CAJ | 학술논문

目的：探讨2型糖尿病肾病(T2DN)患者不同时期凝血四项与血脂的改变及其临床意义。方法本研究选择健康对照组37例，2型糖尿病肾病(T2DN)组150例。根据24 h微量白蛋白(MAU)定量将T2DN患者分为正常蛋白尿组(n=70例，24 h MAU<30 mg/24 h)，微量白蛋白尿组(n=50例，24 h MAU 30~300 mg/24 h)、临床蛋白尿组(n=30例，24 h MAU>300 mg/24 h)。比较各组的空腹血糖(FBG)、甘油三酯（TG）、同型半胱氨酸(HCY)、糖化血红蛋白(HbA1c)、凝血酶原时间(PT)、活化部分凝血酶时间（APTT）、纤维蛋白原（FIB）水平以及凝血酶时间(TT)。除此之外，以尿总蛋白(MTP)为应变量，FBG、TG、HCY、HbA1c为自变量进行多元线性回归分析。结果(1)与健康对照组比较，其他三组的FBG、TG、FIB均明显增高(P<0.01)，TT明显延长(P<0.01)；(2)与正常蛋白尿组、微量白蛋白尿组比较，临床蛋白尿组的FIB明显增高(P<0.05)，TT明显延长(P<0.05)；(3)与正常蛋白尿组、微量白蛋白尿组比较，临床蛋白尿组HCY明显增高(P<0.05)；与正常蛋白尿组比较，临床蛋白尿组HbA1c明显增高(P<0.05)；(4)多元线性回归方程分析显示，对MTP的影响从大到小依次为HCY、FBG、TG、HbA1c。结论(1) T2DN患者较正常人群存在着血脂水平的异常及凝血功能的紊乱；(2)随着MAU的升高，HCY、HbA1C、FIB逐渐升高，TT逐渐延长；(3)HCY对MTP的影响最大，其次为FBG。
목적：탐토2형당뇨병신병(T2DN)환자불동시기응혈사항여혈지적개변급기림상의의。방법본연구선택건강대조조37례，2형당뇨병신병(T2DN)조150례。근거24 h미량백단백(MAU)정량장T2DN환자분위정상단백뇨조(n=70례，24 h MAU<30 mg/24 h)，미량백단백뇨조(n=50례，24 h MAU 30~300 mg/24 h)、림상단백뇨조(n=30례，24 h MAU>300 mg/24 h)。비교각조적공복혈당(FBG)、감유삼지（TG）、동형반광안산(HCY)、당화혈홍단백(HbA1c)、응혈매원시간(PT)、활화부분응혈매시간（APTT）、섬유단백원（FIB）수평이급응혈매시간(TT)。제차지외，이뇨총단백(MTP)위응변량，FBG、TG、HCY、HbA1c위자변량진행다원선성회귀분석。결과(1)여건강대조조비교，기타삼조적FBG、TG、FIB균명현증고(P<0.01)，TT명현연장(P<0.01)；(2)여정상단백뇨조、미량백단백뇨조비교，림상단백뇨조적FIB명현증고(P<0.05)，TT명현연장(P<0.05)；(3)여정상단백뇨조、미량백단백뇨조비교，림상단백뇨조HCY명현증고(P<0.05)；여정상단백뇨조비교，림상단백뇨조HbA1c명현증고(P<0.05)；(4)다원선성회귀방정분석현시，대MTP적영향종대도소의차위HCY、FBG、TG、HbA1c。결론(1) T2DN환자교정상인군존재착혈지수평적이상급응혈공능적문란；(2)수착MAU적승고，HCY、HbA1C、FIB축점승고，TT축점연장；(3)HCY대MTP적영향최대，기차위FBG。
Objective To explore the changes and clinical significance of blood lipids and four coagulation tests in patients with type 2 diabetic nephropathy. Methods 150 cases of type 2 diabetic nephropathy (T2DN) and 37 healthy people (control group) were selected in the study. According to MAU, the patients with Type 2 Diabetic Ne-phropathy were subdivided into three group:normal albuminura group (70 cases,24 h MAU<30 mg/24 h), microalbu-minura group (50 cases, 24 h MAU 30~300 mg/24 h) and clinical proteinuria group (30 cases, 24 h MAU>300 mg/24 h). Fasting blood glucose (FBG), triglyceride (TG), homocysteine (HCY), glycosylated hemoglobin (HbA1c), prothrom-bin time (PTc, activated partial thrombin time (APTT), fibrinogen (FIB) and thrombin time (TT) were compared be-tween groups. In addition, multiple linear regression analysis was applied with MTP as a dependent variable and FBG, TG, HCY and HbA1c as independent variables. Results (1) Compared with healthy controls, FBG, TG and FIB in the other three groups significantly increased (P<0.01), and TT was extended obviously (P<0.01). (2) Compared with healthy control and microalbuminura groups,FIB in clinical proteinuria group significantly increased (P<0.05) and TT extended significantly (P<0.05). (3) Compared with healthy controls and microalbuminura group, HCY in clinical pro-teinuria group significantly increased (P<0.05). Compared with healthy controls, HbA1c in clinical proteinuria group significantly increased (P<0.05). (4) The multivariate linear regression equation analysis demonstrated that HCY, FBG, TG and HbA1c were in descending order to impact MTP. Conclusion (1) There were abnormal blood lipid levels and blood coagulation function disorder in T2DN patients compared to healthy people. (2) With the increase of MAU, HCY, HbA1c and FIB gradually raised and TT gradually extended. (3) HCY impacted MTP mostly, followed by FBG.