同型半胱氨酸、糖化血红蛋白与2型糖尿病肾病肾功能的相关性分析
发布时间：2018-10-26 21:40
【摘要】：目的:通过检测2型糖尿病和糖尿病肾病患者血清中同型半胱氨酸(Hcy)、糖化血红蛋白(Hb Alc)的水平,了解2型糖尿病和糖尿病肾病患者血清Hcy和HbAlc浓度的变化,并分析其与2型糖尿病肾病患者肾功能之间的相关性。方法:选取2015年3月一2015年12月在兰州大学第一医院肾病科及内分泌科收治入院的2型糖尿病和糖尿病肾病患者136例,收集所有研究对象的血Hcy、Hb Alc、尿微量白蛋白排泄率(UAER)、尿素氮(BUN)、血肌酐(SCr)、24h尿蛋白及估算肾小球滤过率(eGFR)的水平,根据UAER检测值,分为单纯糖尿病组(UAER20 ug/min,n=52)、微量蛋白尿组(UAER 20~300 ug/min,n=39)和临床蛋白尿组(UAER300 ug/min,n=45)三个组,分析比较三组之间Hcy、HbAlc水平的变化,并通过Pearson相关分析法分析探讨血清Hcy、Hb Alc水平与24h尿蛋白及与eGFR之间的相关关系。同时还以2型糖尿病病人有无并发肾功能损伤作为状态变量,以血Hcy和HbAlc水平为检测变量,通过检测变量和状态变量描绘出ROC曲线。结果:微量蛋白尿组血Hcy、Hb Alc水平较单纯糖尿病组比较有显著差异(p0.05),临床蛋白尿组中血Hcy、HbAlc水平较微量蛋白尿组明显升高(p0.05),有统计学意义,24h尿蛋白水平逐渐升高,而eGFR水平逐渐下降,组间差异均有统计学意义(p0.001);Pearson相关分析显示,血Hcy、Hb Alc水平升高与24h尿蛋白呈正相关(r=0.319 p0.05,r=0.379p0.05),而血Hcy、HbAlc水平与eGFR呈明显负相关(r=-0.508 p0.05,r=-0.294 p0.05);ROC曲线分析显示,Hcy和HbAlc联合检测诊断早期糖尿病肾病的曲线下面积(AUC)明显大于两项指标Hcy及HbAlc的单项检测。结论:2型糖尿病和糖尿病肾病患者中,Hcy、Hb Alc水平逐渐升高,而eGFR水平逐渐降低,Hcy、Hb Alc水平的表达与糖尿病肾病的发生及进展有关,检测其水平有利于早期发现糖尿病肾病,并监测糖尿病肾病患者病情进展情况。2型糖尿病病人血清Hcy及Hb Alc水平的升高,对2型糖尿病肾病患者肾脏功能的损害的诊治及评估评价具有一定的指导意义。
[Abstract]:Objective: to detect the level of homocysteine (Hcy), glycosylated hemoglobin (Hb Alc) in the serum of patients with type 2 diabetes mellitus and diabetic nephropathy, and to understand the changes of serum Hcy and HbAlc levels in patients with type 2 diabetes mellitus and diabetic nephropathy. The relationship between renal function and type 2 diabetic nephropathy was analyzed. Methods: from March 2015 to December 2015, 136 patients with type 2 diabetes mellitus and diabetic nephropathy admitted to the Department of Renal Diseases and Endocrinology, first Hospital of Lanzhou University, were selected and their blood Hcy,Hb Alc, was collected. Urinary microalbuminuria excretion rate (UAER), urea nitrogen (BUN), serum creatinine (SCr), 24 hours urinary protein and estimated glomerular filtration rate (eGFR) levels were divided into simple diabetes mellitus (UAER20 ug/min,n=52) group according to UAER detection value. The changes of Hcy,HbAlc levels in UAER 20 ug/min,n=39 group and clinical proteinuria group (UAER300 ug/min,n=45) were analyzed and compared, and the serum Hcy, levels were analyzed by Pearson correlation analysis. The correlation between Hb Alc level and 24 h urinary protein and eGFR. At the same time, the serum Hcy and HbAlc levels were used as state variables, and the ROC curves were drawn by detecting variables and state variables in patients with type 2 diabetes mellitus (T2DM). Results: the serum Hcy,Hb Alc level in microalbuminuria group was significantly higher than that in diabetic group (p0.05), and the serum Hcy,HbAlc level in clinical proteinuria group was significantly higher than that in microalbuminuria group (p0.05). The level of urinary protein increased gradually and the level of eGFR decreased gradually. The differences between the two groups were statistically significant (p0. 001). Pearson correlation analysis showed that the increase of serum Hcy,Hb Alc level was positively correlated with 24-hour urinary protein (r = 0.319 p 0.05, r = 0.379p0.05), while the level of serum Hcy,HbAlc was negatively correlated with eGFR (r = 0.508 p 0.05, r = 0.294 p0.05). ROC curve analysis showed that the area under the curve of Hcy and HbAlc in the diagnosis of early diabetic nephropathy was significantly larger than that of Hcy and HbAlc. Conclusion: in patients with type 2 diabetes mellitus and diabetic nephropathy, the level of Hcy,Hb Alc increases gradually, while the level of eGFR decreases gradually. The expression of Hcy,Hb Alc is related to the occurrence and progression of diabetic nephropathy. It is helpful to detect early diabetic nephropathy and to monitor the progression of diabetic nephropathy. The serum Hcy and Hb Alc levels in type 2 diabetic patients are increased. The diagnosis, treatment and evaluation of renal dysfunction in patients with type 2 diabetic nephropathy have certain guiding significance.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R692.9
