血清胰岛素样生长因子-1与糖尿病肾病严重程度的相关性研究
发布时间：2019-03-25 18:21
【摘要】：目的观察胰岛素样生长因子-1(IGF-1)在不同严重程度的糖尿病肾病(DN)患者血清中的水平,探讨并进一步分析血IGF-1与DN严重程度的相关性,为糖尿病肾病的早期防治提供基础理论依据。方法依据1999年WHO糖尿病诊断及分型标准选取华北理工大学附属医院内分泌科2013年3月~2014年3月住院的T2DM患者120例。根据尿微量白蛋白排泄率(UAER)将2型糖尿病患者分为4类:2型糖尿病非肾病组(DM组),UAER㩳20ug/min;早期糖尿病肾病组(DN1组),UAER20~200ug/min;临床糖尿病肾病组(DN2组),UAER200ug/min,24 h尿蛋白定量0.5g,肾功能指标正常;终末期糖尿病肾病组(DN3组),UAER200ug/min,24h尿蛋白定量0.5g,肾功能指标异常。所有研究对象均排除糖尿病急性并发症、原发性高血压肾脏损伤、肾小球肾炎及肾盂肾炎、泌尿系感染、肿瘤及其他肾脏疾病。同期华北理工大学附属医院30例体检的正常健康人群作为对照组。所有研究对象空腹8h以上,留取尿样测尿微量白蛋白,晨起抽取肘静脉血5ml检测胰岛素样生长因子-1(IGF-1)、糖化血红蛋白(Hb A1c)、空腹血糖(FPG)、生长激素(GH)、血清总胆固醇(TC)、甘油三酯(TG)、低密度胆固醇(LDL-C)、高密度胆固醇(HDL-C)及肾小球滤过率(GFR)等指标。根据血肌酐水平结合年龄、体重、性别按公式计算肾小球滤过率(GFR)。所有数据分析应用IBM SPSS19.0统计软件包进行统计分析,对于计量资料采用均数±标准差表示。比较采用单因素方差分析,两组间比较采用t检验,多组间两两比较采用LSD检验。多因素之间相关统计采用logisitc回归分析、线性相关分析、多元逐步回归分析。检验水准:P0.05为有统计学意义。结果1 2型糖尿病各组人群的Hb A1c、FPG、TC、TG、LDL-C、收缩压水平均高于对照组,HDL-C水平低于对照组。糖尿病肾病各组Hb A1c、FPG、TC、TG、LDL-C、收缩压水平均高于糖尿病非肾病组,HDL-C水平低于糖尿病非肾病组。差异有统计学意义(P0.05)。2型糖尿病非肾病组肾小球滤过率稍高于对照组,2型糖尿病肾病组肾小球滤过率依次降低,终末期糖尿病肾病组肾小球滤过率最低。说明2型糖尿病患者在非糖尿病肾病时肾小球滤过率轻度升高,随着肾脏损害程度的增加,肾小球滤过率逐渐下降。临床糖尿病肾病组、终末期糖尿病肾病组患者病程长于2型糖尿病非肾病组、早期糖尿病肾病组,说明糖尿病病程越长,糖尿病肾损害发生越明显。2早期组患者血IGF-1水平高于2型糖尿病非肾病组及对照组,随着病情的进展,血IGF-1水平也逐渐增加。终末期糖尿病肾病组血IGF-1水平最高。3 UAER与IGF-1、Hb A1c、FPG、TC、TG、LDL-C、收缩压、病程呈正相关,与GFR、HDL-C呈负相关,(P0.05)。其中IGF-1的标准回归系数最大,说明血IGF-1水平对糖尿病肾病程度的影响最大,进一步对不同程度的DN进行血IGF-1水平的Logistic回归分析,结果说明血IGF-1高于正常值范围时,糖尿病患者发生DN的危险性也在增加。4经Pearson相关分析,血IGF-1与UAER、Hb A1c、FPG、TC、TG、LDL-C、收缩压、病程呈正相关(P0.05),与GFR、HDL-C呈负相关(P0.05)。结论1血清IGF-1水平的增高与糖尿病肾病的严重程度呈正相关。2血清IGF-1是糖尿病肾病的独立危险因素,可能参与了糖尿病肾病的发生、发展。
[Abstract]:Objective To study the level of insulin-like growth factor-1 (IGF-1) in the serum of patients with diabetic nephropathy (DN) with different severity. Methods 120 patients with T2DM from March 2013 to March 2014 were selected according to the WHO type of diabetes diagnosis and classification in 1999. According to the urinary micro-albumin excretion rate (UAER), type 2 diabetic patients were divided into 4 groups: type 2 diabetic non-diabetic group (DM group), UAER-20ug/ min, early diabetic nephropathy group (DN1 group), UAER20-200ug/ min, clinical diabetic nephropathy group (DN2 group), UAER200ug/ min, 24h urinary protein quantitative 0.5g, and renal function index normal; The urinary protein of the end-stage diabetic nephropathy group (DN3 group), UAER200ug/ min, 24h urinary protein was 0.5 g, and the renal function index was abnormal. All subjects of the study excluded acute diabetic complications, primary hypertension, renal injury, glomerulonephritis and pyelonephritis, urinary tract infections, tumors, and other renal disorders. In the same period, the normal healthy population of 30 physical examinations in the affiliated hospital of the North China University of Technology was used as the control group. All subjects were fasting for more than 8 hours, urine samples were collected for urine microalbumin, and 5 ml of cubital venous blood were taken in the morning to detect insulin-like growth factor-1 (IGF-1), glycosylated hemoglobin (Hb), fasting blood glucose (FPG), growth hormone (GH), total serum cholesterol (TC), Indicators such as triglyceride (TG), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C), and glomerular filtration rate (GFR). Glomerular filtration rate (GFR) was calculated by formula based on the level of blood myoglobin binding to age, body weight, and sex. The statistical analysis was performed using the IBM SPSS19.0 statistical software package for all data analysis, and the mean square standard deviation was used for the measurement data. One-factor analysis of variance was used, and t-test was used between the two groups. LSD was used for two groups. Logistic regression analysis, linear correlation analysis and multiple stepwise regression analysis were used in the correlation between multiple