罹患糖尿病腎病的臨床危險因素
發(fā)布時間：2019-05-24 03:02
【摘要】：目的研究2型糖尿病(T2DM)患者并發(fā)糖尿病腎病(DN)的危險因素,并探尋不同疾病階段可用于預(yù)測和診斷的非侵襲性臨床標志物。 方法收集一年中在蘭州大學(xué)第二醫(yī)院腎病內(nèi)科住院的所有糖尿病合并腎臟疾病(DKD)患者,共140例。根據(jù)腎活檢結(jié)果將納入研究對象分為兩組：第一組：糖尿病腎病組(DN),共116人,其中男性73人,女性43人；第二組：非糖尿病腎病組(NDN),共24人,其中男性12人,女性12人。對所納入的所有研究對象分別記錄年齡、性別、體重、身高、計算體重指數(shù)、測血壓；詳細詢問現(xiàn)病史,既往史,手術(shù)、外傷史,過敏史等；詳細記錄患者體格檢查中的異常體征；對血液、尿液指標按照實驗步驟進行檢驗。再將收集的所有臨床及實驗室指標進行統(tǒng)計學(xué)分析,分析結(jié)果與臨床實際進行對比檢測,探討其臨床實際意義。 結(jié)果1、對所有入選對象分兩組進行比較分析：①臨床指標：與NDN患者相比,DN患者年齡偏大(52.53±0.95,P=0.036)、糖尿病病程較長(104.80±7.06,P=0.000),患有眼底非增殖性病變(35.3%,P=0.001)、肢體麻木疼痛(31.9%,P=0.013)、高血壓病(85.3%,P=0.013)、白內(nèi)障(18.1%,P=0.014)及脂肪肝(30.2%,P=0.019)的比例較高,患者易出現(xiàn)左室舒張功能減低(53.4%,P=0.000)及ST-T改變(31.0%,P=0.050)。②實驗室檢查指標：與NDN患者相比,DN患者血尿素氮(BUN)(24.39±1.30,P=0.011)、血肌酐(Cr)(1.56±1.33,P=0.032)、血磷(P)(1.31±0.03,P=0.018)、尿β2微球蛋白(β2MG)(5.51±0.63,P=0.015)較高；腎小球濾過率(GFR)(62.43±4.43,P=0.009)、尿滲量(OSM)(533.75±19.9,P=0.044)、空腹C肽/餐后2hC肽(F-CP/2h-CP)(0.93±0.11,P=0.002)指標均較低；③與DN相關(guān)的危險因素依次為空腹C肽/餐后2hC肽(OR=0.151,P=0.010)、左室舒張功能減低(OR=31.307,P=0.010)、尿β2微球蛋白(OR=3.825,P=0.007)、糖尿病病程(OR=1.016,P=0.021)；④DN患者病理表現(xiàn)以腎小球系膜增生性病變與腎小球結(jié)節(jié)性病變多見(88.79%)；NDN患者病理表現(xiàn)以腎小球系膜增生性病變、腎小球膜性病變與FSGS樣病變多見(79.17%)。 2、對入選早期對象分兩組進行比較分析：①臨床指標：與早期NDN患者相比,早期DN患者糖尿病病程較長(111.88±9.21,P=0.000),患有眼底非增殖性病變(35.1%,P=0.018)、肢體麻木疼痛(31.1%,P=0.038)、白內(nèi)障(24.3%,P=0.039)及脂肪肝(30.2%,P=0.019)的比例較高,患者易出現(xiàn)左室舒張功能減低(58.1%,P=0.000)、自主神經(jīng)受損(21.6%,P=0.012)及ST-T改變(39.2%,P=0.027)。②實驗室檢查指標：與早期NDN患者相比,早期DN患者血尿素氮(BUN)(25.21±1.74,P=0.030)、血磷(P)(1.28±0.04,P=0.009)、尿p2微球蛋白(p2MG)(4.95±0.74,P=0.013)較高；腎小球濾過率(GFR)(69.84±4.37,P=0.009)、空腹游離胰島素/后(FINS/2h-INS)(14.55±1.23,P=0.042)、空腹C肽/后2hC肽(F-CP/2h-CP)(0.70±0.06,P=0.001)指標均較低；③與DN相關(guān)的危險因素依次為左室舒張功能減低(OR=9.057,P=0.003)、糖尿病病程(OR=1.015,P=0.011)；④早期DN患者病理表現(xiàn)以腎小球系膜增生性病變與腎小球結(jié)節(jié)性病變多見(94.60%)；早期NDN患者病理表現(xiàn)以腎小球系膜增生性病變、腎小球膜性病變與FSGS樣病變多見(76.19%)。 結(jié)論1.老齡、糖尿病遷延、有高血壓病史、眼底非增殖性病變、白內(nèi)障、脂肪肝、肢體麻木疼痛,心臟病變(左室舒張功能減低、ST-T改變)及血尿素氮、血肌酐、血磷、尿p2微球蛋白水平增高,腎小球濾過率、尿滲量、空腹C肽/后2hC肽指標低下,上述指標異�？捎兄�2型糖尿病患者并發(fā)腎臟病變?yōu)镈N的診斷�？崭笴肽/后2hC肽減低、左室舒張功能減低、尿β2微球蛋白升高、糖尿病病程較長則是DN發(fā)生的獨立危險因素。2.糖尿病遷延、患有眼底非增殖性病變、肢體麻木疼痛、白內(nèi)障、脂肪肝的比例高,血尿素氮、血磷、尿β2微球蛋白較高,腎小球濾過率、空腹游離胰島素/后、空腹C肽/后2hC肽指標較低,上述指標異�？捎兄�2型糖尿病患者并發(fā)早期DN的診斷。左室舒張功能減低、糖尿病病程同樣是早期DN的危險因素。
[Abstract]:Objective To study the risk factors of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM) and to explore the non-invasive clinical markers that can be used for prediction and diagnosis at different stages of disease. Methods All patients with diabetes associated with kidney disease (DKD), who were hospitalized in the second hospital of Lanzhou University in a year, were collected in a total of 140 Example. The study subjects were divided into two groups according to the results of the renal biopsy: the first group: the diabetic nephropathy group (DN), a total of 116, of which 73 were male and 43 in the female; and the second group: the non-diabetic nephropathy group (NDN), of which 24 were male,12 of which were male and 12 in the female. Human. The age, sex, body weight, height, calculated body weight index and blood pressure were recorded for all the subjects included, and the current medical history, past history, operation, history of trauma, history of history, etc. were recorded in detail; the abnormal signs in the physical examination of the patient were recorded in detail; the blood was recorded. The liquid and urine indicators were tested according to the experimental procedure. And then carrying out statistical analysis on all the clinical and laboratory indexes collected, and comparing and detecting the results with the clinical practice, and exploring the clinical practical meaning thereof. Presense. Results 1. Comparative analysis was performed on all the selected subjects in two groups: the following clinical indicators: the patients with DN were older (52.53, 0.95, P = 0.036), and the course of diabetes was longer (104.80, 7.06, P = 0.000), with a non-proliferative lesion of the fundus (35.3%, P = 0.0). 