2型糖尿病肾病与血浆tPA、PAI-1水平及HOMA-IR的关系研究  

Relationship of proteinuria with plasma PAI-1,tPA levels and insulin resistance in patients with diabetic nephropathy

作　　者：孔园珍 张建飞 

机构地区：[1]绍兴柯桥区中医医院内分泌科,312030 [2]绍兴市中心医院内分泌科

出　　处：《浙江医学》2014年第12期1070-1072,共3页Zhejiang Medical Journal

摘　　要：目的探讨2型糖尿病肾病患者蛋白尿程度与血浆中组织型纤溶酶原激活物(tPA)及其抑制物(PAI-1)水平、胰岛素抵抗指数(HOMA-IR)的关系。方法根据患者24h尿白蛋白量将91例患者分为3组,2型糖尿病尿白蛋白正常组(G_1组)33例、持续微量白蛋白尿组(G_2组)33例和临床蛋白尿组(G_3组)25例;选择健康体检者30例作为对照组(G_0组),以ELASA法检测4组的tPA、PAI-1水平,采用HOMA模型评估HOMA-IR,并比较各组间的差异。结果与G_0组相比,G_1组的tPA和PAI-1水平无明显变化(P>0.05);G_2组、G_3组的tPA水平明显下降(P<0.05或0.01),PAI-1水平明显升高(P<0.05或0.01);与G_0组相比,G_1组的HOMA-IR无明显变化(P>0.05);G_2组、G_3组的HOMA-IR明显升高(P<0.05或0.01);相关危险因素分析显示血浆tPA、PAI-1水平及HOMA-IR是2型糖尿病肾病的独立危险因素。结论 2型糖尿病肾病患者蛋白尿程度与tPA、PAI-1水平密切相关,血浆PAI-1和胰岛素抵抗在降低2型糖尿病纤溶活性,并在2型糖尿病肾病发生、发展中发挥了重要作用。Objective To investigate the relationship between degree of proteinuria with plasma PAI- 1, tPA and insulin resistance in patients with diabetic nephropathy. Methods Ninety- one patients with type 2 diabetic mel itus were assigned into three groups according to quantitation of 24h urine protein：group G1（24h urine protein0.05）. Compared with groups G0 or G1, the tPA activity decreased but PAI- 1 activity increased and HOMA- IR was also increased in G2 and G3 groups （P〈0.05 or P〈0.01）. Multiple stepwise regression analysis showed that insulin resistance index and plasma tPA, PAI- 1 levels were independent risk factors for diabetic nephropathy. Conclusion The degree of proteinuria is correlated with plams PAI- 1 and tPA levels and insulin resistance in patients with diabetic nephropathy.

关 键 词：2型糖尿病 纤溶指标 蛋白尿 胰岛素抵抗 

分 类 号：R587.2[医药卫生—内分泌]