罹患糖尿病肾病的临床危险因素
发布时间：2019-05-24 03:02
【摘要】：目的研究2型糖尿病(T2DM)患者并发糖尿病肾病(DN)的危险因素,并探寻不同疾病阶段可用于预测和诊断的非侵袭性临床标志物。 方法收集一年中在兰州大学第二医院肾病内科住院的所有糖尿病合并肾脏疾病(DKD)患者,共140例。根据肾活检结果将纳入研究对象分为两组：第一组：糖尿病肾病组(DN),共116人,其中男性73人,女性43人；第二组：非糖尿病肾病组(NDN),共24人,其中男性12人,女性12人。对所纳入的所有研究对象分别记录年龄、性别、体重、身高、计算体重指数、测血压；详细询问现病史,既往史,手术、外伤史,过敏史等；详细记录患者体格检查中的异常体征；对血液、尿液指标按照实验步骤进行检验。再将收集的所有临床及实验室指标进行统计学分析,分析结果与临床实际进行对比检测,探讨其临床实际意义。 结果1、对所有入选对象分两组进行比较分析：①临床指标：与NDN患者相比,DN患者年龄偏大(52.53±0.95,P=0.036)、糖尿病病程较长(104.80±7.06,P=0.000),患有眼底非增殖性病变(35.3%,P=0.001)、肢体麻木疼痛(31.9%,P=0.013)、高血压病(85.3%,P=0.013)、白内障(18.1%,P=0.014)及脂肪肝(30.2%,P=0.019)的比例较高,患者易出现左室舒张功能减低(53.4%,P=0.000)及ST-T改变(31.0%,P=0.050)。②实验室检查指标：与NDN患者相比,DN患者血尿素氮(BUN)(24.39±1.30,P=0.011)、血肌酐(Cr)(1.56±1.33,P=0.032)、血磷(P)(1.31±0.03,P=0.018)、尿β2微球蛋白(β2MG)(5.51±0.63,P=0.015)较高；肾小球滤过率(GFR)(62.43±4.43,P=0.009)、尿渗量(OSM)(533.75±19.9,P=0.044)、空腹C肽/餐后2hC肽(F-CP/2h-CP)(0.93±0.11,P=0.002)指标均较低；③与DN相关的危险因素依次为空腹C肽/餐后2hC肽(OR=0.151,P=0.010)、左室舒张功能减低(OR=31.307,P=0.010)、尿β2微球蛋白(OR=3.825,P=0.007)、糖尿病病程(OR=1.016,P=0.021)；④DN患者病理表现以肾小球系膜增生性病变与肾小球结节性病变多见(88.79%)；NDN患者病理表现以肾小球系膜增生性病变、肾小球膜性病变与FSGS样病变多见(79.17%)。 2、对入选早期对象分两组进行比较分析：①临床指标：与早期NDN患者相比,早期DN患者糖尿病病程较长(111.88±9.21,P=0.000),患有眼底非增殖性病变(35.1%,P=0.018)、肢体麻木疼痛(31.1%,P=0.038)、白内障(24.3%,P=0.039)及脂肪肝(30.2%,P=0.019)的比例较高,患者易出现左室舒张功能减低(58.1%,P=0.000)、自主神经受损(21.6%,P=0.012)及ST-T改变(39.2%,P=0.027)。②实验室检查指标：与早期NDN患者相比,早期DN患者血尿素氮(BUN)(25.21±1.74,P=0.030)、血磷(P)(1.28±0.04,P=0.009)、尿p2微球蛋白(p2MG)(4.95±0.74,P=0.013)较高；肾小球滤过率(GFR)(69.84±4.37,P=0.009)、空腹游离胰岛素/后(FINS/2h-INS)(14.55±1.23,P=0.042)、空腹C肽/后2hC肽(F-CP/2h-CP)(0.70±0.06,P=0.001)指标均较低；③与DN相关的危险因素依次为左室舒张功能减低(OR=9.057,P=0.003)、糖尿病病程(OR=1.015,P=0.011)；④早期DN患者病理表现以肾小球系膜增生性病变与肾小球结节性病变多见(94.60%)；早期NDN患者病理表现以肾小球系膜增生性病变、肾小球膜性病变与FSGS样病变多见(76.19%)。 结论1.老龄、糖尿病迁延、有高血压病史、眼底非增殖性病变、白内障、脂肪肝、肢体麻木疼痛,心脏病变(左室舒张功能减低、ST-T改变)及血尿素氮、血肌酐、血磷、尿p2微球蛋白水平增高,肾小球滤过率、尿渗量、空腹C肽/后2hC肽指标低下,上述指标异常可有助于2型糖尿病患者并发肾脏病变为DN的诊断。空腹C肽/后2hC肽减低、左室舒张功能减低、尿β2微球蛋白升高、糖尿病病程较长则是DN发生的独立危险因素。2.糖尿病迁延、患有眼底非增殖性病变、肢体麻木疼痛、白内障、脂肪肝的比例高,血尿素氮、血磷、尿β2微球蛋白较高,肾小球滤过率、空腹游离胰岛素/后、空腹C肽/后2hC肽指标较低,上述指标异常可有助于2型糖尿病患者并发早期DN的诊断。左室舒张功能减低、糖尿病病程同样是早期DN的危险因素。
[Abstract]:Objective To study the risk factors of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM) and to explore the non-invasive clinical markers that can be used for prediction and diagnosis at different stages of disease. Methods All patients with diabetes associated with kidney disease (DKD), who were hospitalized in the second hospital of Lanzhou University in a year, were collected in a total of 140 Example. The study subjects were divided into two groups according to the results of the renal biopsy: the first group: the diabetic nephropathy group (DN), a total of 116, of which 73 were male and 43 in the female; and the second group: the non-diabetic nephropathy group (NDN), of which 24 were male,12 of which were male and 12 in the female. Human. The age, sex, body weight, height, calculated body weight index and blood pressure were recorded for all the subjects included, and the current medical history, past history, operation, history of trauma, history of history, etc. were recorded in detail; the abnormal signs in the physical examination of the patient were recorded in detail; the blood was recorded. The liquid and urine indicators were tested according to the experimental procedure. And then carrying out statistical analysis on all the clinical and laboratory indexes collected, and comparing and detecting the results with the clinical practice, and exploring the clinical practical meaning thereof. Presense. Results 1. Comparative analysis was performed on all the selected subjects in two groups: the following clinical indicators: the patients with DN were older (52.53, 0.95, P = 0.036), and the course of diabetes was longer (104.80, 7.06, P = 0.000), with a non-proliferative lesion of the fundus (35.3%, P = 0.0). 