【摘要】：目的：糖尿病腎病(Diabetic nephropathy, DN)是糖尿病(Diabetes mellitus, DM)的常見并發(fā)癥之一,同時也是臨床中導(dǎo)致終末期腎臟疾病的常見原因;而貧血是慢性腎臟病(chronic kidney disease, CKD)的常見并發(fā)癥,我們常稱之為腎性貧血(Renal Anemia, RA),發(fā)病率高,對CKD患者的工作,生活等諸多方面均可造成嚴(yán)重的影響,甚至可能加快CKD腎功能惡化的進(jìn)展。本研究回顧性的分析總結(jié)貧血與2型糖尿病腎病的相關(guān)聯(lián)系。 方法：選取2013年6月至2013年12月在蘭州大學(xué)第二醫(yī)院住院的2型糖尿病腎病患者60例做為研究組,其中男性32例,女性28例,收治年齡47—68歲,平均年齡(59.1±7.2歲),糖尿病病程4—-20年不等,平均病程(11.3年)。同期選取本院收住的無腎功能受損的2型糖尿病患者60例做為對照組,收集患者個人資料,測定空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血紅蛋白(HbAlC)、尿微量白蛋白,C肽、TC、TG, HDL,LDL、C反應(yīng)蛋白(CRP),24h尿白蛋白,以及血型,紅細(xì)胞(RBC),血紅蛋白(HGB),尿素(BUN),肌酐(CREA)測定,并測定患者腎小球?yàn)V過率(GFR)。貧血嚴(yán)重患者進(jìn)一步行貧血三項(xiàng),凝血酶原時間(PT),活化部分凝血活酶時間(APTT), D-2聚體(Dimer)等相關(guān)測定。對比分析兩組間貧血的發(fā)生率,并進(jìn)一步將糖尿病腎病合并貧血組患者的HbAlC, FPG與無合并貧血組患者的HbAlC, FPG進(jìn)行對比,探討貧血對HbAlC測定的影響以及對臨床的指導(dǎo)意義。 結(jié)果：1.與無腎功能受損的2型糖尿病對照組相比較,糖尿病腎病組患者更容易合并發(fā)生貧血,差異有統(tǒng)計學(xué)意義(P0.05)。 2.糖尿病腎病患者合并貧血后,其糖化血紅蛋白(HbAlc)的測定值低于無貧血患者組,說明HbAlc的測定受貧血的影響。 結(jié)論：在2型糖尿病腎病患者人群中,合并貧血的患病率顯著高于非糖尿病腎病患者。并且當(dāng)患者合并貧血后,糖化血紅蛋白(HbAlc)的測定值不能真實(shí)反映患者的血糖水平,不能作為病情觀察和療效的監(jiān)測指標(biāo)。而貧血的發(fā)生會進(jìn)一步加重CKD的惡化進(jìn)展,嚴(yán)重影響糖尿病患者的生活質(zhì)量,因此,需對此類患者盡早行相關(guān)檢查,做到及時診斷和治療。
[Abstract]:Objective: diabetic nephropathy (Diabetic nephropathy, DN) is one of the common complications of diabetic (Diabetes mellitus, DM), and it is also a common cause of end-stage renal disease in clinic. Anemia is a common complication of chronic kidney disease (chronic kidney disease, CKD). We often call it renal anemia with a high incidence of (Renal Anemia, RA), which can have a serious impact on the work, life and other aspects of CKD patients. It may even accelerate the deterioration of renal function in CKD. This study reviewed the relationship between anemia and type 2 diabetic nephropathy. Methods: from June 2013 to December 2013, 60 patients with type 2 diabetic nephropathy hospitalized in the second Hospital of Lanzhou University were selected as the study group, including 32 males and 28 females, with an average age of 59.1 鹵7.2 years. The course of diabetes varied from 4 to 20 years, with an average course of disease (11.3 years). At the same time, 60 patients with type 2 diabetes mellitus without renal function impairment were selected as the control group. The personal data of the patients were collected, and the fasting blood glucose (FPG), postmeal blood glucose (2hPG) and glycosylated hemoglobin (HbAlC), urine microalbumin were measured. C peptide, TC,TG, HDL,LDL,C reactive protein (CRP), 24 h urinary albumin, blood group, red blood cell (RBC), hemoglobin (HGB), urea (BUN), creatine (CREA), and glomerular filtration rate (GFR). Were measured. Patients with severe anemia were further measured by three items of anemia and prothrombin time (PT), activated partial thromboplastin time (APTT), D 鈮，

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