血清同型半胱氨酸、超敏C反应蛋白、胆红素水平与2型糖尿病肾病的相关性  

Serum homocysteine, high-sensitivity C-reactive protein, bilirubin level and type 2 diabetic kidney disease

作　　者：代闪 陈琰[1] 白倩 吕玲 王彦君[1] DAI Shan;CHEN Yan;BAI Qian;Lü Ling;WANG Yanjun(Department of Endocrinology,Second Hospital of Jilin University, Changchun 130000,China)

机构地区：[1]吉林大学第二医院内分泌科

出　　处：《临床与病理杂志》2019年第9期1923-1928,共6页Journal of Clinical and Pathological Research

基　　金：吉林省科技厅优秀青年基金(20180520122JH)~~

摘　　要：目的:分析血清同型半胱氨酸(homocysteine,Hcy)、超敏C反应蛋白(high-sensitivity C-reactiveprotein,hs-CRP)及胆红素(bilirubin,Bil)水平与2型糖尿病肾病(diabetic kidney disease,DKD)的关系及其临床意义。方法:将173例2型糖尿病患者根据尿微量白蛋白/尿肌酐(urinar y albumin/creatinine ratio,UACR)水平分为正常白蛋白尿组(<30 mg/g,n=81)、微量白蛋白尿组(30 mg/g≤UACR<300 mg/g,n=55)和大量白蛋白尿组(≥300 mg/g,n=37)。比较入组患者的一般临床资料及相关血清生化指标[空腹血糖(fasting blood-glucose,FPG)、糖化血红蛋白(HbA1c)、三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC),高密度脂蛋白胆固醇(high-density lipoproteincholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density-lipoprotein cholesterol,LDL-C)、Hcy,hs-CRP,Bil]。应用非条件logistic回归模型分析DKD的危险因素。应用Pearson相关分析血清总胆红素(total bilirubin,TBil),hs-CRP,Hcy之间的相关性,以及三者与UACR的相关性。结果:单因素分析结果显示:随着UACR水平的增加,Hcy,hs-CRP水平逐渐升高,而TBil水平逐渐下降,差异有统计学意义(P<0.05)。Pearson相关分析结果显示:TBil与UACR呈负相关(分别r=-0.225,P=0.025),而Hcy,hs-CRP与UACR呈正相关(分别r=0.208,r=0.259;P=0.006,P=0.001);TBil与hs-CRP,Hcy呈负相关(r=-0.184,r=-0.188;P=0.016,P=0.013);hs-CRP与Hcy呈正相关(r=0.170,P=0.025)。非条件logistic回归分析结果显示:TBil是DKD的保护性因素(OR=0.921,P=0.035),LDL-C,HbA1c,hs-CRP是DKD的独立危险因素(OR=1.43,OR=1.313,OR=1.135;P=0.029,P=0.040,P=0.043)。结论:血清Hcy,hs-CRP,TBil可能会成为预测早期DKD发生的敏感指标。Objective: To analyze the relationship between serum homocysteine (Hcy), hypersensitivity c reactive protein (hs-CRP), bilirubin (Bil) and type 2 diabetic kidney disease (DKD) and these three indexes clinical significance. Methods: A total of 173 patients with type 2 diabetes mellitus were selected as research subjects. According to the level of urinary microalbuminuria/creatinine (UACR), research subjects were divided into a normal albuminuria group (UACR <30 mg/g, n=81), a microalbuminuria group (30 mg/g ≤ UACR <300 mg/g, n=55) and a hyper albuminuria group (UACR ≥300 mg/g, n=37). The general clinical data and serum biochemical indexes [fasting blood-glucose (FPG), HbA1c, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density-lipoprotein cholesterol (LDL-C), Hcy, hs-CRP, Bil] of all patients were compared by SPSS 22.0. Non-conditional logistic regression model was used to analyze the risk factors of DKD. The correlations of serum total bilirubin (TBil), hs-CRP and Hcy and their correlations with UACR were analyzed by Pearson correlation analysis. Results: The results of univariate analysis showed that the level of Hcy, hs-CRP increased and the level of TBil decreased with the increase of UACR level, the difference was statistically significant (P<0.05). Pearson correlation analysis showed that there was a negative correlation between TBil and UACR (r=-0.225, P=0.025), while positive correlations were found between Hcy, hs-CRP and UACR (r=0.208, r=0.259;P=0.006, P=0.001). There were negative correlations between TBil and hs-CRP, Hcy (r=-0.184, r=-0.188;P=0.016, P=0.013), and a positive correlation between hs-CRP and Hcy (r=0.170, P=0.025). Non-conditional logistic regression analysis showed that TBil was the protective factor (OR=0.921, P=0.035) of DKD and LDL, HbA1c, hs-CRP were the independent risk factors (OR=1.43, OR=1.313, OR=1.135;P=0.029, P=0.040, P=0.043) of DKD. Conclusion: Serum Hcy, hs-CRP, TBil may be the sensitive indexes of early DKD, which provides

关 键 词：2型糖尿病 糖尿病肾病 同型半胱氨酸 超敏C反应蛋白 胆红素 

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