本文编号：2297014
[Abstract]:Objective: to detect the level of homocysteine (Hcy), glycosylated hemoglobin (Hb Alc) in the serum of patients with type 2 diabetes mellitus and diabetic nephropathy, and to understand the changes of serum Hcy and HbAlc levels in patients with type 2 diabetes mellitus and diabetic nephropathy. The relationship between renal function and type 2 diabetic nephropathy was analyzed. Methods: from March 2015 to December 2015, 136 patients with type 2 diabetes mellitus and diabetic nephropathy admitted to the Department of Renal Diseases and Endocrinology, first Hospital of Lanzhou University, were selected and their blood Hcy,Hb Alc, was collected. Urinary microalbuminuria excretion rate (UAER), urea nitrogen (BUN), serum creatinine (SCr), 24 hours urinary protein and estimated glomerular filtration rate (eGFR) levels were divided into simple diabetes mellitus (UAER20 ug/min,n=52) group according to UAER detection value. The changes of Hcy,HbAlc levels in UAER 20 ug/min,n=39 group and clinical proteinuria group (UAER300 ug/min,n=45) were analyzed and compared, and the serum Hcy, levels were analyzed by Pearson correlation analysis. The correlation between Hb Alc level and 24 h urinary protein and eGFR. At the same time, the serum Hcy and HbAlc levels were used as state variables, and the ROC curves were drawn by detecting variables and state variables in patients with type 2 diabetes mellitus (T2DM). Results: the serum Hcy,Hb Alc level in microalbuminuria group was significantly higher than that in diabetic group (p0.05), and the serum Hcy,HbAlc level in clinical proteinuria group was significantly higher than that in microalbuminuria group (p0.05). The level of urinary protein increased gradually and the level of eGFR decreased gradually. The differences between the two groups were statistically significant (p0. 001). Pearson correlation analysis showed that the increase of serum Hcy,Hb Alc level was positively correlated with 24-hour urinary protein (r = 0.319 p 0.05, r = 0.379p0.05), while the level of serum Hcy,HbAlc was negatively correlated with eGFR (r = 0.508 p 0.05, r = 0.294 p0.05). ROC curve analysis showed that the area under the curve of Hcy and HbAlc in the diagnosis of early diabetic nephropathy was significantly larger than that of Hcy and HbAlc. Conclusion: in patients with type 2 diabetes mellitus and diabetic nephropathy, the level of Hcy,Hb Alc increases gradually, while the level of eGFR decreases gradually. The expression of Hcy,Hb Alc is related to the occurrence and progression of diabetic nephropathy. It is helpful to detect early diabetic nephropathy and to monitor the progression of diabetic nephropathy. The serum Hcy and Hb Alc levels in type 2 diabetic patients are increased. The diagnosis, treatment and evaluation of renal dysfunction in patients with type 2 diabetic nephropathy have certain guiding significance.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R692.9
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