异有统计学意义(P<0.01),FBS、HOMA-Is分别与UAER、UET-1、SET-1有显著的偏相关性(P<0.01或<0.05)。结论肾内皮功能障碍及MU的出现与糖尿病患者胰岛功能缺陷后胰岛素缺乏并且由此继发的高血糖有关,胰岛功能缺陷在糖尿病肾病的发生发展中不容忽视。Objective To explore the relationship between endothelial dysfunction of kidney and change of islet function in newly diagnosed type 2 diabetic patients with microalbuminuria（MU）. Methods Accorded with 1999 WHO diagnosis diabetic criterion and urine albumin excretion ratio（UAER）≥20μg/min, 〈200μg/min and FBS〉10 mmol/ L and 2 hBS〉15mmol/L,and excluding other causes of MU,32 newly diagnosed type 2 diabetic patients were studied Body mass index （BMI） ,waist-to-hip ratio （WHR） ,fasting blood sugar （FBS） ,fasting serum insulin（FINS） ,fasting C peptide （FCP）, fructosamine （FA）, UAER, urine endothelin-1 （ UET-1 ）, serum endothelin-1 （SET-1） were observed, HOMA insulin secretion index（HOMA- Is） was calculated and the indexes of pre-insulin intensive treatment were compared with those of post-inslin intensive treatment after blood sugar being declined（FBS〈7 mmol/L and 2 hBS〈9 mmol/L,avoid reaction of hypoglycemia）steadily two weeks. Results FBS（15.01 ± 3.15） mmol/L vs （6.81 ±0.86） mmol/L,FA（3. 90±0. 38） mmol/L vs （2.41±0.29）mmol/L, HOMA- Is（2.79±0.89 vs 4.32±0.5）,UAER（53.07 ±19.83） μg/min vs （21.65±8.16） μg/min,UET-1（244. 56±19. 30） pg/min vs （142. 12±27.95） pg/min and SET-1 （153.34±31.52） ng/L vs （103.55 ±20.77） ng/L were significantly different（ P 〈0.01） between pre-treatment and post-treatment ; and FBS, HOMA-Is were respectively significantly correlated wih UAER, UET-1, SET-1 （ P 〈0. 01 or 〈0.05）. Conclusion Endothelial dysfunction of kidney and MU appearing in diabetic patients are correlated with hyperglycemia and insulin deficiency after islet β-cell function decline. Islet β-cell function decline deficiency should not be neglected in occurrence and development of diabetic nephropathy.

关 键 词：糖尿病 2型 糖尿病肾病 内皮生长因子 胰岛素 白蛋白尿 高血糖症 

分 类 号：R587.1[医药卫生—内分泌]