【摘要】：目的測定糖尿病患者血清腫瘤壞死因子α(tumor necrosis factor-alpha,TNF-α)、白介素6(interleukin-6,IL-6)、胱抑素C(Cys C)水平變化,并分析糖尿病腎臟病(Diabetic Kidney Disease,DKD)患者Cys C與血清炎癥因子的相關性,了解其臨床意義;探索糖尿病腎臟病相關危險因素。方法(1)隨機抽取2型糖尿病病例88例,其中男性58例,女性30例。將病例分為3組:糖尿病正常蛋白尿組21例,男15例,女6例;DKD微量白蛋白尿組35例,男24例,女11例;DKD大量白蛋白尿組32例,男19例,女13例。(2)收集所有病例空腹血,測定血清胱抑素C(Cys C)、空腹血糖(FBG)、同型半胱氨酸(Hcy)、糖化血紅蛋白(Hb A1c)、甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、24小時尿白蛋白排泄率、血肌酐(SCr)、血尿酸(SUA)、血尿素氮(BUN)等水平。并留取部分血清采用Elisa法測量血清IL-6、TNF-α水平。(3)比較各組間數(shù)據(jù)變化情況,采用多元線性回歸分析法分析血清Cys C與IL-6、Hcy及TNF-α等數(shù)據(jù)的相關程度。結果(1)血清胱抑素C水平在DKD組中高于糖尿病正常蛋白尿組,DKD大量白蛋白尿組高于DKD微量白蛋白尿組,組間比較有差異(P0.05)。(2)Hcy在DKD微量白蛋白尿組高于糖尿病正常蛋白尿組,DKD大量白蛋白尿組高于DKD微量白蛋白尿組,組間比較有差異(P0.05)。(3)血清TNF-α水平在DKD組中輕度低于糖尿病正常蛋白尿組,差異無意義。(4)血清IL-6水平在DKD組中輕度低于糖尿病正常蛋白尿組,差異無意義。(5)年齡、性別、糖化血紅蛋白、總膽固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白在各組中比較,差異無統(tǒng)計學意義。(6)以Cys C為因變量,以血尿素氮、血肌酐、血尿酸為應變量,進行多元線性回歸,結果與血肌酐、血尿酸呈正相關性(P0.05)。(7)以Cys C為因變量,IL-6、年齡、性別、TNF-α、總膽固醇、甘油三酯、糖化血紅蛋白、HCY、24小時尿白蛋白量為應變量,進行多元線性回歸分析,結果與HCY、24小時尿白蛋白量、年齡成正相關(P0.05)。結論(1)Cys C能早期反應DKD的腎損傷。(2)血清IL-6、TNF-α證實未影響DKD腎損傷疾病進展。(3)HCY、尿蛋白、年齡是引起DKD腎損傷的危險因子。
[Abstract]:Objective to determine the serum levels of tumor necrosis factor 偽 (tumor necrosis factor-alpha,TNF- 偽), interleukin 6 (interleukin-6,IL-6) and cystatin C (Cys C) in patients with diabetes mellitus and to analyze the (Diabetic Kidney Disease, in diabetic nephropathy. Cys-C was correlated with serum inflammatory factors in patients with DKD, and its clinical significance was studied. To explore the risk factors of diabetic nephropathy. Methods (1) 88 cases of type 2 diabetes mellitus were randomly selected, including 58 males and 30 females. The patients were divided into 3 groups: diabetic normal proteinuria group (n = 21, male 15, female 6), DKD microalbuminuria group (n = 35, male 24, female 11), and microalbuminuria group (n = 35, M 24, F 11). (2) fasting blood samples of all patients were collected and serum cystatin C (Cys C), fasting blood glucose (FBG), homocysteine (Hcy), glycosylated hemoglobin (Hb A1c) was measured. Triglyceride (TG), Total cholesterol (TC), High density Lipoprotein cholesterol (HDL-C), low density Lipoprotein cholesterol (LDL-C), 24 hour urinary Albumin excretion rate, Serum creatinine (SCr), Serum uric Acid (SUA), Blood urea nitrogen (BUN) level. Elisa method was used to measure the level of serum IL-6,TNF- 偽. (3) the data of each group were compared, and the correlation degree of serum Cys C with IL-6,Hcy and TNF- 偽 was analyzed by multiple linear regression analysis. Results (1) the level of serum cystatin C in DKD group was higher than that in diabetic normoalbuminuria group, and the level of serum cystatin C in DKD group was higher than that in DKD microalbuminuria group. There was significant difference between groups (P0.05). (2) Hcy in DKD microalbuminuria group was higher than that in diabetic normal albuminuria group, and DKD massive albuminuria group was higher than DKD microalbuminuria group. The level of serum TNF- 偽 in DKD group was slightly lower than that in diabetic normal proteinuria group (P0.05). (3), and there was no significant difference. (4) the serum IL-6 level in DKD group was slightly lower than that in diabetic normal proteinuria group. (5) Age, sex, glycosylated hemoglobin, total cholesterol, triglyceride, high density lipoprotein (HDL) and low density lipoprotein (LDL) were not significantly different in each group. (6) Cys C was used as the dependent variable, and there was no significant difference in age, sex, glycosylated hemoglobin, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein. Multiple linear regression was performed with blood urea nitrogen, serum creatinine and serum uric acid as dependent variables. The results were positively correlated with serum creatinine and serum uric acid (P0.05). (7). Cys C was used as dependent variable, IL-6, age, sex, and TNF- 偽, respectively. Total cholesterol, triglyceride, glycosylated hemoglobin and HCY,24 hour urine albumin were dependent variables. Multivariate linear regression analysis showed that the results were positively correlated with HCY,24 hour urine albumin volume and age (P0.05). Conclusion (1) Cys C can reflect early renal injury of DKD. (2) Serum IL-6,TNF- 偽 does not affect the progression of renal injury in DKD. (3) urinary protein and age of HCY, are risk factors for renal injury of DKD.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.2;R692.9

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