血清胰島素樣生長(zhǎng)因子-1與糖尿病腎病嚴(yán)重程度的相關(guān)性研究
發(fā)布時(shí)間：2019-03-25 18:21
【摘要】：目的觀察胰島素樣生長(zhǎng)因子-1(IGF-1)在不同嚴(yán)重程度的糖尿病腎病(DN)患者血清中的水平,探討并進(jìn)一步分析血IGF-1與DN嚴(yán)重程度的相關(guān)性,為糖尿病腎病的早期防治提供基礎(chǔ)理論依據(jù)。方法依據(jù)1999年WHO糖尿病診斷及分型標(biāo)準(zhǔn)選取華北理工大學(xué)附屬醫(yī)院內(nèi)分泌科2013年3月~2014年3月住院的T2DM患者120例。根據(jù)尿微量白蛋白排泄率(UAER)將2型糖尿病患者分為4類:2型糖尿病非腎病組(DM組),UAER㩳20ug/min;早期糖尿病腎病組(DN1組),UAER20~200ug/min;臨床糖尿病腎病組(DN2組),UAER200ug/min,24 h尿蛋白定量0.5g,腎功能指標(biāo)正常;終末期糖尿病腎病組(DN3組),UAER200ug/min,24h尿蛋白定量0.5g,腎功能指標(biāo)異常。所有研究對(duì)象均排除糖尿病急性并發(fā)癥、原發(fā)性高血壓腎臟損傷、腎小球腎炎及腎盂腎炎、泌尿系感染、腫瘤及其他腎臟疾病。同期華北理工大學(xué)附屬醫(yī)院30例體檢的正常健康人群作為對(duì)照組。所有研究對(duì)象空腹8h以上,留取尿樣測(cè)尿微量白蛋白,晨起抽取肘靜脈血5ml檢測(cè)胰島素樣生長(zhǎng)因子-1(IGF-1)、糖化血紅蛋白(Hb A1c)、空腹血糖(FPG)、生長(zhǎng)激素(GH)、血清總膽固醇(TC)、甘油三酯(TG)、低密度膽固醇(LDL-C)、高密度膽固醇(HDL-C)及腎小球?yàn)V過率(GFR)等指標(biāo)。根據(jù)血肌酐水平結(jié)合年齡、體重、性別按公式計(jì)算腎小球?yàn)V過率(GFR)。所有數(shù)據(jù)分析應(yīng)用IBM SPSS19.0統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)分析,對(duì)于計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差表示。比較采用單因素方差分析,兩組間比較采用t檢驗(yàn),多組間兩兩比較采用LSD檢驗(yàn)。多因素之間相關(guān)統(tǒng)計(jì)采用logisitc回歸分析、線性相關(guān)分析、多元逐步回歸分析。檢驗(yàn)水準(zhǔn):P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果1 2型糖尿病各組人群的Hb A1c、FPG、TC、TG、LDL-C、收縮壓水平均高于對(duì)照組,HDL-C水平低于對(duì)照組。糖尿病腎病各組Hb A1c、FPG、TC、TG、LDL-C、收縮壓水平均高于糖尿病非腎病組,HDL-C水平低于糖尿病非腎病組。差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2型糖尿病非腎病組腎小球?yàn)V過率稍高于對(duì)照組,2型糖尿病腎病組腎小球?yàn)V過率依次降低,終末期糖尿病腎病組腎小球?yàn)V過率最低。說明2型糖尿病患者在非糖尿病腎病時(shí)腎小球?yàn)V過率輕度升高,隨著腎臟損害程度的增加,腎小球?yàn)V過率逐漸下降。臨床糖尿病腎病組、終末期糖尿病腎病組患者病程長(zhǎng)于2型糖尿病非腎病組、早期糖尿病腎病組,說明糖尿病病程越長(zhǎng),糖尿病腎損害發(fā)生越明顯。2早期組患者血IGF-1水平高于2型糖尿病非腎病組及對(duì)照組,隨著病情的進(jìn)展,血IGF-1水平也逐漸增加。終末期糖尿病腎病組血IGF-1水平最高。3 UAER與IGF-1、Hb A1c、FPG、TC、TG、LDL-C、收縮壓、病程呈正相關(guān),與GFR、HDL-C呈負(fù)相關(guān),(P0.05)。其中IGF-1的標(biāo)準(zhǔn)回歸系數(shù)最大,說明血IGF-1水平對(duì)糖尿病腎病程度的影響最大,進(jìn)一步對(duì)不同程度的DN進(jìn)行血IGF-1水平的Logistic回歸分析,結(jié)果說明血IGF-1高于正常值范圍時(shí),糖尿病患者發(fā)生DN的危險(xiǎn)性也在增加。4經(jīng)Pearson相關(guān)分析,血IGF-1與UAER、Hb A1c、FPG、TC、TG、LDL-C、收縮壓、病程呈正相關(guān)(P0.05),與GFR、HDL-C呈負(fù)相關(guān)(P0.05)。結(jié)論1血清IGF-1水平的增高與糖尿病腎病的嚴(yán)重程度呈正相關(guān)。2血清IGF-1是糖尿病腎病的獨(dú)立危險(xiǎn)因素,可能參與了糖尿病腎病的發(fā)生、發(fā)展。
[Abstract]:Objective To study the level of insulin-like growth factor-1 (IGF-1) in the serum of patients with diabetic nephropathy (DN) with different severity. Methods 120 patients with T2DM from March 2013 to March 2014 were selected according to the WHO type of diabetes diagnosis and classification in 1999. According to the urinary micro-albumin excretion rate (UAER), type 2 diabetic patients were divided into 4 groups: type 2 diabetic non-diabetic group (DM group), UAER-20ug/ min, early diabetic nephropathy group (DN1 group), UAER20-200ug/ min, clinical diabetic nephropathy group (DN2 group), UAER200ug/ min, 24h urinary protein quantitative 0.5g, and renal function index normal; The urinary protein of the end-stage diabetic nephropathy group (DN3 group), UAER200ug/ min, 24h urinary protein was 0.5 g, and the renal function index was abnormal. All subjects of the study excluded acute diabetic complications, primary hypertension, renal injury, glomerulonephritis and pyelonephritis, urinary tract infections, tumors, and other renal disorders. In the same period, the normal healthy population of 30 physical examinations in the affiliated hospital of the North China University of Technology was used as the control group. All subjects were fasting for more than 8 hours, urine samples were collected for urine microalbumin, and 5 ml of cubital venous blood were taken in the morning to detect insulin-like growth factor-1 (IGF-1), glycosylated hemoglobin (Hb), fasting blood glucose (FPG), growth hormone (GH), total serum cholesterol (TC), Indicators such as triglyceride (TG), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C), and glomerular filtration rate (GFR). Glomerular filtration rate (GFR) was calculated by formula based on the level of blood myoglobin binding to age, body weight, and sex. The statistical analysis was performed using the IBM SPSS19.0 