CAJ | 학술논문

目的分析糖尿病肾病与同型半胱氨酸及血糖波动的相关性,为糖尿病肾脏疾病的防治提供依据.方法测定154例2型糖尿病(T2DM)患者的糖化血红蛋白(HbA1c)、空腹血糖(FBG)、空腹C肽、同型半胱氨酸(Hcy)、血脂、24h尿微量白蛋白定量(UAlb),行动态血糖监测后测定血糖波动系数.根据UAlb将患者分为高UAlb组81例和正常UAlb组73例,进行组间比较,并将UAlb与各种因素间进行多元逐步回归分析.结果高UAlb组与正常UAlb组比较,糖尿病病程[(9.68 ±7.31)年与(5.44±3.65)年,t=3.427]、HbA1c[ (9.61 ±2.44)％与(8.69±2.35)％,t=2.162]、血糖波动系数(3.06±0.85与2.58±0.91,t=2.437)、低密度脂蛋白胆固醇(LDL-C)[(3.46±0.83) mmol/L与(3.01 ±0.84)mmol/L,=2.596]、尿微量白蛋白[(129.64±118.50) mg/24 h与(18.14±3.54) mg/24 h,t=6.421]、血尿酸[(335.02±90.39) mmol/L与(287.00±92.03) mmol/L,t =2.541]及同型半胱氨酸[(15.55 ±4.53)mmol/L与(13.12±4.44) mmol/L,t=2.603]差异均有统计学意义(P＜0.05或P＜0.01).经Pearson相关性分析,糖尿病病程、LDL-C、血尿酸、同型半胱氨酸及血糖波动系数与2型糖尿病患者尿微量白蛋白成正相关(r值分别为0.363、0.270、0.220、0.252、0.236;P值分别为0.000、0.008、0.033、0.014、0.022),多元逐步回归分析显示UAlb与糖尿病病程、Hcy、血糖波动系数相关(β=0.344,P=0.000;β=0.244,P =0.011;β =0.229,P=0.012).结论同型半胱氨酸与血糖波动是2型糖尿病肾病的危险因子,降低同型半胱氨酸浓度,减少患者血糖波动可作为预防2型糖尿病肾病的新途径.
목적 분석당뇨병신병여동형반광안산급혈당파동적상관성,위당뇨병신장질병적방치제공의거.방법 측정154례2형당뇨병(T2DM)환자적당화혈홍단백(HbA1c)、공복혈당(FBG)、공복C태、동형반광안산(Hcy)、혈지、24h뇨미량백단백정량(UAlb),행동태혈당감측후측정혈당파동계수.근거UAlb장환자분위고UAlb조81례화정상UAlb조73례,진행조간비교,병장UAlb여각충인소간진행다원축보회귀분석.결과 고UAlb조여정상UAlb조비교,당뇨병병정[(9.68 ±7.31)년여(5.44±3.65)년,t=3.427]、HbA1c[ (9.61 ±2.44)％여(8.69±2.35)％,t=2.162]、혈당파동계수(3.06±0.85여2.58±0.91,t=2.437)、저밀도지단백담고순(LDL-C)[(3.46±0.83) mmol/L여(3.01 ±0.84)mmol/L,=2.596]、뇨미량백단백[(129.64±118.50) mg/24 h여(18.14±3.54) mg/24 h,t=6.421]、혈뇨산[(335.02±90.39) mmol/L여(287.00±92.03) mmol/L,t =2.541]급동형반광안산[(15.55 ±4.53)mmol/L여(13.12±4.44) mmol/L,t=2.603]차이균유통계학의의(P＜0.05혹P＜0.01).경Pearson상관성분석,당뇨병병정、LDL-C、혈뇨산、동형반광안산급혈당파동계수여2형당뇨병환자뇨미량백단백성정상관(r치분별위0.363、0.270、0.220、0.252、0.236;P치분별위0.000、0.008、0.033、0.014、0.022),다원축보회귀분석현시UAlb여당뇨병병정、Hcy、혈당파동계수상관(β=0.344,P=0.000;β=0.244,P =0.011;β =0.229,P=0.012).결론 동형반광안산여혈당파동시2형당뇨병신병적위험인자,강저동형반광안산농도,감소환자혈당파동가작위예방2형당뇨병신병적신도경.
Objective To investigate the relationship of homocysteine and blood glucose wavy coefficient with type 2 diabetic nephropathy.Methods Glycosylated hemoglobin A1c (HbA1c),fasting blood glucose(FBG),fasting C-peptide,homocysteine(Hcy),blood-fat and 24h urinary albumin quantitative (UAlb) of 154 patients with type 2 diabetes were determined,and the blood glucose wavy coefficient were calculated after blood glucose monitored by a continuous glucose monitoring system (CGMS).The patients were divided into two groups according to the quantity of UAlb:high UAlb group (n =81 ) and normal UAlb group( n =73 ).Then the difference were compared between two groups and multiple regression analysis was done between UAlb and a variety factors.Results The course of disease in high UAlb group were significantly longer than that in normal UAlb group ( (9.68 ± 7.31 ) years vs ( 5.44 ± 3.65 ) years,t =3.427,P ＜ 0.05 ).There were significant difference on HbA1c [ ( 9.61 ± 2.44 ) ％ vs ( 8.69 ± 2.35 ) ％,t =2.162 ],blood glucose wavy coefficient [ ( 3.06 ± 0.85 ) vs (2.58 ± 0.91 ),t =2.437],low density lipoprotein-cholesterol (LDL-C) [ (3.46 ± 0.83 )mmol/L vs ( 3.01 ± 0.84 ) mmol/L,t =2.596 ],UAlb [ ( 129.64 ± 118.5 ) mg/24 h vs ( 18.14 ± 3.54 )mg/24 h,t =6.421 ),UA ( ( 335.02 ± 90.39 ) mmol/L vs ( 287.00 ± 92.03 ) mmol/L,t =2.541 ) and Hcy [ ( 15.55 ± 4.53 ) mmol/L vs ( 13.12 ± 4.44 ) mmol/L,t =2.603 ] between the two groups ( P ＜ 0.05 or P ＜0.01 ).Pearson analysis showed that the courses of disease,LDL-C,UA,Hcy and blood glucose wavy coefficient were positively correlated with UAlb ( r =0.363,0.270,0.220,0.252,0.236 respectively ; P =0.000,0.008,0.033,0.014,0.022,respectively).And the multiple regression analysis indicated that UAlb was related with courses of disease(β =0.344,P =0.000),Hcy(β =0.244,P =0.011 ) and blood glucose wavy coefficient(β =0.229,P =0.012).Conclusion The elevation of serum Hcy and blood glucose wavy coefficient are risk factors to type 2 diabetic nephropathy.Lowering Hcy concentration and reducing the glucose variability may be a new way to prevent the occurrence of type 2 diabetic nephropathy.