早期2型糖尿病肾病患者血糖波动与氧化应激及尿白蛋白肌酐比、尿β2微球蛋白的相关性研究  

Study on the Correlation Between Glucose Fluctuation and Oxidative Stress.UACR,Uβ2-MG in Patients with Early Type 2 Diabetic Nephropathy

作　　者：周建华[1] 李晓华[1] 贝鹏剑[1] 徐艳红[1] 李丽华 朱祎[1] Zhou Jianhua;Li Xiaohua;Bei Pengjian(Department of Endocrinology and Metabolism,Seventh People's Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China)

机构地区：[1]上海中医药大学附属第七人民医院内分泌与代谢科,200137

出　　处：《医学研究杂志》2020年第3期129-133,145,共6页Journal of Medical Research

基　　金：上海市浦东新区卫生系统优秀青年医学人才培养计划项目(PWRq2016-30)。

摘　　要：目的 探讨糖化血红蛋白(hemoglobin A1c,HbA1c)达标的早期2型糖尿病肾病患者血糖波动与氧化应激及尿白蛋白肌酐比(urinary albumin creatinine ratio,UACR)、尿β2微球蛋白(urinary β2-microglobulin,Uβ2-MG)的相关性.方法 横断面研究120例血糖达标的早期2型糖尿病肾病患者的临床资料.行连续72h动态血糖监测(continuous glucose monitoring system,CGMS),计算MAGE;收集患者一般资料,外周血检测血脂、HbA1c、空腹胰岛素(fasting insulin,FINS),晨尿检测UACR;采用免疫比浊法检测24hUβ2-MG;采用酶联免疫吸附法检测24h尿游离8-异前列腺素F2α(8-iso prostaglandin F2α,8-isoPGF2α)评价氧化应激水平.两两比较采用t检验或秩和检验,相关性因素分析采用多元线性逐步回归分析.结果 微量蛋白尿组MAGE、FINS、8-isoPGF2α及Uβ32-MG高于正常蛋白尿组,差异有统计学意义(P<0.05);血糖波动大的正常蛋白尿组MAGE、Uβ2-MG、8-isoPGF2α高于血糖波动小的正常蛋白组,差异有统计学意义(P<0.05),UACR差异无统计学意义(P>0.05);血糖波动大的微量蛋白尿组MAGE、TG、BMI、8-isoPGF2α及UACR、Uβ32-MG高于血糖波动小的微量蛋白组,差异有统计学意义(P<0.05).MAGE、LDL-C是8-isoPGF2α独立影响因素(P<0.01),其中MAGE与8-isoPGF2α相关系数最大.8-isoPGF2α是正常蛋白尿组Uβ2-MG独立影响因素,MAGE是微量蛋白尿组Uβ2-MG独立影响因素,MAGE、8-isoPGF2α、TG是微量蛋白尿组UACR独立影响因素,其中MAGE与UACR相关系数最大.结论 早期2型糖尿病肾病患者MAGE与8-isoPGF2α密切相关,Uβ2-MG在正常蛋白尿阶段即开始升高,并与MAGE及8-isoPGF2α独立相关,UACR与MAGE密切相关.Objective To explore the correlation between glucose fluctuation and oxidative stress,UACR,Uβ2-MG in patients with early type 2 diabetic nephropathy whose hemoglobin A1c(HbA1c)is up to standard.Methods The clinical data of 120 patients with early type 2 diabetic nephropathy whose blood sugar was up to the standard were studied cross-sectionally.MAGE was caleculated by continuous glucose monitoring system(CGMS).General data of patients were collected,and blood lipids,HbAlc,fasting insulin.(FINS),UACR in morning urine,24h Uβ2-MG by immunoturbidimetry,8-iso prostaglandin F2α(8-isoPGF2α)by enzyme-linked immunosorbent assay(ELISA).8-isoPGF2α were used to evaluate oxidative stress level.T-test or rank sum test were used for compari-son,and multiple linear stepwise regression analysis was used for correlation analysis.Results The levels of MAGE,FINS,8-isoPGF2α and Uβ2-MG in microalbuminuria group were higher than those in normal albuminuria group(P<0.05).The levels of MAGE,Uβ2-MG and 8-isoPGF2α in normal albuminuria group with high glucose fluctuation were higher than those in normal protein group with low glucose fluctuation(P<0.05).and there was no significant difference in UACR(P>0.05).The levels of MAGE,TG,BMI,8-isoPGF2α,UACR and Uβ2-MG in in microprotein group with high glucose fluctuation were higher than those in microprotein group with small glucose fuctuation(P<0.05).MAGE and LDL-C were independent influencing factors of 8-isoPGF2α(P<0.01),and the correlation coefficient between MAGE and 8-isoPGF2α was the largest.8-isoPGF2α is the independent influencing factor of Uβ2-MG in normal proteinuria group.MAGE is the independent influencing factor of Uβ2-MG in microalbuminuria group.MAGE,8-isoPGF2α and TG are the independent influencing factors of UACR in microalbuminuria group,and the correlation coefficient between MAGE and UACR is the largest.Conclusion MAGE is closely related to 8-isoPGF2α in patients with early type 2 diabetic nephropathy.Uβ2-MG begins to increase in normal proteinuria stage,a

关 键 词：糖尿病肾病 平均血糖波动幅度 氧化应激 尿白蛋白肌酐比尿 Β2微球蛋白 

分 类 号：R587[医药卫生—内分泌]