01), limb numbness and pain (31.9%, P = 0.013), hypertension (85.3%, P = 0.013), cataract (18.1%, P = 0.014) and fatty liver (30.2%, P = 0.019), the patients with left ventricular diastolic function decreased (53.4%, P = 0.000) and ST-T (31.0%, P = 0.0 50). The laboratory test index: compared with the NDN, the blood urea nitrogen (BUN) (24.39, 1.30, P = 0.011), the blood muscle strength (Cr) (1.56, 1.33, P = 0.032), the blood phosphorus (P) (1.31, 0.03, P = 0.018), the urine level 2 microglobulin (V2MG) (5.51, 0.63, P = 0.015) were higher, and the glomerular filtration rate (GFR) (62.43, 4.43, P = 0.0) 9), urinary infiltration (OSM) (533.75-19.9, P = 0.044), fasting C-peptide/ postprandial 2hC-peptide (F-CP/ 2h-CP) (0.93-0.11, P = 0.002), and the risk factors associated with DN were fasting C-peptide/ postprandial 2hC peptide (OR = 0.151, P = 0.010), left ventricular diastolic function decreased (OR = 31.307, P = 0.010), and urinary bladder 2 microglobulin (OR = 3.825, P = 0.0). 07), the course of diabetes (OR = 1.016, P = 0.021); the pathological manifestation of the diabetic patients was more common (88.79%) in the glomerular mesangial proliferative lesions and the glomerulosclerosis (88.79%); the pathological manifestations of the NDN patients were the glomerular mesangial proliferative lesions, the glomerular mesangial lesions and the FSGS-like lesions (79.1). 7%).2. Comparative analysis of the two groups of early-stage subjects: the first clinical index: Compared with the early NDN patients, the course of diabetes in the early DN patients was long (111.88, 9.21, P = 0.000), with the non-proliferative lesions of the fundus (35.1%, P = 0.018), and the pain of the limbs (31.1%, P = 0). .038), the proportion of cataract (24.3%, P = 0.039) and fatty liver (30.2%, P = 0.019) was higher, and left ventricular diastolic function (58.1%, P = 0.000), autonomic nerve damage (21.6%, P = 0.012) and ST-T change (39.2%, P = 0). .027). Laboratory test indicators: early DN patients with blood urea nitrogen (BUN) (25.21% 1.74, P = 0.030), blood phosphorus (P) (1.28% 0.04, P = 0.009), urine p2 microglobulin (p2MG) (4.95, 0.74, P = 0.009), glomerular filtration rate (GFR) (69.84, 4.37, P = 0.009), fasting free insulin/ post (FINS/ 2h-INS) (14.55 (1.23, P = 0.042), fasting C-peptide/2 hC peptide (F-CP/2 h-CP) (0.70-0.06, P = 0.001), and the risk factors associated with DN were left ventricular diastolic function (OR = 9.057, P = 0.003), and the course of diabetes (OR = 1.015, P = 0). .011). The pathological manifestations of the early DN patients were more common (94.60%) in the glomerular mesangial proliferative lesions and the glomerulosclerosis (94.60%), and the pathological manifestations of the early NDN patients were the mesangial proliferative lesions, the glomerular mesangial lesions and the FSGS-like lesions (76 .19% Conclusion 1. The changes of age and diabetes, including the history of hypertension, the non-proliferative diseases of the fundus, the cataract, the fatty liver, the numbness of the limbs, the changes of the left ventricular diastolic function, the changes of ST-T and the level of the blood urea nitrogen, the blood myoglobin, the blood phosphorus and the urinary p2microglobulin. The index of glomerular filtration rate, urine leakage, fasting C-peptide/ post-2 hC peptide is low, and the above-mentioned index abnormality can be used to help patients with type 2 diabetes complicated with kidney disease. It became the diagnosis of DN. The decrease of the C-peptide/2 hC peptide, the decrease of the left ventricular diastolic function, the increase of the microglobulin in the urine, the longer the course of diabetes, was the only one of the DN. Vertical risk factors.2. Diabetes, with non-proliferative lesions of the fundus, limb numbness and pain, cataracts, high proportion of fatty liver, high blood urea nitrogen, blood phosphorus, urine level 2 microglobulin, glomerular filtration rate, fasting free insulin/ post, fasting C-peptide/ post 2 The index of hC peptide is low, and the above-mentioned index can help the patients with type 2 diabetes. Early diagnosis of DN. Left ventricular diastolic function is reduced, and the course of diabetes is also early
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.2;R692
[Abstract]:Objective To study the risk factors of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM) and to explore the non-invasive clinical markers that can be used for prediction and diagnosis at different stages of disease. Methods All patients with diabetes associated with kidney disease (DKD), who were hospitalized in the second hospital of Lanzhou University in a year, were collected in a total of 140 Example. The study subjects were divided into two groups according to the results of the renal biopsy: the first group: the diabetic nephropathy group (DN), a total of 116, of which 73 were male and 43 in the female; and the second group: the non-diabetic nephropathy group (NDN), of which 24 were male,12 of which were male and 12 in the female. Human. The age, sex, body weight, height, calculated body weight index and blood pressure were recorded for all the subjects included, and the current medical history, past history, operation, history of trauma, history of history, etc. were recorded in detail; the abnormal signs in the physical examination of the patient were recorded in detail; the blood was recorded. The liquid and urine indicators were tested according to the experimental procedure. And then carrying out statistical analysis on all the clinical and laboratory indexes collected, and comparing and detecting the results with the clinical practice, and exploring the clinical practical meaning thereof. Presense. Results 1. Comparative analysis was performed on all the selected subjects in two groups: the following clinical indicators: the patients with DN were older (52.53, 0.95, P = 0.036), and the course of diabetes was longer (104.80, 7.06, P = 0.000), with a non-proliferative lesion of the fundus (35.3%, P = 0.0). 01), limb numbness and pain (31.9%, P = 0.013), hypertension (85.3%, P = 0.013), cataract (18.1%, P = 0.014) and fatty liver (30.2%, P = 0.019), the patients with left ventricular diastolic function decreased (53.4%, P = 0.000) and ST-T (31.0%, P = 0.0 50). The laboratory test index: compared with the NDN, the blood urea nitrogen (BUN) (24.39, 1.30, P = 0.011), the blood muscle strength (Cr) (1.56, 1.33, P = 0.032), the blood phosphorus (P) (1.31, 0.03, P = 0.018), the urine level 2 microglobulin (V2MG) (5.51, 0.63, P = 0.015) were higher, and the glomerular filtration rate (GFR) (62.43, 4.43, P = 0.0) 9), urinary infiltration (OSM) (533.75-19.9, P = 0.044), fasting C-peptide/ postprandial 2hC-peptide (F-CP/ 2h-CP) (0.93-0.11, P = 0.002), and the risk factors associated with DN were fasting C-peptide/ postprandial 2hC peptide (OR = 0.151, P = 0.010), left ventricular diastolic function decreased (OR = 31.307, P = 0.010), and urinary bladder 2 microglobulin (OR = 3.825, P = 0.0). 