二甲双胍对2型糖尿病患者尿TNF-α排泄的影响  

Effects of metformin treatment on urinary TNF-α excretion in type 2 diabetic patients

作　　者：戴晓康 叶山东[1] 

机构地区：[1]安徽医科大学附属省立医院内分泌科,安徽合肥230001

出　　处：《南京医科大学学报（自然科学版）》2016年第6期746-749,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：安徽省自然科学基金(1508085SMH227);安徽高校省级自然科学研究项目(KJ2011A157)

摘　　要：目的:观察二甲双胍(metformin,Met)对2型糖尿病(type 2 diabetes mellitus,T2DM)患者尿肿瘤坏死因子(tumor necrosis factor,TNF)-α排泄的影响,探讨其可能的肾脏保护作用。方法 :121例T2DM患者(DM组)根据抗糖尿病治疗方案分为胰岛素(insulin,INS)组和磺脲类(sulfonylurea,SU)组,再根据是否联合Met各分2个亚组(INS-Ⅰ组,INS未联合Met,INS-Ⅱ,INS联合Met;SU-Ⅰ组,SU未联合Met,SU-Ⅱ组,SU联合Met),同期选择安徽医科大学附属省立医院体检中心24例健康体检人员作为正常对照组(NC组),比较DM组和NC组及DM各亚组间空腹血浆葡萄糖(fasting blood glucose,FBG)、OGTT试验2 h葡萄糖(postprandial blood glucose,PBG)、糖化血红蛋白A1c(glycated haemoglobin A1c,Hb A1c)、病程、体重指数、血压、血肌酐、尿白蛋白、尿TNF-α排泄的变化。结果:1DM组FBG、PBG、Hb A1c、尿TNF-α肌酐比(urinary TNF-α/creatinine ratio,UTCR)、尿白蛋白肌酐比(urinary albumin/creatinine ratio,UACR)水平较NC组明显升高;2与INS-Ⅰ组相比,INS-Ⅱ组UTCR和UACR明显降低,差异有统计学意义(P<0.05);与SU-Ⅰ组相比,SU-Ⅱ组UTCR和UACR明显降低(P<0.05);3T2DM患者UTCR与UACR呈显著性正相关(r=0.73,P<0.01)。结论:Met可减少T2DM患者尿TNF-α的排泄,该作用可能与其肾脏保护作用有关。Objective：To observe the effects of metformin treatment on urinary TNF-α in type 2 diabetic patients and explore its possible reno-protective mechanisms. Methods：A total of 121 of type 2 patients （the DM group） were divided into the insulin group and the sulfonylurea group,they were divided to 2 subpoups according to whether or not they received metformin （the INS-Ⅰ group,insulin only;the INS-Ⅱ group,insulin＋metformin;the SU-Ⅰ group,sulfonylurea only;the SU-Ⅱ group,sulfonylurea metformin）. Meanwhile,24 healthy subjects were selected as the normal control group （the NC group） so that FPG,PBG,HbA1c,duration,BMI,serum creatinine,urinary albumin/creatinine ratio （UACR） and urinary TNF-α/creatinine ratio （UTCR） were determined respectively between the NC group and the DM group and changes in them excretion were determined in subgroups. Results：1. In the DM group,the levels in FBG,PBG,HbA1c,UTCR and UACR were significantly higher than those in the NC Group. 2. Compared with the INS-Ⅰ group,UTCR and UACR in the INS-Ⅱ group were significantly decreased（P 〈 0.05）;while compared with the SU-Ⅰ group,UTCR and UACR in the SU-Ⅱ group were significantly decreased （P 〈 0.05）. 3. UTCR had significant positive correlation with UACR in patients with T2DM （r=0.73,P 〈 0.01）. Conclusion：Metformin can reduce excretion of urinary TNF-α in type 2 diabetic patients,which may be associated with its renal protection.

关 键 词：二甲双胍 2型糖尿病 糖尿病肾脏疾病 TNF-Α 炎症因子 尿白蛋白 

分 类 号：R587.1[医药卫生—内分泌]