二甲双胍对2型糖尿病患者尿炎症因子排泄的影响

发布时间：2018-03-29 06:09

  本文选题：二甲双胍　切入点：2型糖尿病　出处：《安徽医科大学》2016年硕士论文

【摘要】：目的观察二甲双胍(Metformin,Met)对2型糖尿病(type 2 diabetesmellitus,T2DM)患者肿瘤坏死因子(tumor necrosis factor,TNF)-α、单核细胞趋化蛋白(monocyte chemoattractant protein,MCP)-1及C反应蛋白(C-reactive protein, CRP)等尿炎症因子排泄的影响,探讨其可能存在的肾脏保护作用。方法121例2型糖尿病(type 2 diabetes mellitus, T2DM)患者(DM组)根据抗糖尿病治疗方案分为胰岛素(insulin, INS)组(N=60)和磺脲类(sulfonylurea,SU)组,再依据是否联合Met各分两个亚组(INS-Ⅰ组：单一INS治疗；INS-Ⅱ组：INS联合Met；SU-Ⅰ组：单一SU治疗；SU-Ⅱ组：SU联合Met治疗),同期,选取我院体检中心24名健康体检人员作为正常对照组(normal control, NC组),比较各组之间年龄、体重指数(body mass index, BMI)、血压和血肌酐(creatinine,SCr)、空腹血糖(fasting blood glucose, FBG)、餐后2小时后血糖(postprandial blood glucose, PBG)、糖化血红蛋白(glycated haemoglobinA1c, HbA1c)、尿白蛋白肌酐比(Urinary albumin/creatinine ratio, UACR)、尿TNF-α肌酐比(urinary TNF-α/creatinineratio, UTCR)、尿MCP-1肌酐比(urinary MCP-1/creatinineratio, UMCR)、尿CRP肌酐比(urinary CRP/creatinineratio,UCCR)等指标的变化。结果1、DM组与NC组比较1.1 DM组与NC组组间年龄、BMI、血压和血SCr差异无统计学意义(P0.05)。1.2与NC组比较,DM组FBG、PBG和HbA1c显著升高,差异有统计学意义,P0.05,分别为(7.21±0.14 VS 4.85±0.10) mmol/L, (9.71±0.31 VS 5.24±0.22) mmol/L, (7.03±0.10 VS 5.22±0.06)%。1.3与NC组比较,DM组UACR、UTCR、UMCR和UCCR显著升高,差异均有统计学意义,P0.05,分别为(27.68±3.99 VS 13.63±1.03) mg/gCr,(152±34.43 VS 60.23±12.27) pg/ngCr, (95.96±17.10 VS 30.71±1.83) pg/ngCr, (6.89±1.25 VS 2.14±0.89) pg/mgCr。2、INS-Ⅱ组与INS-Ⅰ组比较2.1 INS-Ⅱ组与INS-Ⅰ组间年龄、病程、BMI、血压、血SCr、FBG、PBG和HbA1c差异无统计学意义(P0.05)。2.2与INS-Ⅰ组比较,INS-Ⅱ组UACR、UTCR, UMCR和UCCR明显降低,差异有统计学意义,P0.05,分别为(10.48±1.98 VS 42.96±6.24) mg/gCr, (51.12±9.56VS 166.9±44.04)pg/ngCr, (27.42±4.45 VS 116.2±10.47)pg/ngCr, (2.83±0.43VS10.04±2.96) pg/mgCr。3、SU-Ⅱ组与SU-Ⅰ组比较3.1 SU-Ⅱ组与SU-Ⅰ组间年龄、病程、BMI、血压、血SCr、FBG、PBG和HbA1c差异无统计学意义(P0.05)。3.2与SU-Ⅰ组比较,SU-Ⅱ组UACR, UTCR, UMCR和UCCR明显降低,差异有统计学意,P0.05,分别为(18.31±5.70 VS 52.43±7.80) mg/gCr, (62.14±7.38 VS110.4±14.27) pg/ngCr, (53.58±8.11 VS 240.8±12.77) pg/ngCr, (3.11±0.68 VS11.26±3.18) pg/mgCr。4、T2DM患者UTCR、UMCR、UCCR分别与UACR呈显著性正相关(r=0.73,P0.01；r=0.79,P0.01；r=0.53,P0.01；)。分别以UTCR、UMCR、UCCR作为应变量,以其他因素作为自变量,进行多元线性逐步回归分析,结果显示UACR分别是UTCR、UMCR、UCCR的独立相关因素。结论1、糖尿病患者体内存在低度增强的炎症反应并与糖尿病肾损害有关。2、联合应用Met可降低T2DM患者尿炎症因子的排泄,该作用可能与其肾脏保护有关。
[Abstract]:Objective to observe the effect of metformin metformin on the excretion of inflammatory cytokines such as tumor necrosis factor- 伪, monocyte chemoattractant protein MCP-1and C-reactive protein (CRP-) in patients with type 2 diabetes mellitus type 2 diabetes mellitus (type 2 diabetes mellitus). Methods 121 patients with type 2 diabetes mellitus (type 2 diabetes mellitus, T2DM) were divided into two groups according to the antidiabetic regimen: insulin (ins) group (n = 60) and sulfonylurea suis group (n = 121). According to whether or not combined with Met, each group was divided into two subgroups: single INS group: single INS group: 1% ins combined with Metsu- 鈪，

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