糖尿病前期、糖尿病正常尿白蛋白与糖尿病早期肾病者的内皮功能障碍与胰岛素抵抗  

Insulin resistance and endothelial dysfunction in inchoate diabetic nephropathy,normal urine albumin and prophase of diabetes mellitus

作　　者：吕以培[1] 符春晖[2] 张素华[3] 李舒敏[1] 黄永婵[1] 李媛[1] 

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

出　　处：《中国现代医学杂志》2007年第17期2102-2106,共5页China Journal of Modern Medicine

基　　金：广西科学基金项目(桂科基0342062)

摘　　要：目的为了探讨内皮功能障碍与胰岛素抵抗(IR)在2型糖尿病早期肾病(IDN)、2型糖尿病正常尿白蛋白(NDN)、糖尿病前期(IGR)者的不同特点。方法选择NDN40例、IDN36例,观察体重指数(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(HbA1c)、尿白蛋白排泄率(UAER)、血/尿内皮素(S/UET-1)、血脂与血液流变学,计算ln(Homa-IR)、ln(Homa-Is)并与IGR及正常人(NGR)各30例比较分析。结果IDN、NDN与IGR者ln(Homa-IR)、ln(Homa-Is)、UAER、S/UET-1、血脂与血液流变学均与NGR相比差异有显著性(P<0.01或<0.05),随病程ln(Homa-Is)呈进行性下降而UAER、S/UET-1、血液流变学各项呈进行性增高,UEAR、S/UET-1与FPG、HbA1C、ln(Homa-IR)、ln(Homa-Is)、血脂与血液流变学显著相关。结论糖尿病前期就出现IR、胰岛素分泌缺陷与内皮功能障碍,随着胰岛功能的减退出现高血糖,逐渐出现蛋白尿;高血脂与血流变学的改变是DN的危险因素;DN起病、发展与这些机制的相互作用有关。[Objective] To explore the different characteristics of insulin resistance and endothelial dysfunction in inchoate diabetic nephropathy （IDN）, normal urine albumin diabetic nephropathy （NDN）of type 2 diabetes melli- tus and pre-diabetes（impared glucose regulation, IGR）. [Methods] 40 NDN, 36 IDN, 30 IGR and 30 normal glucose regulation（NGR） were selected to observe body mass index （BMI）, waist-to-hip ratio （WHR）, fasting plasma glucose （FPG）, fasting insulin（FINS）, fasting C peptide （FCP）, glycosylated hemoglobin （HbA1C）,urine albumin excretion ratio（UAER）, urine endothelin-1（UET-1）, serum endothelin-1（SET-1）, dyslipidemia and hemorheology, then In （Homa-IR） and ln（Homa-Is） were calculated, and all above index were analysed and compared with each group. [Results] In（Homa-IR）, ln（Homa-Is）, UAER, S/UET-1, dyslipidemia and hemorheology had very significant difference（P 〈0.01 or P 〈0.05） between IDN, NDN, IGR and NGR; ln（Homals） decreased in procession but UAER, S/ UET-1 and hemorheology increased with development of disease. UEAR and S/UET-1 were significantly correlated wih FPG, HbA1C, ln（Homa-IR）, ln（Homa-Is）, dyslipidemia and hemorheology. [Conclusions] Endothelial dysfunction, insulin resistance and islet β-cell dysfunction appears in IGR. Hyperglycemia appears and then urine albumin gradually appears in type 2 diabetes mellitus with the descending of islet function. Dyslipidemia and hemorheology are dangerous factors of DN. The pathogenesises of above interplay with each other in occurrence and development of DN.

关 键 词：糖尿病前期 胰岛素抵抗 内皮功能障碍 2型糖尿病 糖尿病肾病 

分 类 号：R587.1[医药卫生—内分泌]