01), limb numbness and pain (31.9%, P = 0.013), hypertension (85.3%, P = 0.013), cataract (18.1%, P = 0.014) and fatty liver (30.2%, P = 0.019), the patients with left ventricular diastolic function decreased (53.4%, P = 0.000) and ST-T (31.0%, P = 0.0 50). The laboratory test index: compared with the NDN, the blood urea nitrogen (BUN) (24.39, 1.30, P = 0.011), the blood muscle strength (Cr) (1.56, 1.33, P = 0.032), the blood phosphorus (P) (1.31, 0.03, P = 0.018), the urine level 2 microglobulin (V2MG) (5.51, 0.63, P = 0.015) were higher, and the glomerular filtration rate (GFR) (62.43, 4.43, P = 0.0) 9), urinary infiltration (OSM) (533.75-19.9, P = 0.044), fasting C-peptide/ postprandial 2hC-peptide (F-CP/ 2h-CP) (0.93-0.11, P = 0.002), and the risk factors associated with DN were fasting C-peptide/ postprandial 2hC peptide (OR = 0.151, P = 0.010), left ventricular diastolic function decreased (OR = 31.307, P = 0.010), and urinary bladder 2 microglobulin (OR = 3.825, P = 0.0). 07), the course of diabetes (OR = 1.016, P = 0.021); the pathological manifestation of the diabetic patients was more common (88.79%) in the glomerular mesangial proliferative lesions and the glomerulosclerosis (88.79%); the pathological manifestations of the NDN patients were the glomerular mesangial proliferative lesions, the glomerular mesangial lesions and the FSGS-like lesions (79.1). 7%).2. Comparative analysis of the two groups of early-stage subjects: the first clinical index: Compared with the early NDN patients, the course of diabetes in the early DN patients was long (111.88, 9.21, P = 0.000), with the non-proliferative lesions of the fundus (35.1%, P = 0.018), and the pain of the limbs (31.1%, P = 0). .038), the proportion of cataract (24.3%, P = 0.039) and fatty liver (30.2%, P = 0.019) was higher, and left ventricular diastolic function (58.1%, P = 0.000), autonomic nerve damage (21.6%, P = 0.012) and ST-T change (39.2%, P = 0). .027). Laboratory test indicators: early DN patients with blood urea nitrogen (BUN) (25.21% 1.74, P = 0.030), blood phosphorus (P) (1.28% 0.04, P = 0.009), urine p2 microglobulin (p2MG) (4.95, 0.74, P = 0.009), glomerular filtration rate (GFR) (69.84, 4.37, P = 0.009), fasting free insulin/ post (FINS/ 2h-INS) (14.55 (1.23, P = 0.042), fasting C-peptide/2 hC peptide (F-CP/2 h-CP) (0.70-0.06, P = 0.001), and the risk factors associated with DN were left ventricular diastolic function (OR = 9.057, P = 0.003), and the course of diabetes (OR = 1.015, P = 0). .011). The pathological manifestations of the early DN patients were more common (94.60%) in the glomerular mesangial proliferative lesions and the glomerulosclerosis (94.60%), and the pathological manifestations of the early NDN patients were the mesangial proliferative lesions, the glomerular mesangial lesions and the FSGS-like lesions (76 .19% Conclusion 1. The changes of age and diabetes, including the history of hypertension, the non-proliferative diseases of the fundus, the cataract, the fatty liver, the numbness of the limbs, the changes of the left ventricular diastolic function, the changes of ST-T and the level of the blood urea nitrogen, the blood myoglobin, the blood phosphorus and