论文部分内容阅读
目的探讨短期胰岛素泵强化治疗对糖尿病慢性肾脏疾病(CKD)患者不同时期体内氧化应激水平的影响。方法选取T2DM患者80例为T2DM组,再根据白蛋白尿/肌酐比值(UACR)分为正常白蛋白尿(NA)亚组,微量白蛋白尿(MA)亚组,临床肾病(CA)亚组。另选同期健康体检者30名为正常对照(NC)组,应用胰岛素泵对T2DM组强化治疗2周,比较治疗前后氧化应激指标8-羟基脱氧鸟苷(8-OHdG)、3-硝基酪氨酸(3-NT)、谷胱甘肽(GSH)及超氧化物歧化酶(SOD)的变化情况。结果 (1)治疗前T2DM组8-OHdG、3-NT、HbA1c、BUN、Cr水平及胰岛素抵抗指数(HOMA-IR)高于NC组,且随着UACR增加而增加,组间差异有统计学意义(P<0.05);T2DM组GSH、SOD水平低于NC组(P<0.05),且随着UACR增加而降低,但NA、MA、CA组间GSH、SOD比较差异无统计学意义(P>0.05)。(2)治疗后T2DM组血压、血糖、TG、TC、LDL-C、HOMA-IR较治疗前均下降;HDL-C升高,差异有统计学意义(P<0.05);但HbA1c治疗前后差异无统计学意义(P>0.05)。(3)治疗后NA、MA、CA组8-OHdG、3-NT水平降低;GSH、SOD水平升高。但NA、MA组变化较CA组显著,差异有统计学意义(P<0.05)。(4)相关分析显示,8-OHdG、3-NT和HbA1c、病程、HOMA-IR及FPG呈正相关,GSH、SOD和HbA1c、病程、HOMA-IR及FPG呈负相关。结论 CKD早期使用胰岛素泵强化治疗可改善患者体内氧化应激水平,延缓或阻止向临床肾病期和终末期肾病进展。
Objective To investigate the effects of short-term insulin pump intensive therapy on oxidative stress in patients with chronic kidney disease (CKD) at different periods. Methods Twenty patients with T2DM were selected as T2DM group and then divided into normal albuminuria (NA) group, microalbuminuria (MA) subgroup and clinical nephropathy (CA) subgroup according to albuminuria / creatinine ratio (UACR) . Thirty healthy subjects were enrolled in the same period as the normal control (NC) group. Patients in T2DM group were treated with insulin pump for 2 weeks. The levels of 8-OHdG, Tyrosine (3-NT), glutathione (GSH) and superoxide dismutase (SOD) changes. Results (1) The levels of 8-OHdG, 3-NT, HbA1c, BUN, Cr and HOMA-IR in T2DM group were higher than those in NC group before treatment, and increased with the increase of UACR (P <0.05). The levels of GSH and SOD in T2DM group were lower than those in NC group (P <0.05), and decreased with the increase of UACR. However, there was no significant difference in GSH and SOD among NA, MA and CA groups > 0.05). (2) After treatment, the blood pressure, blood glucose, TG, TC, LDL-C, HOMA-IR of T2DM patients were all lower than those before treatment; HDL-C was increased, the difference was statistically significant No statistical significance (P> 0.05). (3) After treatment, the levels of 8-OHdG and 3-NT in NA, MA and CA groups decreased and the levels of GSH and SOD increased. However, the changes in NA and MA groups were significantly higher than those in CA group (P <0.05). (4) Correlation analysis showed that there was a positive correlation between duration of disease, HOMA-IR and FPG in 8-OHdG, 3-NT and HbA1c, duration of HOMA-IR and FPG. Conclusions The early treatment of CKD with insulin pump can improve the level of oxidative stress in patients and delay or stop the progress of clinical nephropathy and end-stage renal disease.