2型糖尿病微蛋白尿与血液高凝状态、胰岛素抵抗的关系  

Relationship Between Hypercoagulability and Insulin Resistance in Type 2 Diabetic Mellitus with Microalbuminuria

作　　者：舒冏[1] 曾龙驿[1] 王曼曼[1] 穆攀伟[1] 张国超[1] 陈燕铭[1] 

机构地区：[1]中山大学附属第三医院内分泌科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2009年第A04期267-270,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科研基金(A2005237)

摘　　要：【目的】探讨2型糖尿病患者微量蛋白尿(MAU)与凝血系统、胰岛素抵抗的关系。【方法】将70例2型糖尿病患者根据尿白蛋白排泄率(UAER)分为2型糖尿病患者非微量白蛋白尿组(DM+NA)34例及2型糖尿病微量白蛋白尿组(DM+MA)36例,体检健康者35例作为正常对照组(NC);检测各组24 h尿微量白蛋白排泄率(UAER)、空腹血糖(FBG)、空腹胰岛素(Fins)、总胆固醇(TC)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)及糖化血红蛋白(HbA1c)水平,按HOMA模型计算胰岛素抵抗指数(Homa-IR),Homa-IR=(FBG×FinR)/22.5。分别以APTT和UAER为应变量,TC、PT、TT、FIB、HbA1c及Homa-IR为自变量,进行多元逐步回归分析。【结果】DM+MA组与DM+NA组的Homa-IR、FIB、TC及HbA1c水平均较NC组高,APTT、PT、TT水平均较NC组低(P<0.05),DM+MA组与DM+NA组比较,Homa-IR与FIB水平升高更显著,而APTT、PT、TT降低更明显(P<0.05)。多元逐步回归分析结果显示(α=0.05):进入模型的自变量及其与APTT的关系是:Homa-IR、TC、HbA1c均与APTT呈负相关;进入模型的自变量及其与UAER关系是:Homa-IR、FIB、TC、HbA1c与UAER呈正相关,而PT、TT与UAER呈负相关。【结论】2型糖尿病患者MAU的出现与高凝血症、胰岛素抵抗均有密切关系,IR可导致血液高凝状态,凝血功能亢进致2型糖尿病患者肾脏损害加重而致MAU的出现,MAU时的内皮功能障碍可损害胰岛β细胞功能,进一步加重IR。[ Objective ] To explore the relationship between hypercoagulability and insulinresistance in type 2 diabetic mellitus with microalbuminuria（MUA）. [Methods] 70 patients with the type 2 diabetic mellitus were separated into two groups based on urinary album in concentration in morning samples ：normoalbuminuria group （DM ＋ NA, 34 eases） and mieroalbuminuria group （DM ＋ MA, 36 cases）. 35 cases of physical health as normal control group（NC）. Urine albumium excretion rate（UAER）, Fasting blood glucose （FBG）, fasting insulin （Fins）, Total cholesterol （TC）, Activated partial thromboplastin time （APTY）, Prothrombin time （PT）, Thrombin time （TT）, Fibrinogen （ FIB ）, and diabetes Hemoglobin A 1C （ HbA1C ） were measured and insulin resistance index（Homa-IR） were caculated By HOMA model, Homa-IR = （FBG × Fins）/22.5. We studied with multiple stepwise regression analysis, respectively used APTT and UAER for hemodiastase as the dependent variable and the other 14 factors such as the blood glucose as the independent variable. [Results] Compared with NC Group, Homa-IR, FIB, TC and HbAle were significantly increased in DM ＋ MA group and DM ＋ NA group, and APTT, PT, and TT were significantly decreased in DM ＋ MA group and DM ＋ NA group（P 〈 0.05）. The levels of Homa-IR and FIB in group DM ＋ MA were obviously higher than those in group DM ＋ NA, and APTF, PT, and TT were remarkable lower than those in group DM ＋ NA （P 〈 0.05）. Multiple stepwise regression analysis indicated that （α = 0.05） the independent variables into the model and its relations with the APTr is： Homa-IR, FIB, TC and HbAlc were negatively correlated with APTT; the independent variables into the model and its relations with the UAER is： Homa-IR, FIB, TC, and HbAlc were positively correlated with the UAER, but the PT and TT were negatively correlated with UAER. [Conclusion] The MUA in type 2 diabetic patients are closely correlated with hypercoagulability and insulin r

关 键 词：2型糖尿病 微量蛋白尿 胰岛素抵抗 血液高凝状态 

分 类 号：R768.4[医药卫生—耳鼻咽喉科]