the urinary p2microglobulin. The index of glomerular filtration rate, urine leakage, fasting C-peptide/ post-2 hC peptide is low, and the above-mentioned index abnormality can be used to help patients with type 2 diabetes complicated with kidney disease. It became the diagnosis of DN. The decrease of the C-peptide/2 hC peptide, the decrease of the left ventricular diastolic function, the increase of the microglobulin in the urine, the longer the course of diabetes, was the only one of the DN. Vertical risk factors.2. Diabetes, with non-proliferative lesions of the fundus, limb numbness and pain, cataracts, high proportion of fatty liver, high blood urea nitrogen, blood phosphorus, urine level 2 microglobulin, glomerular filtration rate, fasting free insulin/ post, fasting C-peptide/ post 2 The index of hC peptide is low, and the above-mentioned index can help the patients with type 2 diabetes. Early diagnosis of DN. Left ventricular diastolic function is reduced, and the course of diabetes is also early
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R587.2;R692
[Abstract]:Objective To study the risk factors of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM) and to explore the non-invasive clinical markers that can be used for prediction and diagnosis at different stages of disease. Methods All patients with diabetes associated with kidney disease (DKD), who were hospitalized in the second hospital of Lanzhou University in a year, were collected in a total of 140 Example. The study subjects were divided into two groups according to the results of the renal biopsy: the first group: the diabetic nephropathy group (DN), a total of 116, of which 73 were male and 43 in the female; and the second group: the non-diabetic nephropathy group (NDN), of which 24 were male,12 of which were male and 12 in the female. Human. The age, sex, body weight, height, calculated body weight index and blood pressure were recorded for all the subjects included, and the current medical history, past history, operation, history of trauma, history of history, etc. were recorded in detail; the abnormal signs in the physical examination of the patient were recorded in detail; the blood was recorded. The liquid and urine indicators were tested according to the experimental procedure. And then carrying out statistical analysis on all the clinical and laboratory indexes collected, and comparing and detecting the results with the clinical practice, and exploring the clinical practical meaning thereof. Presense. Results 1. Comparative analysis was performed on all the selected subjects in two groups: the following clinical indicators: the patients with DN were older (52.53, 0.95, P = 0.036), and the course of diabetes was longer (104.80, 7.06, P = 0.000), with a non-proliferative lesion of the fundus (35.3%, P = 0.0). 01), limb numbness and pain (31.9%, P = 0.013), hypertension (85.3%, P = 0.013), cataract (18.1%, P = 0.014) and fatty liver (30.2%, P = 0.019), the patients with left ventricular diastolic function decreased (53.4%, P = 0.000) and ST-T (31.0%, P = 0.0 50). The laboratory test index: compared with the NDN, the blood urea nitrogen (BUN) (24.39, 1.30, P = 0.011), the blood muscle strength (Cr) (1.56, 1.33, P = 0.032), the blood phosphorus (P) (1.31, 0.03, P = 0.018), the urine level 2 microglobulin (V2MG) (5.51, 0.63, P = 0.015) were higher, and the glomerular filtration rate (GFR) (62.43, 4.43, P = 0.0) 9), urinary infiltration (OSM) (533.75-19.9, P = 0.044), fasting C-peptide/ postprandial 2hC-peptide (F-CP/ 2h-CP) (0.93-0.11, P = 0.002), and the risk factors associated with DN were fasting C-peptide/ postprandial 2hC peptide (OR = 0.151, P = 0.010), left ventricular diastolic function decreased (OR = 31.307, P = 0.010), and urinary bladder 2 microglobulin (OR = 3.825, P = 0.0). 