本文選題：2型糖尿病 + 早期腎損傷�。� 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討血清可溶性腫瘤壞死因子受體1(soluble tumor necrosis factor receptors 1,TNFRl)、血清可溶性腫瘤壞死因子受體2(soluble tumor necrosis factor receptors 1,TNFR2)與2型糖尿病早期腎損傷的關(guān)系;并探討哪個(gè)受體和2型糖尿病腎損傷相關(guān)性更大及血清受體水平變化的影響因素,為2型糖尿病患者早期腎損傷診斷提供一定的參考價(jià)值。方法:應(yīng)用病例對(duì)照研究,收集2016年4月至2016年10月前來山西省人民醫(yī)院內(nèi)分泌科門診及病房診療的70例2型糖尿病病患組成實(shí)驗(yàn)組,半年內(nèi)至少檢測兩次尿微量白蛋白/尿肌酐(mAIb/Cr),取其均值,根據(jù)mAIb/Cr均值分為A組:正常白蛋白尿組(mAIb/Cr30mg/g);B組:微量白蛋白尿組(mAIb/Cr 30~299mg/g);并收集同期在我院健康中心正常體檢者38例組成C組:健康對(duì)照組。分別測定其血清可溶性TNFRl、TNFR2水平,并記錄其他臨床資料,進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:正常白蛋白尿組[TNFRl(2517.77±1475.54)pg/ml、TNFR2(841.97±493.67)pg/m1]與微量白蛋白尿組[TNFRl(4790.85±1613.22)pg/ml、TNFR2(1236.25±778.96)pg/m1]的水平較健康對(duì)照組[TNFRl(1800.90±1037.22)pg/ml、TNFR2(299.74±60.50)pg/m1]均升高(P0.001);在糖尿病患者中,微量白蛋白尿組較正常白蛋白尿組TNFR1、TNFR2水平升高(P0.001)。TNFR1、TNFR2與mAIb/Cr、年齡、空腹血糖、糖尿病病程呈正相關(guān)(P0.001),且TNFR1相關(guān)性更大;與估算腎小球?yàn)V過率(eGFR)、高密度脂蛋白膽固醇(HDL-C)呈負(fù)相關(guān)(P0.001),且TNFR1相關(guān)性更大�；貧w分析顯示HDL-C對(duì)TNFR1、TNFR2的影響最大。結(jié)論:與健康對(duì)照組相比,正常白蛋白尿的2型糖尿病患者循環(huán)血中可溶性TNFRl、TNFR2濃度明顯升高,且TNFR1升高更顯著。血清TNFRl可能成為尿白蛋白陰性的2型糖尿病早期腎損傷的標(biāo)志物。血清TNFR1的水平受HDL-C影響較大,臨床中需要密切關(guān)注糖尿病人群的低HDL-C血癥。
[Abstract]:Objective: to investigate the relationship between serum soluble tumor necrosis factor receptor 1(soluble tumor necrosis factor receptors 1 and serum soluble tumor necrosis factor receptor 2(soluble tumor necrosis factor receptors 1 TNFR2 in patients with type 2 diabetes mellitus.To explore which type 2 diabetic renal injury is more correlated with type 2 diabetes and the influence factors of serum receptor level, and to provide a certain reference value for the early diagnosis of renal injury in type 2 diabetes mellitus.Methods: from April 2016 to October 2016, 70 patients with type 2 diabetes mellitus in the Department of Endocrinology, Shanxi Provincial people's Hospital, were collected from a case-control study to form an experimental group.At least twice in half a year, urine microalbumin / urinary creatinine mAIb / Cr was detected, and its mean value was calculated.According to the mean value of mAIb/Cr, the patients were divided into group A: normal albuminuria group: normal albuminuria group: normal albuminuria group: group B: microalbuminuria group: mAIb / Cr 30cr 299mg / g group, and 38 cases of normal physical examination in the health center of our hospital at the same time were collected to form group C: healthy control group.The serum levels of soluble TNFR 2 were measured and other clinical data were recorded for statistical analysis.緇撴灉:姝ｅ父鐧借泲鐧藉翱緇刐TNFRl(2517.77鹵1475.54)pg/ml,TNFR2(841.97鹵493.67)pg/m1]涓庡井閲忕櫧铔嬬櫧灝跨粍[TNFRl(4790.85鹵1613.22)pg/ml,TNFR2(1236.25鹵778.96)pg/m1]鐨勬按騫寵緝鍋ュ悍瀵圭収緇刐TNFRl(1800.90鹵1037.22)pg/ml,TNFR2(299.74鹵60.50)pg/m1]鍧囧崌楂，

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