CAJ | 학술논문

目的:观察2型糖尿病肾病(T2DN)患者肾小球滤过膜超微结构改变与肾功能及代谢指标的关系.方法:将明确诊断的T2DN 75例患者分为:微量白蛋白尿组(尿白蛋白/24h 30～300 mg);蛋白尿组(尿蛋白0.5～2.0g/24h)和大量蛋白尿组(尿蛋白＞3.5g/24h).收集三组患者临床指标,并分别使用Cockcroft-Gault公式、简化的肾脏疾病饮食控制(MDRD)公式等计算患者的肾小球滤过率(eGFR);采用形态学计量分析方法分别测算肾小球体积、肾小球足细胞和内皮细胞的相对密度、绝对数目和足细胞足突宽度及肾小球基膜(GBM)厚度.结果:(1)肾小球滤过膜结构与GFR的关系:微量白蛋白尿组Ccr与肾小球足细胞密度及数日均负相关(分别为r=-0.480,P＜=0.05;r=-0.478,P＜0.05);大量蛋白尿组以SCr估算的eGFR与肾小球足细胞密度正相关(r=0.462,P＜0.05);余均未见明显相关.(2)多元回归分析结果:微量白蛋白尿组中肾小球足细胞密度、糖化血红蛋白、三酰甘油、尿酸与Ccr相关(R~2=0.616,P＜0.01);大量蛋白尿组肾小球足细胞密度、尿酸与以SCr估算的eGFR相关(R~2=0.613,P＜0.01).(3)肾小球滤过膜结构及肾小球体积与糖、脂质代谢指标的关系:①肾小球体积与血糖的关系:微量白蛋白尿组中肾小球体积和糖化血红蛋白正相关(r=0.425,P＜0.05);而在蛋白尿组则为负相关(r=-0.427,P＜0.05).②GBM厚度与血糖、血脂代谢指标的关系:微量白蛋白尿组中,以GBM厚度为因变量,糖及脂质代谢水平为自变量,可见空腹血糖水平和总胆固醇与基膜厚度相关(R~2=0.247,P＜0.05).结论:肾小球滤过膜结构与GFR及糖、脂质代谢水平间存在着密切联系,且与DN发展的不同阶段相关.
목적:관찰2형당뇨병신병(T2DN)환자신소구려과막초미결구개변여신공능급대사지표적관계.방법:장명학진단적T2DN 75례환자분위:미량백단백뇨조(뇨백단백/24h 30～300 mg);단백뇨조(뇨단백0.5～2.0g/24h)화대량단백뇨조(뇨단백＞3.5g/24h).수집삼조환자림상지표,병분별사용Cockcroft-Gault공식、간화적신장질병음식공제(MDRD)공식등계산환자적신소구려과솔(eGFR);채용형태학계량분석방법분별측산신소구체적、신소구족세포화내피세포적상대밀도、절대수목화족세포족돌관도급신소구기막(GBM)후도.결과:(1)신소구려과막결구여GFR적관계:미량백단백뇨조Ccr여신소구족세포밀도급수일균부상관(분별위r=-0.480,P＜=0.05;r=-0.478,P＜0.05);대량단백뇨조이SCr고산적eGFR여신소구족세포밀도정상관(r=0.462,P＜0.05);여균미견명현상관.(2)다원회귀분석결과:미량백단백뇨조중신소구족세포밀도、당화혈홍단백、삼선감유、뇨산여Ccr상관(R~2=0.616,P＜0.01);대량단백뇨조신소구족세포밀도、뇨산여이SCr고산적eGFR상관(R~2=0.613,P＜0.01).(3)신소구려과막결구급신소구체적여당、지질대사지표적관계:①신소구체적여혈당적관계:미량백단백뇨조중신소구체적화당화혈홍단백정상관(r=0.425,P＜0.05);이재단백뇨조칙위부상관(r=-0.427,P＜0.05).②GBM후도여혈당、혈지대사지표적관계:미량백단백뇨조중,이GBM후도위인변량,당급지질대사수평위자변량,가견공복혈당수평화총담고순여기막후도상관(R~2=0.247,P＜0.05).결론:신소구려과막결구여GFR급당、지질대사수평간존재착밀절련계,차여DN발전적불동계단상관.
Objective:To explore the relationships between ultrastructural changes of glomerular filtration barrier and renal function and metabolic syndrome in patients with type 2 diabetic nephropathy(T2DN).Methodology:Seventyfive cages with T2DN were enrolled in this study.According to urinary protein excretion they were divided into three groups:microalbuminuria(albuminuria 30-300 mg/24h),overtproteinuria(proteinuria 0.5-2.0g/24h)and heavyproteinuria group(proteinuria＞3.5g/24h).The glomerular volume,endothelial cell density,endothelial cell number,glomerular basement membrane(GBM)width,podocyte density,podocyte number and foot-process width were evaluated using light and electron microscopic morphometry.The clinical data was collected,and glomerular filtration rate (eGFR)was calculated.Results:(1)The relationship between morphometric data and GFR:in microalbuminuria,eGFR was inversely related to the podocyte density and number(r=-0.480,P＜0.05;r=-0.478,P＜0.05,respectively);and in heavyproteinuria,eGFR was directly related to the podocyte density(r=0.462,P＜0.05).(2)In microalbuminuria,the podocyte density,HbA1c,TG and UA were contributed to the changes of eGFR(R~2=0.616,P＜0.01);and in heavyproteinuria,the podocvte density and UA were contributed to the changes of eGFR which was caculated by SCr (R~2=0.613,P＜0.01).(3)The relationship between morphometric and metabolic data:①the relationship between glomerular volume and glycaemia:In microalbuminuria,glomerular volume was directly related to HbAlC(r=0.425,P＜0.05);and in overtproteinuria,glomerular volume was inversely related to HbAlC(r=-0.427,P＜0.05).②Besides,in microalbuminuria.the levels of total cholesterol and fasting blood glucose were the variables with an independent influence on GBM width(R~2=0.247,P＜0.05).Conclusion:There is a close relationship between glomerular morphometrical changes,GFR and metabolic data,besides,the interrelationships depends on the T2DN stage.