factors. Test level: P0.05 is of statistical significance. Results The levels of Hb, FPG, TC, TG, LDL-C and systolic blood pressure in all groups of type 2 diabetes were higher than that in the control group, and the level of HDL-C was lower than that of the control group. The levels of Hb, FPG, TC, TG, LDL-C and systolic blood pressure in diabetic nephropathy were higher than those of non-diabetic group, and the level of HDL-C was lower than that of non-diabetic group. The glomerular filtration rate of the type 2 diabetic nephropathy group was slightly higher than that of the control group, and the glomerular filtration rate of the type 2 diabetic nephropathy group was decreased, and the glomerular filtration rate of the end-stage diabetic nephropathy group was the lowest. The glomerular filtration rate of type 2 diabetic patients was slightly increased in non-diabetic nephropathy, and the glomerular filtration rate decreased with the increase of the degree of renal damage. in that clinical diabetic nephropathy group, the course of the end-stage diabetic nephropathy group was longer than that of the type 2 diabetic nephropathy group, the early diabetic nephropathy group, the longer the course of the diabetes, the more obvious the diabetic nephropathy, the blood IGF-1 level in the early group was higher than that of the type 2 diabetic non-diabetic group and the control group, With the progress of the disease, the level of IGF-1 gradually increased. The level of IGF-1 in the end-stage diabetic nephropathy group was the highest. 3UAER was positively correlated with IGF-1, Hb, FPG, TC, TG, LDL-C, systolic blood pressure and course of disease, and negatively correlated with GFR and HDL-C (P0.05). The standard regression coefficient of IGF-1 was the largest, indicating that the effect of blood IGF-1 level on the degree of diabetic nephropathy was the most, and a logistic regression analysis of the blood IGF-1 level was further performed on the DN of different degree, and the results indicated that when the blood IGF-1 was higher than the normal range, The risk of DN was also increased in the patients with diabetes. The results showed that the serum IGF-1 was positively correlated with UAER, Hb, FPG, TC, TG, LDL-C, systolic blood pressure and the course of the disease (P0.05), and negatively correlated with GFR and HDL-C (P0.05). Conclusion The level of IGF-1 in serum is positively related to the severity of diabetic nephropathy. Serum IGF-1 is an independent risk factor of diabetic nephropathy and may be involved in the development and development of diabetic nephropathy.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2
本文编号：2447204
[Abstract]:Objective To study the level of insulin-like growth factor-1 (IGF-1) in the serum of patients with diabetic nephropathy (DN) with different severity. Methods 120 patients with T2DM from March 2013 to March 2014 were selected according to the WHO type of diabetes diagnosis and classification in 1999. According to the urinary micro-albumin excretion rate (UAER), type 2 diabetic patients were divided into 4 groups: type 2 diabetic non-diabetic group (DM group), UAER-20ug/ min, early diabetic nephropathy group (DN1 group), UAER20-200ug/ min, clinical diabetic nephropathy group (DN2 group), UAER200ug/ min, 24h urinary protein quantitative 0.5g, and renal function index normal; The urinary protein of the end-stage diabetic nephropathy group (DN3 group), UAER200ug/ min, 24h urinary protein was 0.5 g, and the renal function index was abnormal. All subjects of the study excluded acute diabetic complications, primary hypertension, renal injury, glomerulonephritis and pyelonephritis, urinary tract infections, tumors, and other renal disorders. In the same period, the normal healthy population of 30 physical examinations in the affiliated