糖尿病肾病患者血清网膜素-1水平的变化

发布时间：2019-01-15 21:00

【摘要】：目的:目前研究认为糖尿病肾病(diabetic nephropathy,DN)的发病与炎症反应、相关细胞因子、氧化应激等因素相关。透析是其晚期主要维持手段,据统计2012年我国在透析已登记原发疾病的患者共有143145例,其中糖尿病肾病患者22217例,占总数的15.5%,以仅次于肾小球肾炎位居第二,其中每个患者仅透析一项就需要近6万元/年,而且透析还会导致高血压、电解质紊乱、心力衰竭、贫血、营养不良等多种并发症。可见在糖尿病肾病方面的更加深入研究有着极大的必要性。网膜素(omentin-1)是一种新发现的脂肪结构特异性分泌因子,与糖脂代谢紊乱、炎症、氧化应激等关系密切。omentin-1与无糖尿病的慢性肾脏疾病相关,但已有的关于omentin-1与糖尿病肾病的报道少见。本研究通过检测2型糖尿病肾病患者、新发2型糖尿病患者、健康对照者血清omentin-1的含量,探讨血清omentin-1水平与2型糖尿病肾病的关系,为糖尿病早期诊断、病情监测、糖尿病肾病的发病机制提供一些依据。方法:1)研究对象:以2013年6月至2014年10月山西医科大学第二医院内分泌科、肾内科住院的60例糖尿病肾病患者(III期30例,IV期30例),内分泌科门诊新确诊无肾损害的46例2型糖尿病(Tybe 2 diabetes mellitus,T2DM)患者,以及同时期健康体检的年龄、性别等相匹配的44例健康者为实验研究对象。2)临床指标采集:记录研究对象的一般情况,测定相关生化指标及血清omentin-1。结果:三组间的性别、年龄、BMI比较差异均无统计学意义,新诊断T2DM组、DN组与对照组相比FBG、Hb AIc、TG、HOMA-IR显著增高(P0.05)、(P0.01),LDL-C、omentin-1水平显著下降(P0.05)、(P0.01)。DN组较新诊断T2DM组Scr、BUN显著增高,FBG、Hb AIc、TG、FINs、omentin-1水平显著下降(P0.05)、(P0.01)。经Pearson相关分析,发现新诊断T2DM患者血清网膜素-1与HDL-C正相关(r=0.413,P=0.004),与HOMA-IR负相关(r=-0.358,P=0.015),DN患者网膜素-1与Scr、e GFR正相关(r=0.315,P=0.026)(r=0.349,P=0.013)。结论:血清网膜素-1水平降低可能是糖尿病肾病的发病原因之一,网膜素-1是否能成为2型糖尿病病情、糖尿病肾病肾功能监测指标之一,仍需进一步研究。
[Abstract]:Aim: the present study suggests that the pathogenesis of diabetic nephropathy (diabetic nephropathy,DN) is associated with inflammatory response, cytokines, oxidative stress and other factors. Dialysis is the main maintenance method in late stage. According to statistics, there were 143145 cases of primary diseases registered in dialysis in our country in 2012, of which 22217 cases were diabetic nephropathy patients, accounting for 15.5% of the total, second only to glomerulonephritis. Each patient needs nearly 60,000 yuan per year to dialysis alone, and dialysis can lead to hypertension, electrolyte disorders, heart failure, anemia, malnutrition and other complications. It can be seen that there is a great need for more in-depth research on diabetic nephropathy. Omentin (omentin-1) is a newly discovered secretory factor of fatty structure, which is closely related to metabolic disorder of glucose and lipid, inflammation, oxidative stress and so on. Omentin-1 is associated with chronic renal disease without diabetes. However, there have been few reports of omentin-1 and diabetic nephropathy. In this study, the levels of serum omentin-1 in patients with type 2 diabetic nephropathy, newly diagnosed type 2 diabetic patients, and healthy controls were detected, and the relationship between serum omentin-1 level and type 2 diabetic nephropathy was investigated. The pathogenesis of diabetic nephropathy provides some evidence. Methods: 1) from June 2013 to October 2014, 60 patients with diabetic nephropathy (III 30 cases, IV 30 cases), Department of Endocrinology, second Hospital of Shanxi Medical University, were enrolled in this study. 46 newly diagnosed patients with type 2 diabetes mellitus (Tybe 2 diabetes mellitus,T2DM) without renal damage and the age of physical examination at the same time, Sex matched 44 healthy subjects as experimental subjects. 2) Clinical indicators collection: record the general situation of the study subjects, determine the relevant biochemical indicators and serum omentin-1. Results: there was no significant difference in sex, age and BMI among the three groups. In the newly diagnosed T2DM group, the FBG,Hb AIc,TG,HOMA-IR in the DN group was significantly higher than that in the control group (P0.05), (P0.01), LDL-C, was significantly higher than that in the control group (P0.05). The level of omentin-1 significantly decreased (P0.05), (P0.01). DN group compared with the newly diagnosed T2DM group Scr,BUN significantly increased, FBG,Hb AIc,TG,FINs,omentin-1 level significantly decreased (P0.05), (P0.01). By Pearson correlation analysis, it was found that the serum omentin-1 was positively correlated with HDL-C in newly diagnosed patients with T2DM (r = 0.413), and negatively correlated with HOMA-IR (r = 0.358A, P < 0.015). The level of omentin-1 was negatively correlated with Scr, in patients with), DN. E GFR was positively correlated (r = 0.315, P = 0.026) (r = 0.349, P = 0.013). Conclusion: the decrease of serum omentin-1 level may be one of the causes of diabetic nephropathy.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2

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