2型糖尿病患者血清游离脂肪酸与肾小球滤过率的关系  

Correlation between serum free fatty acid level and estimated glomerular filtration rate in type 2 diabetic patients

作　　者：宣丽萍[1] 郑芬萍[1] 林细华[1] 朱伟芬[1] 尹雪瑶[1] 李红[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院内分泌科宣丽萍现在余姚市人民医院,杭州310016

出　　处：《中华医学杂志》2016年第17期1320-1324,共5页National Medical Journal of China

基　　金：国家科技支撑计划（2012BA102803）;浙江省重大科技专项重点社会发展项目（2009C03104）

摘　　要：目的探讨血清游离脂肪酸（FFA）水平与2型糖尿病（T2DM）患者肾小球滤过率的关系及意义。方法回顾性分析2013年1月至2015年6月浙江大学医学院附属邵逸夫医院内分泌科的442例＇F2DM患者资料，以改良的肾脏病饮食改善（MDRD）公式估测肾小球滤过率（eGFR），根据eGFR水平分为A组（eGFR≥90ml·min^-1·1．73m^-2，227例），B组（60ml·min^-1·1．73m^-2≤eGFR〈90ml·min^-1·1．73m^-2，118例）和C组（eGFR〈60ml·min^-1·1．73m^-2，97例），并选取50名体质指数匹配的非糖尿病者作为对照组。检测各组的血清FFA水平，分析其与eGFR的关系。结果C组患者FFA水平[（450±203）μmol／L]明显高于A组[（326±167）μmol／L]、B组[（394±184）μmol／L]和对照组[（320±90）ixmol／L]（均P〈0．05）；B组FFA水平明显高于A组（P〈0．05），A组和对照组间FFA水平差异无统计学意义（P〉0．05）。多重线性回归分析显示，血尿酸（UA）、FFA、三酰甘油（TG）、总胆固醇（TC）、白蛋白尿、合并高血压、吸烟和糖尿病病程是eGFR下降的独立影响因素（均P〈0．05）。结论血清FFA水平升高与2型糖尿病患者。肾功能下降相关，可能是影响2型糖尿病肾病进展的因素之一。Objective To investigate the relationship between serum free fatty acid （FFA） level and glomerular filtration rate （GFR） in patients with type 2 diabetes mellitus （T2DM）. Methods A total of 442 T2DM patients treated in Sir Run Run Shaw Hospital from January 2013 to June 2015 were retrospectively analyzed and divided into three groups according to estimated glomerular filtration rate （eGFR） levels using modified modification of diet in renal disease （MDRD） formula： eGFR I〉 90 ml · min^-1· 1.73 m^-2 group （group A, 227 cases）, 60 ml · min^-1 · 1.73 m-2 〈eGFR 〈90 ml · min^-1 1.73 m^-2 group （group B, 118 cases）, and eGFR 〈60 ml · min^-1· 1.73 m^-2 group （group C, 97 cases）. In addition, 50 body mass index （BMI）-matched non-diabetic subjects were selected as control group. Fasting serum FFA level was measured in each group, and its relationship with eGFR was analyzed. Results FFA level in group C [ （450 ± 203） μmol/L] was significantly higher than that in group A[ （326 ± 167） μmol/L] , group B[ （394 ± 184） μmol/L] and control group[ （320 ±90） μmol/L] （all P〈0.05）. Meanwhile, FFA level in group B was higher compared with that in group A （P 〈 0.05 ）. However, no statistical difference was found in FFA level between group A and Control group （P 〉 0. 05）. Multiple linear regression analysis using eGFR as the dependent variable demonstrated that uric acid （UA）, FFA, triglyceride （TG）, total cholesterol （TC）, albuminuria, hypertension, smoking and duration of diabetes were all independent risk factors for decreased eGFR （all P 〈 0.05 ）. Conclusion The present results suggest that increased FFA level might be involved in the development of diabetic nephropathy.

关 键 词：脂肪酸类 非酯化 糖尿病 2型 糖尿病肾病 肾小球滤过率 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]