【摘要】：目的:通過檢測2型糖尿病和糖尿病腎病患者血清中同型半胱氨酸(Hcy)、糖化血紅蛋白(Hb Alc)的水平,了解2型糖尿病和糖尿病腎病患者血清Hcy和HbAlc濃度的變化,并分析其與2型糖尿病腎病患者腎功能之間的相關性。方法:選取2015年3月一2015年12月在蘭州大學第一醫(yī)院腎病科及內(nèi)分泌科收治入院的2型糖尿病和糖尿病腎病患者136例,收集所有研究對象的血Hcy、Hb Alc、尿微量白蛋白排泄率(UAER)、尿素氮(BUN)、血肌酐(SCr)、24h尿蛋白及估算腎小球濾過率(eGFR)的水平,根據(jù)UAER檢測值,分為單純糖尿病組(UAER20 ug/min,n=52)、微量蛋白尿組(UAER 20~300 ug/min,n=39)和臨床蛋白尿組(UAER300 ug/min,n=45)三個組,分析比較三組之間Hcy、HbAlc水平的變化,并通過Pearson相關分析法分析探討血清Hcy、Hb Alc水平與24h尿蛋白及與eGFR之間的相關關系。同時還以2型糖尿病病人有無并發(fā)腎功能損傷作為狀態(tài)變量,以血Hcy和HbAlc水平為檢測變量,通過檢測變量和狀態(tài)變量描繪出ROC曲線。結果:微量蛋白尿組血Hcy、Hb Alc水平較單純糖尿病組比較有顯著差異(p0.05),臨床蛋白尿組中血Hcy、HbAlc水平較微量蛋白尿組明顯升高(p0.05),有統(tǒng)計學意義,24h尿蛋白水平逐漸升高,而eGFR水平逐漸下降,組間差異均有統(tǒng)計學意義(p0.001);Pearson相關分析顯示,血Hcy、Hb Alc水平升高與24h尿蛋白呈正相關(r=0.319 p0.05,r=0.379p0.05),而血Hcy、HbAlc水平與eGFR呈明顯負相關(r=-0.508 p0.05,r=-0.294 p0.05);ROC曲線分析顯示,Hcy和HbAlc聯(lián)合檢測診斷早期糖尿病腎病的曲線下面積(AUC)明顯大于兩項指標Hcy及HbAlc的單項檢測。結論:2型糖尿病和糖尿病腎病患者中,Hcy、Hb Alc水平逐漸升高,而eGFR水平逐漸降低,Hcy、Hb Alc水平的表達與糖尿病腎病的發(fā)生及進展有關,檢測其水平有利于早期發(fā)現(xiàn)糖尿病腎病,并監(jiān)測糖尿病腎病患者病情進展情況。2型糖尿病病人血清Hcy及Hb Alc水平的升高,對2型糖尿病腎病患者腎臟功能的損害的診治及評估評價具有一定的指導意義。
[Abstract]:Objective: to detect the level of homocysteine (Hcy), glycosylated hemoglobin (Hb Alc) in the serum of patients with type 2 diabetes mellitus and diabetic nephropathy, and to understand the changes of serum Hcy and HbAlc levels in patients with type 2 diabetes mellitus and diabetic nephropathy. The relationship between renal function and type 2 diabetic nephropathy was analyzed. Methods: from March 2015 to December 2015, 136 patients with type 2 diabetes mellitus and diabetic nephropathy admitted to the Department of Renal Diseases and Endocrinology, first Hospital of Lanzhou University, were selected and their blood Hcy,Hb Alc, was collected. Urinary microalbuminuria excretion rate (UAER), urea nitrogen (BUN), serum creatinine (SCr), 24 hours urinary protein and estimated glomerular filtration rate (eGFR) levels were divided into simple diabetes mellitus (UAER20 ug/min,n=52) group according to UAER detection value. The changes of Hcy,HbAlc levels in UAER 20 ug/min,n=39 group and clinical proteinuria group (UAER300 ug/min,n=45) were analyzed and compared, and the serum Hcy, levels were analyzed by Pearson correlation analysis. The correlation between Hb Alc level and 24 h urinary protein and eGFR. At the same time, the serum Hcy and HbAlc levels were used as state variables, and the ROC curves were drawn by detecting variables and state variables in patients with type 2 diabetes mellitus (T2DM). Results: the serum Hcy,Hb Alc level in microalbuminuria group was significantly higher than that in diabetic group (p0.05), and the serum Hcy,HbAlc level in clinical proteinuria group was significantly higher than that in microalbuminuria group (p0.05). The level of urinary protein increased gradually and the level of eGFR decreased gradually. The differences between the two groups were statistically significant (p0. 001). Pearson correlation analysis showed that the increase of serum Hcy,Hb Alc level was positively correlated with 24-hour urinary protein (r = 0.319 p 0.05, r = 0.379p0.05), while the level of serum Hcy,HbAlc was negatively correlated with eGFR (r = 0.508 p 0.05, r = 0.294 p0.05). ROC curve analysis showed that the area under the curve of Hcy and HbAlc in the diagnosis of early diabetic nephropathy was significantly larger than that of Hcy and HbAlc. Conclusion: in patients with type 2 diabetes mellitus and diabetic nephropathy, the level of Hcy,Hb Alc increases gradually, while the level of eGFR decreases gradually. The expression of Hcy,Hb Alc is related to the occurrence and progression of diabetic nephropathy. It is helpful to detect early diabetic nephropathy and to monitor the progression of diabetic nephropathy. The serum Hcy and Hb Alc levels in type 2 diabetic patients are increased. The diagnosis, treatment and evaluation of renal dysfunction in patients with type 2 diabetic nephropathy have certain guiding significance.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.2;R692.9

