2型糖尿病患者肾小管功能受损与胰岛α和β细胞功能的关系研究  

Association between isletα-cell andβ-cell function and impaired renal tubular function in patients with type 2 diabetes mellitus

作　　者：任惠珠[1] 马泽军[2] 王珊珊 程静丽[1] 朱艳娟 单春艳[1] Ren Huizhu;Ma Zejun;Wang Shanshan;Cheng Jingli;Zhu Yanjuan;Shan Chunyan(Department of Nephrology,Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology,Tianjin Medical University,National Health Commission Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases,Tianjin 300134,China;Blood Purification Center,Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology,Tianjin Medical University,National Health Commission Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases,Tianjin 300134,China;Medical Records Statistics Department,Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology,Tianjin Medical University,National Health Commission Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases,Tianjin 300134,China)

机构地区：[1]天津医科大学朱宪彝纪念医院肾病内科,天津市内分泌研究所,国家卫健委激素与发育重点实验室,天津市代谢性疾病重点实验室,天津300134 [2]天津医科大学朱宪彝纪念医院血液净化中心,天津市内分泌研究所,国家卫健委激素与发育重点实验室,天津市代谢性疾病重点实验室,天津300134 [3]天津医科大学朱宪彝纪念医院病案统计科,天津市内分泌研究所,国家卫健委激素与发育重点实验室,天津市代谢性疾病重点实验室,天津300134

出　　处：《中华糖尿病杂志》2024年第6期648-653,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-032A);京津冀基础研究合作专项项目(J210008,21JCZXJC00170,H2021202008)。

摘　　要：目的探讨2型糖尿病(T2DM)患者肾小管功能受损与胰岛α和β细胞功能的关系。方法为横断面研究。收集2020年1月至2023年7月于天津医科大学朱宪彝纪念医院住院、尿白蛋白正常、资料完整的T2DM患者为研究对象。根据研究对象肾小管功能是否正常将其分为肾小管功能正常组和肾小管功能受损组。收集研究对象糖化血红蛋白(HbA1c)、24 h尿糖,所有研究对象行口服葡萄糖耐量试验(OGTT)并于空腹及口服75 g葡萄糖后30、60、120、180 min检测血糖、胰岛素、C肽和胰高糖素,计算其稳态模型评估胰岛素抵抗指数(HOMA-IR)、胰高糖素曲线下面积(AUCG)、C肽曲线下面积(AUCC)和胰岛素敏感性指数(ISI)。采用独立样本t检验或χ^(2)检验进行组间比较,采用二元logistic回归分析肾小管功能受损的影响因素。结果共纳入T2DM患者196例,其中肾小管功能正常组104例,肾小管功能受损组92例。与肾小管功能正常组相比,肾小管功能受损组T2DM患者空腹血糖(t=2.00)、HbA1c(t=3.58)、24 h尿糖(t=2.97)、HOMA-IR(t=8.17)、180 min胰高糖素(t=1.98)均更高,AUCG更大(t=2.33),ISI更低(t=2.80),AUCc更小(t=2.52)(均P<0.05)。logistic回归分析结果显示,肾小管功能受损与HbA1c、HOMA-IR、AUCG均呈正相关[OR值(95%CI)分别为4.705(2.080~10.643)、4.055(1.751~9.394)和1.930(1.324~2.812),均P<0.05],与AUCC呈负相关[OR值(95%CI)为0.187(0.059~0.589),P=0.004]。结论T2DM患者肾小管功能受损可能与胰岛α和β细胞功能有关。Objective To investigate the association between isletα-cell andβ-cell function and impaired renal tubular function in patients with type 2 diabetes mellitus(T2DM).Methods A cross-sectional study was used to collect the patients of T2DM with normoalbuminuria and complete data who were hospitalized at Tianjin Medical University Chu Hsien-I Memorial Hospital from January 2020 to July 2023.According to the renal tubular function,the subjects were divided into normal tubular function group and impaired tubular function group.The subjects′glycosylated hemoglobin A1c(HbA1c)and 24h urinary glucose were collected.All subjects underwent oral glucose tolerance test(OGTT)and blood samples were taken at fasting and 30,60,120,180 min after 75 g oral glucose load to detect blood glucose,insulin,C-peptide and glucagon.The homeostasis model assessment of insulin resistance(HOMA-IR),area under curve of glucagon(AUCG),area under curve of C-peptide(AUCC)and insulin sensitivity index(ISI)were calculated.Independent sample t test orχ^(2) test was used for comparison between groups.Binary logistic regression analysis was performed to evaluate influencing factors of impaired renal tubular function.Results A total of 196 patients with T2DM were enrolled.Patients were divided into normal renal tubular function group(104 cases)and impaired renal tubular function group(92 cases).Compared to normal renal tubular function group,the levels of fasting glucose(t=2.00),HbA1c(t=3.58),24 h urinary glucose(t=2.97),HOMA-IR(t=8.17),180 min glucagon(t=1.98),AUCG(t=2.33)were significantly higher and ISI(t=2.80)and AUCC(t=2.52)were significantly lower in impaired renal tubular function group.Logistic regression analysis showed that renal tubular function impairment was positively related to HbA1c,HOMA-IR,AUCG[OR values(95%CI)were 4.705(2.080-10.643),4.055(1.751-9.394)and 1.930(1.324-2.812)respectively,all P<0.05]and negatively related to AUCC[OR value(95%CI)was 0.187(0.059-0.589),P=0.004].Conclusion Impairment of renal tubular function may be assoc

关 键 词：糖尿病 2型 肾小管功能受损 胰岛Α细胞 胰岛Β细胞 

分 类 号：R587.2[医药卫生—内分泌] R692[医药卫生—内科学]