血压变异性对2型糖尿病患者尿中肾小管损伤相关指标的影响  

Effect of blood pressure variability on urinary renal tubule injury in type 2 diabetic patients

作　　者：张苗 于洋 王刚 潘振涛 李秀云 李现财 ZHANG Miao;YU Yang;WANG Gang;PAN Zhentao;LI Xiuyun;LI Xiancai(Department of Endocrinology,Weifang Endocrine and Metabolic Disease Hospital,Shandong Province,Linqu 262600,China;Department of Nephrology,Weifang Endocrine and Metabolic Disease Hospital,Shandong Province,Linqu 262600,China)

机构地区：[1]山东省潍坊内分泌与代谢病医院内分泌科,山东临朐262600 [2]山东省潍坊内分泌与代谢病医院肾内科,山东临朐262600

出　　处：《中国当代医药》2025年第2期55-58,共4页China Modern Medicine

基　　金：山东省潍坊市卫生健康委科研项目(WFWSJK-2020-282)。

摘　　要：目的通过对无高血压及蛋白尿的2型糖尿病(T2DM)患者的血压变异性及尿中肾小管损伤相关指标的观察,探讨血压变异性对T2DM患者肾小管损伤的影响。方法选取2021年1月至2023年6月在潍坊内分泌与代谢病医院治疗的129例T2DM患者作为研究对象,根据24 h动态血压监测中夜间血压下降比值分为非杓型组(68例)和杓型组(61例)。比较两组患者尿中N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、β_(2)-微球蛋白(β_(2)-MG)、视黄醇结合蛋白(RBP)与肌酐(Cr)比值的差异,同时分析24 h收缩压变异性(24 h SBPV)、白天收缩压变异性(dSBPV)、夜间收缩压变异性(nSBPV)及24 h舒张压变异性(24 h DBPV)、白天舒张压变异性(dDBPV)、夜间舒张压变异性(nDBPV)与尿中NAG、β_(2)-MG、RBP之间的相关性。结果杓型组24 h SBPV、24 h DBPV、dSBPV、dDBPV、nSBPV、nDBPV高于非杓型组,差异有统计学意义(P<0.05)。杓型组尿中NAG、β_(2)-MG/Cr、RBP/Cr均低于非杓型组,差异有统计学意义(P<0.05)。T2DM患者的24 h SBPV、dSBPV、nSBPV、24 h DBPV、dDBPV、nDBPV均与尿NAG、β_(2)-MG、RBP呈正相关(P<0.05),且nSBPV、nDBPV与尿NAG、β_(2)-MG、RBP呈中度正相关(0.3<r≤0.6)。结论非杓型血压会加重T2DM患者的肾小管损伤;血压变异性与肾小管损伤程度呈正相关,且夜间血压变异性越大、尿中肾小管损伤指标越高。血压变异性与尿中肾小管损伤相关指标的联合检测可有助于早期发现T2DM的高危肾脏病变人群。Objective To investigate the effect of blood pressure variability on renal tubule injury in type 2 diabetes mellitus(T2DM)patients without hypertension and proteinuria by observing the blood pressure variability and related indexes of urinary tubular injury.Methods A total of 129 T2DM patients admitted to Weifang Endocrine and Metabolic Disease Hospital from January 2021 to June 2023 were selected as the study subjects,and they were divided into non-arytenoid group(68 cases)and arytenoid group(61 cases)according to the ratio of blood pressure drop at night during 24-h ambulate blood pressure monitoring.The difference of urinary N-acetyl-β-D-glucosaminidase(NAG),β_(2)-microglobulin(β_(2)-MG),retinol-binding protein(RBP)to creatinine(Cr)ratios were compared between the two groups.At the same time,24-hour systolic blood pressure variability(24 h SBPV),24-hour diastolic blood pressure variability(24 h DBPV),diurnal systolic blood pressure variability(dSBPV),diurnal diastolic blood pressure variability(dDBPV),nocturnal systolic blood pressure variability(nSBPV),and nocturnal diastolic blood pressure variability(nDBPV)were analysed correlation with urinary NAG,β_(2)-MG,RBP.Results The 24 h SBPV,24 h DBPV,dSBPV,dDBPV,nSBPV and nDBPV in arytenoid group were higher than those in non-arytenoid group,and the differences were statistically significant(P<0.05).Urine NAG,β_(2)-MG/Cr and RBP/Cr in arytenoid group were lower than those in non-arytenoid blood pressure group,and the differences were statistically significant(P<0.05).In T2DM patients,24 h SBPV,24 h DBPV,dSBPV,dDBPV,nSBPV,and nDBPV were positively correlated with urinary NAG,β_(2)-MG and RBP,and nSBPV and nDBPV were moderately positively correlated with urinary NAG,β_(2)-MG and RBP(0.3<r≤0.6).Conclusion Non-arytenoid blood pressure exacerbates tubular damage in patients with T2DM.The blood pressure variability was positively correlated with the degree of renal tubule injury,and the greater the variability of nocturnal blood pressure,the higher the index of

关 键 词：2型糖尿病 血压变异性 肾脏病 肾小管 

分 类 号：R587.1[医药卫生—内分泌]