07), the course of diabetes (OR = 1.016, P = 0.021); the pathological manifestation of the diabetic patients was more common (88.79%) in the glomerular mesangial proliferative lesions and the glomerulosclerosis (88.79%); the pathological manifestations of the NDN patients were the glomerular mesangial proliferative lesions, the glomerular mesangial lesions and the FSGS-like lesions (79.1). 7%).2. Comparative analysis of the two groups of early-stage subjects: the first clinical index: Compared with the early NDN patients, the course of diabetes in the early DN patients was long (111.88, 9.21, P = 0.000), with the non-proliferative lesions of the fundus (35.1%, P = 0.018), and the pain of the limbs (31.1%, P = 0). .038), the proportion of cataract (24.3%, P = 0.039) and fatty liver (30.2%, P = 0.019) was higher, and left ventricular diastolic function (58.1%, P = 0.000), autonomic nerve damage (21.6%, P = 0.012) and ST-T change (39.2%, P = 0). .027). Laboratory test indicators: early DN patients with blood urea nitrogen (BUN) (25.21% 1.74, P = 0.030), blood phosphorus (P) (1.28% 0.04, P = 0.009), urine p2 microglobulin (p2MG) (4.95, 0.74, P = 0.009), glomerular filtration rate (GFR) (69.84, 4.37, P = 0.009), fasting free insulin/ post (FINS/ 2h-INS) (14.55 (1.23, P = 0.042), fasting C-peptide/2 hC peptide (F-CP/2 h-CP) (0.70-0.06, P = 0.001), and the risk factors associated with DN were left ventricular diastolic function (OR = 9.057, P = 0.003), and the course of diabetes (OR = 1.015, P = 0). .011). The pathological manifestations of the early DN patients were more common (94.60%) in the glomerular mesangial proliferative lesions and the glomerulosclerosis (94.60%), and the pathological manifestations of the early NDN patients were the mesangial proliferative lesions, the glomerular mesangial lesions and the FSGS-like lesions (76 .19% Conclusion 1. The changes of age and diabetes, including the history of hypertension, the non-proliferative diseases of the fundus, the cataract, the fatty liver, the numbness of the limbs, the changes of the left ventricular diastolic function, the changes of ST-T and the level of the blood urea nitrogen, the blood myoglobin, the blood phosphorus and the urinary p2microglobulin. The index of glomerular filtration rate, urine leakage, fasting C-peptide/ post-2 hC peptide is low, and the above-mentioned index abnormality can be used to help patients with type 2 diabetes complicated with kidney disease. It became the diagnosis of DN. The decrease of the C-peptide/2 hC peptide, the decrease of the left ventricular diastolic function, the increase of the microglobulin in the urine, the longer the course of diabetes, was the only one of the DN. Vertical risk factors.2. Diabetes, with non-proliferative lesions of the fundus, limb numbness and pain, cataracts, high proportion of fatty liver, high blood urea nitrogen, blood phosphorus, urine level 2 microglobulin, glomerular filtration rate, fasting free insulin/ post, fasting C-peptide/ post 2 The index of hC peptide is low, and the above-mentioned index can help the patients with type 2 diabetes. Early diagnosis of DN. Left ventricular diastolic function is reduced, and the course of diabetes is also early
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.2;R692
【参考文献】
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1 王国洪;许瑞吉;张中书;王筱R，
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