浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2014年
12期
1070-1072
,共3页
2型糖尿病%纤溶指标%蛋白尿%胰岛素抵抗
2型糖尿病%纖溶指標%蛋白尿%胰島素牴抗
2형당뇨병%섬용지표%단백뇨%이도소저항
Type- 2 diabetes mel itus%Fibrinolytic index%Albuminuria%Insulin resistance
目的：探讨2型糖尿病肾病患者蛋白尿程度与血浆中组织型纤溶酶原激活物（tPA）及其抑制物（PAI-1）水平、胰岛素抵抗指数（HOMA- IR）的关系。方法根据患者24h尿白蛋白量将91例患者分为3组，2型糖尿病尿白蛋白正常组（G1组）33例、持续微量白蛋白尿组（G2组）33例和临床蛋白尿组（G3组）25例；选择健康体检者30例作为对照组（G0组），以ELASA法检测4组的tPA、PAI-1水平，采用HOMA模型评估HOMA- IR，并比较各组间的差异。结果与G0组相比，G1组的tPA和PAI-1水平无明显变化（P＞0.05）；G2组、G3组的tPA水平明显下降（P＜0.05或0.01），PAI-1水平明显升高（P＜0.05或0.01）；与G0组相比， G1组的HOMA- IR无明显变化（P＞0.05）；G2组、G3组的HOMA- IR明显升高（P＜0.05或0.01）；相关危险因素分析显示血浆tPA、PAI-1水平及HOMA- IR是2型糖尿病肾病的独立危险因素。结论2型糖尿病肾病患者蛋白尿程度与tPA、PAI-1水平密切相关，血浆PAI-1和胰岛素抵抗在降低2型糖尿病纤溶活性，并在2型糖尿病肾病发生、发展中发挥了重要作用。
目的：探討2型糖尿病腎病患者蛋白尿程度與血漿中組織型纖溶酶原激活物（tPA）及其抑製物（PAI-1）水平、胰島素牴抗指數（HOMA- IR）的關繫。方法根據患者24h尿白蛋白量將91例患者分為3組，2型糖尿病尿白蛋白正常組（G1組）33例、持續微量白蛋白尿組（G2組）33例和臨床蛋白尿組（G3組）25例；選擇健康體檢者30例作為對照組（G0組），以ELASA法檢測4組的tPA、PAI-1水平，採用HOMA模型評估HOMA- IR，併比較各組間的差異。結果與G0組相比，G1組的tPA和PAI-1水平無明顯變化（P＞0.05）；G2組、G3組的tPA水平明顯下降（P＜0.05或0.01），PAI-1水平明顯升高（P＜0.05或0.01）；與G0組相比， G1組的HOMA- IR無明顯變化（P＞0.05）；G2組、G3組的HOMA- IR明顯升高（P＜0.05或0.01）；相關危險因素分析顯示血漿tPA、PAI-1水平及HOMA- IR是2型糖尿病腎病的獨立危險因素。結論2型糖尿病腎病患者蛋白尿程度與tPA、PAI-1水平密切相關，血漿PAI-1和胰島素牴抗在降低2型糖尿病纖溶活性，併在2型糖尿病腎病髮生、髮展中髮揮瞭重要作用。
목적：탐토2형당뇨병신병환자단백뇨정도여혈장중조직형섬용매원격활물（tPA）급기억제물（PAI-1）수평、이도소저항지수（HOMA- IR）적관계。방법근거환자24h뇨백단백량장91례환자분위3조，2형당뇨병뇨백단백정상조（G1조）33례、지속미량백단백뇨조（G2조）33례화림상단백뇨조（G3조）25례；선택건강체검자30례작위대조조（G0조），이ELASA법검측4조적tPA、PAI-1수평，채용HOMA모형평고HOMA- IR，병비교각조간적차이。결과여G0조상비，G1조적tPA화PAI-1수평무명현변화（P＞0.05）；G2조、G3조적tPA수평명현하강（P＜0.05혹0.01），PAI-1수평명현승고（P＜0.05혹0.01）；여G0조상비， G1조적HOMA- IR무명현변화（P＞0.05）；G2조、G3조적HOMA- IR명현승고（P＜0.05혹0.01）；상관위험인소분석현시혈장tPA、PAI-1수평급HOMA- IR시2형당뇨병신병적독립위험인소。결론2형당뇨병신병환자단백뇨정도여tPA、PAI-1수평밀절상관，혈장PAI-1화이도소저항재강저2형당뇨병섬용활성，병재2형당뇨병신병발생、발전중발휘료중요작용。
Objective To investigate the relationship between degree of proteinuria with plasma PAI- 1, tPA and insulin resistance in patients with diabetic nephropathy. Methods Ninety- one patients with type 2 diabetic mel itus were assigned into three groups according to quantitation of 24h urine protein:group G1(24h urine protein<0.03g, n=33), group G2(0.03g≤24h urine protein<0.3g, n=33) and group G3(24h urine protein≥0.30g, n=25). Thirty healthy subjects were selected as controls (Group G0). The plasma levels of PAI- 1 and tPA were tested by ELASA , and their insulin resistance index was assessed by HOMA model. Results There were no significant differences in plasma PAI- 1 and tPA levels and HOMA- IR between G0 and G1 groups (P>0.05). Compared with groups G0 or G1, the tPA activity decreased but PAI- 1 activity increased and HOMA- IR was also increased in G2 and G3 groups (P<0.05 or P<0.01). Multiple stepwise regression analysis showed that insulin resistance index and plasma tPA, PAI- 1 levels were independent risk factors for diabetic nephropathy. Conclusion The degree of proteinuria is correlated with plams PAI- 1 and tPA levels and insulin resistance in patients with diabetic nephropathy.
