二甲双胍对糖尿病肾病患者肾功能的影响  

Influence of metformin on renal function in diabetic neuropathy patients

作　　者：陈淼[1] 娄宁[1] 陈福莲[1] 王文汇[1] 

机构地区：[1]山东大学附属济南市中心医院内分泌科,山东济南250013

出　　处：《南京医科大学学报（自然科学版）》2010年第5期713-716,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：济南市科学技术发展计划(066002)

摘　　要：目的:探讨二甲双胍对于糖尿病肾病患者尿微量白蛋白排泄率(UAE)、血清胱抑素C(CysC)、血浆同型半胱氨酸(Hcy)的影响。方法:根据UAE将104例2型糖尿病患者分为无蛋白尿组(NAU组)40例、微量白蛋白尿组(MIAU组)36例、大量白蛋白尿组(MAAU组)28例,给予胰岛素(INS组)或胰岛素+二甲双胍(INS+MET组)控制血糖在空腹血糖(FPG)≤7mmol/L,糖基化血红蛋白(HbA1c)≤7%,疗程为3个月。并设正常对照组28例。检测干预前后的UAE、体质指数(BMI)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、血清肌酐(Cr)、血清CysC及血浆Hcy。结果:INS+MET干预后与干预前相比,糖尿病各组的BMI、TC和Hcy降低,HDL-C升高,差异有统计学意义(P﹤0.05),UAE有降低趋势,但和Cr、CysC、内生肌酐清除率(Ccr)一样未见统计学差异(P>0.05)。相关分析显示Hcy与Cr、CysC(均P﹤0.05)独立相关。结论:在糖尿病肾病患者中应用二甲双胍未见白蛋白排泄增加和肾功能损害;二甲双胍可降低Hcy,对糖尿病肾病有利。Objective：To investigate the influence of metformin on urinary albumin excretion,serum cystatin C and plasma homocysteine in patients with diabetic nephropathy.Methods：According to the levels of urinary albumin excretion,104 patients of type 2 diabetes mellitus were divided into non-albuminuria group（40 cases）,microalbuminuria group（36 cases）and macroalbuminuria group（28 cases）.Patients in each group were treated with insulin（INS subgroup）or insulin and metformin（INS＋MET subgroup） so as to control FPG≤7 mmol /L and HbA1c≤7%.UAE,BMI,TG,TC,HDL-C,Cr,CysC and Hcy were measured before and after medication.28 normal subjects were involved as control.Results：BMI,Hcy and TC were reduced and HDL-C was increased（P 〈0.05） of whom had been medicated with metformin and insulin for 3 monthes.Cr,Ccr and CysC had no differences（P〉0.05）before and after the pharmacotherapy.Hcy was correlated independently with Cr and CysC（P 〈0.05）.Conclusion：Metformin had not showed an increase of nephropatic UAE and injuring effects to renal function.The decrease of Hcy by metformin showed beneficial effects on the renal function.

关 键 词：二甲双胍 糖尿病肾病 同型半胱氨酸 尿微白蛋白排泄率 胱抑素C 

分 类 号：R587[医药卫生—内分泌]