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目的探讨新诊断2型糖尿病(T2DM)伴高血压者与不伴高血压患者的血清C肽(CP)、胰升糖素(Gluc)与肾小球损害指标胱抑素C(Cys-C)之间的关系,了解糖尿病患者肾损害的危险因素。方法选取2012年3月至2014年10月在安徽医科大学附属第三医院内分泌科住院新诊断的近3个月内未应用降糖药物治疗的T2DM患者152例为研究对象(其中伴高血压者69例,血压正常患者83例),分别测定体重、身高、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)、糖化血红蛋白(Hb A1C)、空腹血糖(FPG)、血尿酸(UA)和Cys-C,并行100 g馒头餐试验,测定餐后30、60、120和180 min血清Gluc、CP,对Cys-C、FPG、血脂、Hb A1C进行独立样本t检验、对各点Gluc、CP进行多变量方差分析,然后进行多元逐步回归分析。结果两组的FPG、TG、TC、HDL-C、LDL-C、Hb A1C、CP和Gluc水平差异均无统计学意义(P>0.05),但T2DM合并高血压患者的年龄、Cys-C水平[分别为(57.5±10.3)岁、(0.91±0.3)mg/L]高于单纯T2DM组[分别为(51.3±9.7)岁、(0.80±0.2)mg/L],差异均有统计学意义(P<0.01)。多元逐步回归分析结果显示,收缩压(SBP)、UA和体质指数(BMI)是Cys-C的重要影响因素(β值分别为0.003,0.001和-0.016,P<0.05,P<0.01)。结论在新诊断T2DM合并高血压患者中,肾小球功能较不伴有高血压者减退,SBP、UA和BMI为Cys-C的风险因素,积极控制这些危险因素有助于预防T2DM慢性肾脏并发症的发生。
Objective To investigate the changes of serum C-peptide, Gluc and glomerular damage index cystatin C (Cys-C) in patients with newly diagnosed type 2 diabetes mellitus (T2DM) The relationship between the understanding of risk factors for kidney damage in diabetic patients. Methods From March 2012 to October 2014, 152 newly diagnosed inpatients with endocrinology in the Third Affiliated Hospital of Anhui Medical University who were not diagnosed with hypoglycemic drugs during the recent 3 months were enrolled in this study. Among them, (N = 69) and normotensive patients (n = 83). The body weight, height, TG, TC, HDL-C and LDL- Hb A1C, FPG, UA and Cys-C were measured in 100 g steamed bread meal. The levels of Gluc and CP at 30, 60, 120 and 180 min after meal were measured. The levels of Cys- C, FPG, lipids and Hb A1C were analyzed by multivariate analysis of variance (ANOVA) for Gluc and CP at each point. Then multivariate stepwise regression analysis was performed. Results There were no significant differences in the levels of FPG, TG, TC, HDL-C, LDL-C, Hb A1C, CP and Gluc between the two groups (P> 0.05) [(57.5 ± 10.3) years, (0.91 ± 0.3) mg / L] were significantly higher than those in T2DM group [(51.3 ± 9.7) years and (0.80 ± 0.2) mg / L, respectively] (P <0.01). Multiple stepwise regression analysis showed that systolic blood pressure (SBP), UA and body mass index (BMI) were the important factors of Cys-C (β values were 0.003,0.001 and -0.016 respectively, P <0.05, P <0.01). Conclusion SBP, UA and BMI are the risk factors of Cys-C in newly diagnosed T2DM patients with hypertension, and glomerular function is less associated with hypertension. The positive control of these risk factors is helpful to prevent the occurrence of chronic kidney disease in T2DM Occurrence of the disease.