2型糖尿病患者血糖波动对尿相关蛋白的影响  

Effect of blood glucose variability on urinary proteins in type 2 diabetes mellitus

作　　者：方玲娜[1] 钟绍[1] 卢冰[1] 张莉[1] 沈莉雯[1] 沈鲜安[1] 朱文华[1] 

机构地区：[1]江苏大学附属昆山医院内分泌科,215300

出　　处：《中国综合临床》2015年第1期57-60,共4页Clinical Medicine of China

摘　　要：目的观察不同血糖波动幅度的2型糖尿病患者尿相关蛋白的浓度，探讨血糖波动对早期糖尿病肾病的影响。方法选取56例2型糖尿病患者，测定糖化血红蛋白（HbAlc），分为HbAlC〈7．0％组和HbAlC〉7．0％组，比较两组的尿微量白蛋白、尿转铁蛋白、d1微球蛋白和B2微球蛋白等相关蛋白的水平。对研究对象进行动态血糖监测，分析平均血糖波动幅度，分为平均血糖波动幅度〈3．9mmol组和平均血糖波动幅度〉3．9mmol／L组，比较两组尿相关蛋白水平。结果HbAlC〉7．O％组与HbAlc〈7．0％组相比，尿微量白蛋白、尿转铁蛋白（UTRF）、尿微量白蛋白／尿肌酐（A／C）比值均明显升高[（81．28±44．13）mg／L与（21．63±10．16）mg／L、（4．54±1．54）mg／L与（2．48±0．29）mg／L、（22．17±14．52）me,／mmol与（2．05±0．76）mg／mmol，t值分别为4．758、5．360、4．805，P均〈0．05），空腹C肽则明显降低[（1．01±0．13）μg／L与（1．51±0．21）μg/L；t=4．826，P〈0．05）。血糖波动幅度〉3．9mmol／L组与血糖波动幅度〈3．9mmol／L组相比，A／C比值、尿α1微球蛋白（α1-MG）、132微球蛋白（β2-MG）均显著性升高（￡值分别为4．358、8．641、12．702，P均〈0．05）。结论血糖持续升高和血糖波动幅度增大均促进糖尿病肾病的发生。Objective To investigate the level of urinary protein in type 2 diabetic patients with different glucose excursion and investigation the effect of the glucose excursion on early diabetic nephropathy. Methods Fifty-six type 2 diabetes patients were divided into two groups by the level of glycosylated hemoglobin （HbA1c）, good glycemic. Patients in control group with HbA1 c 〈 7. 0% and patients in poor glycemic control group with HbAlc 〈 7.0%. Microalbuminuria, urine transferring （UTRF）, α1- microglobulin （α1-MG） and β2-microglobulin（β2-MG） were measured. All the patients were monitored using the continuous glucose monitoring system （CGMS）, and mean amplitude of glucose excursions （MAGE） were analyzed. Patients were divided into two groups by MAGE, one group＇s MAGE was lower than 3.9 mmolfL, and another group＇s MAGE was higher than 3.9 mmol/L. Urinary proteins were measured and analyzed in the two groups. Results In the poor glycemie control group, the levels of microalbuminuria, UTRF and albunin/ creatinine（A/C） rate were （81.28 ± 44. 13）mg/L, （4. 54 ± 1.54） mg/L and （22. 17 ±14. 52） mg/mmol significantly higher than that in the good glyeemic control group（ （21.63± 10. 16） mg/L, （2.48 ±0. 29） mg/L and （2.05± O. 76 ） mg/mmol ; t = 4. 758,5. 360,4. 805 ; P 〈 0. 05 ）. Fasting C peptide in the poor glycemic control group was （ 1.01± O. 13 ） ng/ml, significant lower than that in the good glycemic control group （ （ 1.51 ±0. 21）μg/L;t =4. 826;P 〈0. 05）. The levels of A/C rate,α1-MG and β2-MG in the group with MAGE above 3.9 mmol/L significantly higher than those in the group with MAGE below 3.9 mmol/L （ t = 4. 358,8. 641, 12. 702 ;P 〈 0. 05 ）. Conclusion Both persistent hyperglycemia and blood glucose variability could influent diabetic nephropathy.

关 键 词：2型糖尿病 动态血糖监测 尿蛋白 

分 类 号：R587.1[医药卫生—内分泌]