本文選題：糖尿病腎病　切入點(diǎn)：腎衰竭　出處：《山東醫(yī)藥》2017年33期

【摘要】：目的探討血清膽紅素水平與2型糖尿病腎病(DKD)腎衰竭患者左室舒張功能的關(guān)系。方法選擇2型DKD腎衰竭患者103例(觀察組),根據(jù)尿白蛋白/肌酐比值水平,患者分為正常白蛋白尿組(NA組)34例、微量白蛋白尿組(MA組)39例和大量蛋白尿組(OA組)30例;依據(jù)左心室舒張功能不全(LVDD)的診斷標(biāo)準(zhǔn),患者分為LVDD組43例和非LVDD組60例。選擇健康志愿者58例為對(duì)照組。采用全自動(dòng)生化分析儀檢測(cè)各組血清總膽紅素(TBIL)、直接膽紅素(DBIL)和間接膽紅素(IBIL)水平,采用彩色多普勒超聲診斷儀檢測(cè)左室質(zhì)量指數(shù)(LVMI)、舒張末期室間隔厚度(IVST)、左心室后壁厚度(LVPWT)、左室舒張末內(nèi)徑(LVEDD)、左室射血分?jǐn)?shù)(LVEF)及左室舒張末容積(LVEDV)、舒張?jiān)缙谧畲笱魉俣菶峰/舒張晚期A峰(E/A),分析血清TBIL、DBIL和IBIL水平與左室舒張功能的相關(guān)性。結(jié)果與對(duì)照組相比,觀察組血清TBIL、DBIL和IBIL水平均明顯下降(P均0.05);與NA組相比,MA組和OA組血清膽紅素水平均降低,同時(shí)OA組血清膽紅素水平低于MA組(P均0.05);LVDD組膽紅素水平明顯低于非LVDD組(P均0.05)。觀察組患者的LVMI、LVPWT、LVEDD及IVST水平明顯高于對(duì)照組(P均0.05),而LVEF、LVEDV及E/A水平顯著低于對(duì)照組(P均0.05)。DKD患者血清中TBIL水平與IVST、LVEF及E/A呈負(fù)相關(guān)(r分別為-0.708、-0.716、-0.703,P均0.05),與LVMI、LVPWT、LVEDD呈正相關(guān)(r分別為0.727、0.729、0.732,P均0.05);血清DBIL水平與IVST及E/A呈負(fù)相關(guān)(r分別為-0.721、-0.719,P均0.05),與LVMI及LVPWT呈正相關(guān)(r分別為0.706、0.698,P均0.05);血清IBIL水平與IVST、LVEF及E/A呈負(fù)相關(guān)(r分別為-0.705、-0.702、-0.651,P均0.05),與LVMI、LVPWT及LVEDD呈正相關(guān)(r分別為0.713、0.719、0.723,P均0.05)。結(jié)論血清膽紅素水平可以用于反映2型DKD腎衰竭患者的疾病狀態(tài),并且與左室舒張功能密切相關(guān)。
[Abstract]:Objective to investigate the relationship between serum bilirubin level and left ventricular diastolic function in type 2 diabetic nephropathy patients with renal failure.Methods one hundred and three patients with type 2 DKD renal failure were divided into normal albuminuria group (n = 34), microalbuminuria group (n = 39) and large albuminuria group (n = 30) according to urinary albumin / creatinine ratio.According to the diagnostic criteria of left ventricular diastolic dysfunction (LVD), the patients were divided into LVDD group (n = 43) and non LVDD group (n = 60).58 healthy volunteers were selected as control group.Serum total bilirubin (TBILL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) were measured by automatic biochemical analyzer.Left ventricular mass index (LVMIN), left ventricular septal thickness (IVSTT), left ventricular posterior wall thickness (LVPWTT), left ventricular end-diastolic diameter (LVEDDD), left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDVV) were detected by color Doppler echocardiography.Blood flow velocity peak E / E / E / A in late diastolic phase was used to analyze the correlation between serum TBI DBIL and IBIL levels and left ventricular diastolic function.Results compared with the control group, the serum levels of TBILB, DBIL and IBIL in the observation group were significantly lower than those in the na group, and the serum bilirubin levels in the MA group and OA group were lower than those in the na group.At the same time, the serum bilirubin level in OA group was lower than that in MA group (P < 0.05). The serum bilirubin level in OA group was significantly lower than that in LVDD group (P < 0.05).Conclusion Serum bilirubin level can be used to reflect the state of disease in patients with type 2 DKD renal failure and is closely related to left ventricular diastolic function.
【作者單位】： 山東青島市海慈醫(yī)療集團(tuán);日照市中醫(yī)醫(yī)院;
【基金】：山東省自然科學(xué)基金項(xiàng)目(2016ZRB14388)
【分類號(hào)】：R587.2;R692.5

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