血清胆红素水平与2型糖尿病肾病肾衰竭患者左室舒张功能的相关性

发布时间：2018-04-09 21:44

本文选题：糖尿病肾病　切入点：肾衰竭　出处：《山东医药》2017年33期

【摘要】：目的探讨血清胆红素水平与2型糖尿病肾病(DKD)肾衰竭患者左室舒张功能的关系。方法选择2型DKD肾衰竭患者103例(观察组),根据尿白蛋白/肌酐比值水平,患者分为正常白蛋白尿组(NA组)34例、微量白蛋白尿组(MA组)39例和大量蛋白尿组(OA组)30例;依据左心室舒张功能不全(LVDD)的诊断标准,患者分为LVDD组43例和非LVDD组60例。选择健康志愿者58例为对照组。采用全自动生化分析仪检测各组血清总胆红素(TBIL)、直接胆红素(DBIL)和间接胆红素(IBIL)水平,采用彩色多普勒超声诊断仪检测左室质量指数(LVMI)、舒张末期室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)及左室舒张末容积(LVEDV)、舒张早期最大血流速度E峰/舒张晚期A峰(E/A),分析血清TBIL、DBIL和IBIL水平与左室舒张功能的相关性。结果与对照组相比,观察组血清TBIL、DBIL和IBIL水平均明显下降(P均0.05);与NA组相比,MA组和OA组血清胆红素水平均降低,同时OA组血清胆红素水平低于MA组(P均0.05);LVDD组胆红素水平明显低于非LVDD组(P均0.05)。观察组患者的LVMI、LVPWT、LVEDD及IVST水平明显高于对照组(P均0.05),而LVEF、LVEDV及E/A水平显著低于对照组(P均0.05)。DKD患者血清中TBIL水平与IVST、LVEF及E/A呈负相关(r分别为-0.708、-0.716、-0.703,P均0.05),与LVMI、LVPWT、LVEDD呈正相关(r分别为0.727、0.729、0.732,P均0.05);血清DBIL水平与IVST及E/A呈负相关(r分别为-0.721、-0.719,P均0.05),与LVMI及LVPWT呈正相关(r分别为0.706、0.698,P均0.05);血清IBIL水平与IVST、LVEF及E/A呈负相关(r分别为-0.705、-0.702、-0.651,P均0.05),与LVMI、LVPWT及LVEDD呈正相关(r分别为0.713、0.719、0.723,P均0.05)。结论血清胆红素水平可以用于反映2型DKD肾衰竭患者的疾病状态,并且与左室舒张功能密切相关。
[Abstract]:Objective to investigate the relationship between serum bilirubin level and left ventricular diastolic function in type 2 diabetic nephropathy patients with renal failure.Methods one hundred and three patients with type 2 DKD renal failure were divided into normal albuminuria group (n = 34), microalbuminuria group (n = 39) and large albuminuria group (n = 30) according to urinary albumin / creatinine ratio.According to the diagnostic criteria of left ventricular diastolic dysfunction (LVD), the patients were divided into LVDD group (n = 43) and non LVDD group (n = 60).58 healthy volunteers were selected as control group.Serum total bilirubin (TBILL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) were measured by automatic biochemical analyzer.Left ventricular mass index (LVMIN), left ventricular septal thickness (IVSTT), left ventricular posterior wall thickness (LVPWTT), left ventricular end-diastolic diameter (LVEDDD), left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDVV) were detected by color Doppler echocardiography.Blood flow velocity peak E / E / E / A in late diastolic phase was used to analyze the correlation between serum TBI DBIL and IBIL levels and left ventricular diastolic function.Results compared with the control group, the serum levels of TBILB, DBIL and IBIL in the observation group were significantly lower than those in the na group, and the serum bilirubin levels in the MA group and OA group were lower than those in the na group.At the same time, the serum bilirubin level in OA group was lower than that in MA group (P < 0.05). The serum bilirubin level in OA group was significantly lower than that in LVDD group (P < 0.05).Conclusion Serum bilirubin level can be used to reflect the state of disease in patients with type 2 DKD renal failure and is closely related to left ventricular diastolic function.
【作者单位】：山东青岛市海慈医疗集团;日照市中医医院;
【基金】：山东省自然科学基金项目(2016ZRB14388)
【分类号】：R587.2;R692.5

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