07), the course of diabetes (OR = 1.016, P = 0.021); the pathological manifestation of the diabetic patients was more common (88.79%) in the glomerular mesangial proliferative lesions and the glomerulosclerosis (88.79%); the pathological manifestations of the NDN patients were the glomerular mesangial proliferative lesions, the glomerular mesangial lesions and the FSGS-like lesions (79.1). 7%).2. Comparative analysis of the two groups of early-stage subjects: the first clinical index: Compared with the early NDN patients, the course of diabetes in the early DN patients was long (111.88, 9.21, P = 0.000), with the non-proliferative lesions of the fundus (35.1%, P = 0.018), and the pain of the limbs (31.1%, P = 0). .038), the proportion of cataract (24.3%, P = 0.039) and fatty liver (30.2%, P = 0.019) was higher, and left ventricular diastolic function (58.1%, P = 0.000), autonomic nerve damage (21.6%, P = 0.012) and ST-T change (39.2%, P = 0). .027). Laboratory test indicators: early DN patients with blood urea nitrogen (BUN) (25.21% 1.74, P = 0.030), blood phosphorus (P) (1.28% 0.04, P = 0.009), urine p2 microglobulin (p2MG) (4.95, 0.74, P = 0.009), glomerular filtration rate (GFR) (69.84, 4.37, P = 0.009), fasting free insulin/ post (FINS/ 2h-INS) (14.55 (1.23, P = 0.042), fasting C-peptide/2 hC peptide (F-CP/2 h-CP) (0.70-0.06, P = 0.001), and the risk factors associated with DN were left ventricular diastolic function (OR = 9.057, P = 0.003), and the course of diabetes (OR = 1.015, P = 0). .011). The pathological manifestations of the early DN patients were more common (94.60%) in the glomerular mesangial proliferative lesions and the glomerulosclerosis (94.60%), and the pathological manifestations of the early NDN patients were the mesangial proliferative lesions, the glomerular mesangial lesions and the FSGS-like lesions (76 .19% Conclusion 1. The changes of age and diabetes, including the history of hypertension, the non-proliferative diseases of the fundus, the cataract, the fatty liver, the numbness of the limbs, the changes of the left ventricular diastolic function, the changes of ST-T and the level of the blood urea nitrogen, the blood myoglobin, the blood phosphorus and the urinary p2microglobulin. The index of glomerular filtration rate, urine leakage, fasting C-peptide/ post-2 hC peptide is low, and the above-mentioned index abnormality can be used to help patients with type 2 diabetes complicated with kidney disease. It became the diagnosis of DN. The decrease of the C-peptide/2 hC peptide, the decrease of the left ventricular diastolic function, the increase of the microglobulin in the urine, the longer the course of diabetes, was the only one of the DN. Vertical risk factors.2. Diabetes, with non-proliferative lesions of the fundus, limb numbness and pain, cataracts, high proportion of fatty liver, high blood urea nitrogen, blood phosphorus, urine level 2 microglobulin, glomerular filtration rate, fasting free insulin/ post, fasting C-peptide/ post 2 The index of hC peptide is low, and the above-mentioned index can help the patients with type 2 diabetes. Early diagnosis of DN. Left ventricular diastolic function is reduced, and the course of diabetes is also early
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R587.2;R692
【參考文獻】
相關(guān)期刊論文 前10條
1 王國洪;許瑞吉;張中書;王筱R，
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