胰岛素敏感性及血浆纤溶系统与肥胖T2DM肾病相关性研究  

Relationship between Minim Albumin and Insulin Sensitivity and Fibrinolysis System in Patients of Obese Type 2 Diabetic Nephropathy

作　　者：袁彩红[1] 康运凯[1] 王志新[1] 

机构地区：[1]郑州市第五人民医院,郑州市450003

出　　处：《医药论坛杂志》2008年第4期26-28,共3页Journal of Medical Forum

摘　　要：目的探讨胰岛素敏感性及血浆纤溶系统与肥胖2型糖尿病(T2DM)肾病患者相关性。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(t-PA)及其抑制物-1(PAI-1)活性和D-二聚体(D-D)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<0.05)与正常对照者比较,肥胖T2DM患者血浆PAI-1活性明显升高(均P<0.05),大量白蛋白尿组更明显;糖尿病肾病患者血浆t-PA活性及大量白蛋白尿组D-D水平大于正常对照者(P<0.05,P<0.01)。多因素逐步回归分析显示,PAI-1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PAI-1活性及D-D水平明显增加,而t-PA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 minim albumin insulin sensitivity and fibrinolysis system in patients with obese type 2 diabetic （OBDM） nephropathy. Methods Total 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, HbAlc levels, plasma tissue plasminogen activator （ t - PA） activity, plasminogen activator inhibitor - 1 （ PAl - 1 ） activity and D - dimer （ D - D） concentration were assayed in all the cases. Results The degree of o- besity （especially central obesity）,concentration of HbAlc and insulin sensitivity index （ISI） in OB- DM nephropathy patients with mass - excretion of urine albumin were more and less than those in OB- DM nephropathy patients with a little and normal excretion of urine albumin （P 〈 0. 05, respectively）. Plasma PAl - 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 that of normal control group （ P 〈 0. 05 ,P 〈 0. 01 ） . Stepwise multivariate analysis showed that plasma PAl - 1 activity was correlated positively with body mass index （ BMI）, waistline and serum triglyceride levels, negatively with ISI respectively. Conclusion PAl - 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 PAl -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：R587.2[医药卫生—内分泌]