肾功能正常的2型糖尿病患者血乳酸水平的变化及影响因素  

Lactic acid levels and related influencing factors in type 2 diabetes with normal renal function

作　　者：刘芳[1] 陆俊茜[1] 唐峻岭[1] 候旭宏[1] 王静[1] 李诀[1] 贾伟平[1] 项坤三[1] 

机构地区：[1]上海交通大学第六人民医院内分泌代谢科上海市糖尿病临床医学中心上海市糖尿病研究所,上海200233

出　　处：《上海交通大学学报（医学版）》2007年第7期791-794,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的探讨2型糖尿病患者血乳酸(LA)水平的变化及其影响因素。方法选择肾功能正常的住院2型糖尿病患者455例,用酶电极法测定空腹静脉血浆LA水平,同时检测空腹血糖、胰岛素、糖化血红蛋白、肝肾功能等指标,用锝99-DTPA同位素法测定肾小球滤过率(GFR),并计算胰岛素抵抗指数(HOMA-IR)和体质量指数(BMI)。结果2型糖尿病患者空腹静脉全血LA水平为(1.16±0.47)mmol/L,与正常人无明显差异(P>0.05),但21例(4.62%)患者存在高LA血症。血LA水平随着血肌酐(Cr)水平升高而增加,在Cr>90μmol/L后更明显;相反,随着GFR的降低而升高,在总GFR<80 mL/min后更显著。相关性分析显示,血LA水平与Cr、谷丙转氨酶、BMI呈正相关。引起血LA水平增高的Cr截点是95.35μmol/L。结论糖尿病患者基础血LA水平与正常人相似,其水平主要受肝肾功能和BMI的影响。血Cr超过95μmol/L时易出现高LA血症。Objective To study the change of plasma lactic acid （ LA ） and related influencing factors in type 2 diabetes mellitus （T2DM）. Methods Four hundred and fifty-five inpatients with T2DM and normal renal function were selected. The fasting venous plasma LA was detected with enzyme-electrode assay, and fasting plasma glucose, serum insulin, alanine aminotransferase （ALT）, HbA1 c and parameters of renal and hepatic function were measured. Glomerular filtration rate （GFR） was determined by ^99mTc-DTPA isotope assay, and body mass index （BMI） and insulin resistance index （HOMA-IR） was calculated. Results The mean fasting LA level was （1.16 ±0.47） mmol/L, with no significant difference with the normal one（P 〉 0.05） , while hyperlactacidemia existed in 21 patients （4.62%）. LA levels increased with the creatinine levels, especially in those with Cr more than 90 μmoL/L. However, LA levels increased with the reduction of GFR, especially in those with GFR less than 80 mL/min. It was revealed by correlation analysis that LA level was positively correlated with Cr, ALT and BMI. The optimal cutoff of Cr inducing the lactic acidemia was 95.35 μmol/L. Conclusion The baseline LA levels of patients with T2DM are similar to those of healthy adults, and LA levels are mainly influenced by BMI and renal and hepatic function. Hyperlactacidemia may be induced when Cr reaches a level more than 95 μmol/L.

关 键 词：糖尿病 血乳酸 肌酐 体质量指数 

分 类 号：R587.1[医药卫生—内分泌]