糖尿病肾脏病患者血炎症因子的变化及其临床意义

发布时间：2019-04-02 19:26

【摘要】：目的测定糖尿病患者血清肿瘤坏死因子α(tumor necrosis factor-alpha,TNF-α)、白介素6(interleukin-6,IL-6)、胱抑素C(Cys C)水平变化,并分析糖尿病肾脏病(Diabetic Kidney Disease,DKD)患者Cys C与血清炎症因子的相关性,了解其临床意义;探索糖尿病肾脏病相关危险因素。方法(1)随机抽取2型糖尿病病例88例,其中男性58例,女性30例。将病例分为3组:糖尿病正常蛋白尿组21例,男15例,女6例;DKD微量白蛋白尿组35例,男24例,女11例;DKD大量白蛋白尿组32例,男19例,女13例。(2)收集所有病例空腹血,测定血清胱抑素C(Cys C)、空腹血糖(FBG)、同型半胱氨酸(Hcy)、糖化血红蛋白(Hb A1c)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、24小时尿白蛋白排泄率、血肌酐(SCr)、血尿酸(SUA)、血尿素氮(BUN)等水平。并留取部分血清采用Elisa法测量血清IL-6、TNF-α水平。(3)比较各组间数据变化情况,采用多元线性回归分析法分析血清Cys C与IL-6、Hcy及TNF-α等数据的相关程度。结果(1)血清胱抑素C水平在DKD组中高于糖尿病正常蛋白尿组,DKD大量白蛋白尿组高于DKD微量白蛋白尿组,组间比较有差异(P0.05)。(2)Hcy在DKD微量白蛋白尿组高于糖尿病正常蛋白尿组,DKD大量白蛋白尿组高于DKD微量白蛋白尿组,组间比较有差异(P0.05)。(3)血清TNF-α水平在DKD组中轻度低于糖尿病正常蛋白尿组,差异无意义。(4)血清IL-6水平在DKD组中轻度低于糖尿病正常蛋白尿组,差异无意义。(5)年龄、性别、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白在各组中比较,差异无统计学意义。(6)以Cys C为因变量,以血尿素氮、血肌酐、血尿酸为应变量,进行多元线性回归,结果与血肌酐、血尿酸呈正相关性(P0.05)。(7)以Cys C为因变量,IL-6、年龄、性别、TNF-α、总胆固醇、甘油三酯、糖化血红蛋白、HCY、24小时尿白蛋白量为应变量,进行多元线性回归分析,结果与HCY、24小时尿白蛋白量、年龄成正相关(P0.05)。结论(1)Cys C能早期反应DKD的肾损伤。(2)血清IL-6、TNF-α证实未影响DKD肾损伤疾病进展。(3)HCY、尿蛋白、年龄是引起DKD肾损伤的危险因子。
[Abstract]:Objective to determine the serum levels of tumor necrosis factor 伪 (tumor necrosis factor-alpha,TNF- 伪), interleukin 6 (interleukin-6,IL-6) and cystatin C (Cys C) in patients with diabetes mellitus and to analyze the (Diabetic Kidney Disease, in diabetic nephropathy. Cys-C was correlated with serum inflammatory factors in patients with DKD, and its clinical significance was studied. To explore the risk factors of diabetic nephropathy. Methods (1) 88 cases of type 2 diabetes mellitus were randomly selected, including 58 males and 30 females. The patients were divided into 3 groups: diabetic normal proteinuria group (n = 21, male 15, female 6), DKD microalbuminuria group (n = 35, male 24, female 11), and microalbuminuria group (n = 35, M 24, F 11). (2) fasting blood samples of all patients were collected and serum cystatin C (Cys C), fasting blood glucose (FBG), homocysteine (Hcy), glycosylated hemoglobin (Hb A1c) was measured. Triglyceride (TG), Total cholesterol (TC), High density Lipoprotein cholesterol (HDL-C), low density Lipoprotein cholesterol (LDL-C), 24 hour urinary Albumin excretion rate, Serum creatinine (SCr), Serum uric Acid (SUA), Blood urea nitrogen (BUN) level. Elisa method was used to measure the level of serum IL-6,TNF- 伪. (3) the data of each group were compared, and the correlation degree of serum Cys C with IL-6,Hcy and TNF- 伪 was analyzed by multiple linear regression analysis. Results (1) the level of serum cystatin C in DKD group was higher than that in diabetic normoalbuminuria group, and the level of serum cystatin C in DKD group was higher than that in DKD microalbuminuria group. There was significant difference between groups (P0.05). (2) Hcy in DKD microalbuminuria group was higher than that in diabetic normal albuminuria group, and DKD massive albuminuria group was higher than DKD microalbuminuria group. The level of serum TNF- 伪 in DKD group was slightly lower than that in diabetic normal proteinuria group (P0.05). (3), and there was no significant difference. (4) the serum IL-6 level in DKD group was slightly lower than that in diabetic normal proteinuria group. (5) Age, sex, glycosylated hemoglobin, total cholesterol, triglyceride, high density lipoprotein (HDL) and low density lipoprotein (LDL) were not significantly different in each group. (6) Cys C was used as the dependent variable, and there was no significant difference in age, sex, glycosylated hemoglobin, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein. Multiple linear regression was performed with blood urea nitrogen, serum creatinine and serum uric acid as dependent variables. The results were positively correlated with serum creatinine and serum uric acid (P0.05). (7). Cys C was used as dependent variable, IL-6, age, sex, and TNF- 伪, respectively. Total cholesterol, triglyceride, glycosylated hemoglobin and HCY,24 hour urine albumin were dependent variables. Multivariate linear regression analysis showed that the results were positively correlated with HCY,24 hour urine albumin volume and age (P0.05). Conclusion (1) Cys C can reflect early renal injury of DKD. (2) Serum IL-6,TNF- 伪 does not affect the progression of renal injury in DKD. (3) urinary protein and age of HCY, are risk factors for renal injury of DKD.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R692.9

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