【參考文獻】

相關期刊論文 前10條

1 林彩鳳;;HbA1c、Cys-C、Hcy水平與糖尿病患者腎臟功能損害的相關性研究[J];中國醫(yī)學創(chuàng)新;2016年11期

2 成君俐;曾建兵;;多項生化指標聯(lián)合檢測對早期糖尿病腎病的診斷價值[J];深圳中西醫(yī)結合雜志;2016年07期

3 楊勇;康志駿;洪燕;;同型半胱氨酸在早期糖尿病腎病診斷中的價值[J];上海醫(yī)藥;2015年18期

4 關旭嶺;;血清胱抑素C和同型半胱氨酸在2型糖尿病腎病患者中檢測意義分析[J];中國實用醫(yī)藥;2015年25期

5 甄卓麗;陳曉銘;周飛;李小漫;支李金;劉付貞;;2型糖尿病腎病患者血清同型半胱氨酸水平的變化及意義[J];廣東醫(yī)學;2015年16期

6 王景;袁素華;李小梅;洪苑;;血漿胱抑素C與同型半胱氨酸聯(lián)合檢測在妊娠期糖尿病早期腎損害診斷中價值的觀察[J];中國糖尿病雜志;2015年08期

7 隋廣宇;;胱抑素C、糖化血紅蛋白和β_2微球蛋白檢測對糖尿病早期腎損傷的診斷價值[J];糖尿病新世界;2015年16期

8 古力尼沙·艾塔洪;太賽爾格林;;糖化血紅蛋白、尿微量白蛋白對糖尿病腎病早期診斷的臨床價值分析[J];中國現(xiàn)代醫(yī)生;2015年21期

9 李磊;安園;李婷婷;;糖化血紅蛋白、尿微量白蛋白、尿微量白蛋白/尿肌酐比值聯(lián)合檢測在早期糖尿病腎病診斷和治療中的價值[J];黑龍江醫(yī)藥;2015年03期

10 黃漓莉;蘇珂;于健;龍艷;彭鷹;江仁美;陸桂榮;;2型糖尿病患者大血管病變與Hcy、CysC、hs-CRP的關系[J];廣東醫(yī)學;2015年10期

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