不同期糖尿病肾病的内皮功能障碍与胰岛素抵抗  

Insulin resistance and endothelial dysfunction in different period diabetic nephropathy

作　　者：吕以培[1] 李舒敏[1] 张素华[2] 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：《中国老年学杂志》2007年第7期647-650,共4页Chinese Journal of Gerontology

基　　金：广西科学基金项目(桂科基0342062)

摘　　要：目的探讨内皮功能障碍与胰岛素抵抗(IR)在糖尿病肾病(DN)不同时期患者的不同特点。方法2型糖尿病患者136例,按照蛋白尿及肾功能将DN分期:无白蛋白尿期40例,微量蛋白尿期36例,临床蛋白尿期30例,肾功能不全期30例,与正常人及糖尿病前期(糖调节异常)各30例作对比,观察血压(BP)、体重指数(BMI)、腰臀比(WHR)、空腹血糖(FPG)、空腹胰岛素(FINS)、空腹C肽(FCP)、糖化血红蛋白(HbAlc)、尿白蛋白排泄率(UAER)、血内皮素(SET-1)、尿内皮素(UET-1)、肌酐(Cr)、血脂与血液流变学,计算稳态模型IR指数(HOMA-IR)、稳态模型β细胞功能指数(HOMA-Is)、肌酐清除率(Ccr)、平均动脉压(MAP)并进行对比分析。结果除肾功能不全期外,DN不同时期患者、糖尿病前期HOMA-IR、HOMA-Is、UAER、SET-1/UET-1、血脂与血液流变学均与正常人相比有显著性差异(P<0.05或P<0.01),HOMA-Is呈进行性下降,SET-1/UET-1、UAER与血液流变学呈进行性增高,SET-1/UET-1、UAER分别与FPG、HbAlc、MAP、HOMA-IR、HOMA-Is、血脂、血液流变学显著相关。结论DN各期均存在IR、胰岛功能减退与内皮功能障碍,DN基本的病机与高血糖、IR、胰岛功能减退及内皮功能障碍相互作用继发各种病理机制有关,高血脂、高血压、血液流变学的改变是DN的危险因素,肾功能不全期有特殊表现。Objective To explore the different characteristics of insulin resistance（IB）and endothelial dysfunction in different peried of diabetic nephropathy （DN）. Methods 136 patients with type 2 diabetes mellitus （T2DM） were divided into 40 cases without microalbuminuria peried,36 cases with microalbuminuria peried,30 cases overt proteinuria peried,30 cases impaired renal function period according to level of microalbuminuria and renal function, and compared with 30 cases pre-diabetes mellitus （impaired glucose regulation, IGR） and 30 cases normal to observe blood pressure（BP） ,body mass index（BMI） ,waist-to-hip ratio（WHR） ,fasting plasma glucose（FPG） ,fasting serum insulin（FINS）, fasting C peptide（FCP）, glycosylated hemoglobin（HbAlc）, urine albumin excretion ratio（ UAER）, urine endothelin-1 （ UET-1 ）, serum endothelin-1 （ SET-1 ）, creatinine （Cr）, dyslipidemia and hemorheology and calculate HOMA-insulin resistance index （ HOMA-IR）, HOMA-insulin secretion index （ HOMA-Is ）, Cr clearance ratio （Ccr） and mean arterial pressure （MAP）. Results Excluded impaired renal function period, HOMA-IR, HOMA-Is, UAER, SET-1/UET-1, dyslipidemia and hemorheology were very significantly different （P 〈 0. 01or P 〈 0. 05 ）, HOMA-Is descended in procession but UAER, SET-1/UET-1 and hemorheology increased with development of DN in different period of DN and pre-diabetes mellitus. UEAR, SET-1/UET-1 were respectively significantly correlated with FPG, HbAlc, HOMA- IR, HOMA-Is, dyslipidemia, MAP and hemorheology. Conclusions Endothelial dysfunction, IR and islet cell function descending appear in each period of DN but especially and differently appear in impaired renal function period. Hypertension, dyslipidemia and hemorheology are dangerous factors of DN. The basic pathogenesis of DN is correlated with interplay of IR, islet cell function descending, hyperglycemia, endothelial dysfunction and secondary various pathogenesis .

关 键 词：2型糖尿病 糖尿病肾病 内皮素 胰岛素抵抗 胰岛细胞功能 

分 类 号：R587.1[医药卫生—内分泌]