糖尿病患者肾小球滤过率和肾有效血浆流量的改变及影响因素分析  

Analyse of influence elements in the process of dynamic renal imaging to measure glomerular filtration rate and effective renal plasma flow in patients with type 2 diabetes meUitus

作　　者：姚立新[1] 李昨非[2] 刘波[3] 郭雷鸣[1] 

机构地区：[1]秦皇岛市第一医院核医学科,066000 [2]秦皇岛市第一医院功能科,066000 [3]秦皇岛市第一医院内分泌科,066000

出　　处：《国际放射医学核医学杂志》2010年第5期281-284,共4页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的探讨2型糖尿病患者肾小球滤过率（GFR）和有效肾血浆流量（ERPF）的变化特点并对其临床影响因素进行分析。方法2型糖尿病患者108例，依据尿白蛋白排泄率fUAER）分为4组：正常尿白蛋白组、微量尿白蛋白组、大量尿白蛋白组、肾功能不全组，行放射性核素动态显像测定GFR及ERPF，同时测定血清尿素氮、血清肌酐、空腹血糖、糖化血红蛋白、空腹胰岛素、体重指数血压。结果随着糖尿病肾病（DN）的进展，UAER逐渐上升，GFR和ERPF水平依次降低，前者与后二者分别呈显著负相关（F1=-0．497，P〈0．05；r2=-0．215，P〈0．051。各组伴有高血压病患者GFR均比同组无高血压病者明显下降“值分别为1．8、2．1、1．9，P〈0．05；t=3．2，P〈0．01）。多元逐步回归分析显示，年龄、收缩压、糖化血红蛋白、胰岛素抵抗指数与GFR和ERPF均呈独立负相关（回归系数分别为-0．507、-0．874，-0．528、-0．587，-0．336、-0．697，-0．348、-0．371，P〈0．01）。结论GFR和ERPF均是反映DN肾损害的敏感指标，高血压、胰岛素抵抗是DN患者GRF与ERPF降低的独立危险因素，DN患者要严格控制血糖、血压及改善胰岛素抵抗以延缓GFR和ERPF下降。Objective To detect the changes and clinical influence elements of radionuclide renal dynamic imaging to measure glomerular filtration rate （GFR） and effective renal plasma flow （ERPF） in patients with type 2 diabetes mellitus （T2DM）. Methods One hundred and eight patients with T2DM were divided into 4 groups according to the values of urinary albumin excretion rate （ UAER ） ： Group Ⅰ ： UAER 〈 20μg·min-1, 31 cases. Group Ⅱ ： UAER 20-200μg·min-1, 28 cases. Group Ⅲ： UAER 〉200μg·min-1, serum creatinine（SCr）〈105μmol/L, 26 cases. GroupⅣ ： UAER〉200μg·min-1, SCr≥ 105μmol/L, 23 cases. ^99Tc^m -diethylenetriamine pentaacetic acid and99Tc^m -ethylenedicysteine renal dynamic imaging were performed in all patients. GFR, ERPF and renogram were derived simultaneously. The levels of blood creatinine, blood urea nitrogen, urine albumin, blood press, fasting blood insulin, glycosylated hemoglobin, fasting blood glucousewere measured in the four groups. Results With the evolvement of diabetes nephropathy（DN）,UAERs were gradually ascended and the values of GFR and ERPF was gradually descended, the former offered remarkable inverse correlation with the two latters（r1= -0.497, P〈0.05 ; r2=-0,215, P〈0.05）. The values of GFR and ERPF in four groups patients with hypertension was lower than without hypertension （h= 1.8, t2=2.1, t3=1.9, P〈0.05 ; t4=3.2, P〈0.01）. Multielement stepwise regression analyses assumed that age, systolic pressure, glycosylated hemoglobin and insulin resistance index offered inverse correlationwith GFR and ERPF （coefficient of regression factor ： -0.507, -0.874, -0.528, -0.587, -0.336, -0.697, - 0.348, -0.371, P〈0.01）. Conclusion GFR and ERPF were sensitive index reflecting the changes of DN. Hypertension and insulin resistance were independence risk factors to make the value of GFR and ERPF decreased in patients with DN.

关 键 词：糖尿病 2型 肾小球滤过率 肾血浆流量 有效 体层摄影术 发射型计算机 单光子 99M锝五乙酸盐 99m锝双半胱氨酸 

分 类 号：R692[医药卫生—泌尿科学]