statistical software package for all data analysis, and the mean square standard deviation was used for the measurement data. One-factor analysis of variance was used, and t-test was used between the two groups. LSD was used for two groups. Logistic regression analysis, linear correlation analysis and multiple stepwise regression analysis were used in the correlation between multiple factors. Test level: P0.05 is of statistical significance. Results The levels of Hb, FPG, TC, TG, LDL-C and systolic blood pressure in all groups of type 2 diabetes were higher than that in the control group, and the level of HDL-C was lower than that of the control group. The levels of Hb, FPG, TC, TG, LDL-C and systolic blood pressure in diabetic nephropathy were higher than those of non-diabetic group, and the level of HDL-C was lower than that of non-diabetic group. The glomerular filtration rate of the type 2 diabetic nephropathy group was slightly higher than that of the control group, and the glomerular filtration rate of the type 2 diabetic nephropathy group was decreased, and the glomerular filtration rate of the end-stage diabetic nephropathy group was the lowest. The glomerular filtration rate of type 2 diabetic patients was slightly increased in non-diabetic nephropathy, and the glomerular filtration rate decreased with the increase of the degree of renal damage. in that clinical diabetic nephropathy group, the course of the end-stage diabetic nephropathy group was longer than that of the type 2 diabetic nephropathy group, the early diabetic nephropathy group, the longer the course of the diabetes, the more obvious the diabetic nephropathy, the blood IGF-1 level in the early group was higher than that of the type 2 diabetic non-diabetic group and the control group, With the progress of the disease, the level of IGF-1 gradually increased. The level of IGF-1 in the end-stage diabetic nephropathy group was the highest. 3UAER was positively correlated with IGF-1, Hb, FPG, TC, TG, LDL-C, systolic blood pressure and course of disease, and negatively correlated with GFR and HDL-C (P0.05). The standard regression coefficient of IGF-1 was the largest, indicating that the effect of blood IGF-1 level on the degree of diabetic nephropathy was the most, and a logistic regression analysis of the blood IGF-1 level was further performed on the DN of different degree, and the results indicated that when the blood IGF-1 was higher than the normal range, The risk of DN was also increased in the patients with diabetes. The results showed that the serum IGF-1 was positively correlated with UAER, Hb, FPG, TC, TG, LDL-C, systolic blood pressure and the course of the disease (P0.05), and negatively correlated with GFR and HDL-C (P0.05). Conclusion The level of IGF-1 in serum is positively related to the severity of diabetic nephropathy. Serum IGF-1 is an independent risk factor of diabetic nephropathy and may be involved in the development and development of diabetic nephropathy.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.2
本文編號(hào)：2447204
[Abstract]:Objective To study the level of insulin-like growth factor-1 (IGF-1) in the serum of patients with diabetic nephropathy (DN) with different severity. Methods 120 patients with T2DM from March 2013 to March 2014 were selected according to the WHO type of diabetes diagnosis and classification in 1999. According to the urinary micro-albumin excretion rate (UAER), type 2 diabetic patients were divided into 4 groups: type 2 diabetic non-diabetic group (DM group), UAER-20ug/ min, early diabetic nephropathy group (DN1 group), UAER20-200ug/ min, clinical diabetic nephropathy group (DN2 group), UAER200ug/ min, 24h urinary protein quantitative 0.5g, and renal function index normal; The urinary protein of the end-stage diabetic nephropathy group (DN3 group), UAER200ug/ min, 24h urinary protein was 0.5 g, and the renal function index was abnormal. All subjects of the study excluded acute diabetic complications, primary hypertension, renal injury, glomerulonephritis and