hospital of the North China University of Technology was used as the control group. All subjects were fasting for more than 8 hours, urine samples were collected for urine microalbumin, and 5 ml of cubital venous blood were taken in the morning to detect insulin-like growth factor-1 (IGF-1), glycosylated hemoglobin (Hb), fasting blood glucose (FPG), growth hormone (GH), total serum cholesterol (TC), Indicators such as triglyceride (TG), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C), and glomerular filtration rate (GFR). Glomerular filtration rate (GFR) was calculated by formula based on the level of blood myoglobin binding to age, body weight, and sex. The statistical analysis was performed using the IBM SPSS19.0 statistical software package for all data analysis, and the mean square standard deviation was used for the measurement data. One-factor analysis of variance was used, and t-test was used between the two groups. LSD was used for two groups. Logistic regression analysis, linear correlation analysis and multiple stepwise regression analysis were used in the correlation between multiple factors. Test level: P0.05 is of statistical significance. Results The levels of Hb, FPG, TC, TG, LDL-C and systolic blood pressure in all groups of type 2 diabetes were higher than that in the control group, and the level of HDL-C was lower than that of the control group. The levels of Hb, FPG, TC, TG, LDL-C and systolic blood pressure in diabetic nephropathy were higher than those of non-diabetic group, and the level of HDL-C was lower than that of non-diabetic group. The glomerular filtration rate of the type 2 diabetic nephropathy group was slightly higher than that of the control group, and the glomerular filtration rate of the type 2 diabetic nephropathy group was decreased, and the glomerular filtration rate of the end-stage diabetic nephropathy group was the lowest. The glomerular filtration rate of type 2 diabetic patients was slightly increased in non-diabetic nephropathy, and the glomerular filtration rate decreased with the increase of the degree of renal damage. in that clinical diabetic nephropathy group, the course of the end-stage diabetic nephropathy group was longer than that of the type 2 diabetic nephropathy group, the early diabetic nephropathy group, the longer the course of the diabetes, the more obvious the diabetic nephropathy, the blood IGF-1 level in the early group was higher than that of the type 2 diabetic non-diabetic group and the control group, With the progress of the disease, the level of IGF-1 gradually increased. The level of IGF-1 in the end-stage diabetic nephropathy group was the highest. 3UAER was positively correlated with IGF-1, Hb, FPG, TC, TG, LDL-C, systolic blood pressure and course of disease, and negatively correlated with GFR and HDL-C (P0.05). The standard regression coefficient of IGF-1 was the largest, indicating that the effect of blood IGF-1 level on the degree of diabetic nephropathy was the most, and a logistic regression analysis of the blood IGF-1 level was further performed on the DN of different degree, and the results indicated that when the blood IGF-1 was higher than the normal range, The risk of DN was also increased in the patients with diabetes. The results showed that the serum IGF-1 was positively correlated with UAER, Hb, FPG, TC, TG, LDL-C, systolic blood pressure and the course of the disease (P0.05), and negatively correlated with GFR and HDL-C (P0.05). Conclusion The level of IGF-1 in serum is positively related to the severity of diabetic nephropathy. Serum IGF-1 is an independent risk factor of diabetic nephropathy and may be involved in the development and development of diabetic nephropathy.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2
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