pyelonephritis, urinary tract infections, tumors, and other renal disorders. In the same period, the normal healthy population of 30 physical examinations in the affiliated hospital of the North China University of Technology was used as the control group. All subjects were fasting for more than 8 hours, urine samples were collected for urine microalbumin, and 5 ml of cubital venous blood were taken in the morning to detect insulin-like growth factor-1 (IGF-1), glycosylated hemoglobin (Hb), fasting blood glucose (FPG), growth hormone (GH), total serum cholesterol (TC), Indicators such as triglyceride (TG), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C), and glomerular filtration rate (GFR). Glomerular filtration rate (GFR) was calculated by formula based on the level of blood myoglobin binding to age, body weight, and sex. The statistical analysis was performed using the IBM SPSS19.0 statistical software package for all data analysis, and the mean square standard deviation was used for the measurement data. One-factor analysis of variance was used, and t-test was used between the two groups. LSD was used for two groups. Logistic regression analysis, linear correlation analysis and multiple stepwise regression analysis were used in the correlation between multiple factors. Test level: P0.05 is of statistical significance. Results The levels of Hb, FPG, TC, TG, LDL-C and systolic blood pressure in all groups of type 2 diabetes were higher than that in the control group, and the level of HDL-C was lower than that of the control group. The levels of Hb, FPG, TC, TG, LDL-C and systolic blood pressure in diabetic nephropathy were higher than those of non-diabetic group, and the level of HDL-C was lower than that of non-diabetic group. The glomerular filtration rate of the type 2 diabetic nephropathy group was slightly higher than that of the control group, and the glomerular filtration rate of the type 2 diabetic nephropathy group was decreased, and the glomerular filtration rate of the end-stage diabetic nephropathy group was the lowest. The glomerular filtration rate of type 2 diabetic patients was slightly increased in non-diabetic nephropathy, and the glomerular filtration rate decreased with the increase of the degree of renal damage. in that clinical diabetic nephropathy group, the course of the end-stage diabetic nephropathy group was longer than that of the type 2 diabetic nephropathy group, the early diabetic nephropathy group, the longer the course of the diabetes, the more obvious the diabetic nephropathy, the blood IGF-1 level in the early group was higher than that of the type 2 diabetic non-diabetic group and the control group, With the progress of the disease, the level of IGF-1 gradually increased. The level of IGF-1 in the end-stage diabetic nephropathy group was the highest. 3UAER was positively correlated with IGF-1, Hb, FPG, TC, TG, LDL-C, systolic blood pressure and course of disease, and negatively correlated with GFR and HDL-C (P0.05). The standard regression coefficient of IGF-1 was the largest, indicating that the effect of blood IGF-1 level on the degree of diabetic nephropathy was the most, and a logistic regression analysis of the blood IGF-1 level was further performed on the DN of different degree, and the results indicated that when the blood IGF-1 was higher than the normal range, The risk of DN was also increased in the patients with diabetes. The results showed that the serum IGF-1 was positively correlated with UAER, Hb, FPG, TC, TG, LDL-C, systolic blood pressure and the course of the disease (P0.05), and negatively correlated with GFR and HDL-C (P0.05). Conclusion The level of IGF-1 in serum is positively related to the severity of diabetic nephropathy. Serum IGF-1 is an independent risk factor of diabetic nephropathy and may be involved in the development and development of diabetic nephropathy.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.2
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相關(guān)期刊論文 前4條
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