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目的通过检测尿Ⅳ型胶原探讨胰岛素抵抗和动态血压对2型糖尿病肾病的影响。方法 90例2型糖尿病患者根据尿微量白蛋白排泄量分为3组(各30例):糖尿病无肾病组、糖尿病早期肾病组及糖尿病临床肾病组。另选健康体检者34例作为正常对照组。采用ELISA法测定尿Ⅳ型胶原,免疫比浊法测定尿微量白蛋白;并进行胰岛素敏感指数、相关的肾功能指标和24h动态血压监测。结果胰岛素敏感指数在2型糖尿病各组均低于正常对照组(P均<0.05)。24h平均血压、白天和夜间平均血压在糖尿病临床肾病组高于其他3组(P均<0.05)。尿Ⅳ型胶原与胰岛素敏感指数呈负相关,与24h平均舒张压、夜间血压、尿微量白蛋白排泄量、尿β2-微球蛋白、尿α1-微球蛋白和尿-乙酰-β-D-氨基葡萄糖苷酶呈正相关。结论胰岛素抵抗和动态血压通过Ⅳ型胶原影响2型糖尿病肾病的发展。
Objective To investigate the effect of insulin resistance and ambulatory blood pressure on type 2 diabetic nephropathy by detecting urinary type Ⅳ collagen. Methods 90 patients with type 2 diabetes were divided into 3 groups (30 in each group) according to their urinary albumin excretion: diabetic nephropathy group, diabetic nephropathy group and diabetic nephropathy group. Another 34 healthy subjects were selected as normal control group. Urinary type Ⅳ collagen was detected by ELISA and urine microalbumin was measured by immunoturbidimetry. Insulin sensitivity index, related renal function indexes and 24h ambulatory blood pressure monitoring were also performed. Results Insulin sensitivity index in type 2 diabetes mellitus group was lower than that in normal control group (all P <0.05). Mean blood pressure at 24h, mean blood pressure at daytime and at night were higher in the diabetic nephropathy group than in the other three groups (all P <0.05). Urine type Ⅳ collagen and insulin sensitivity index was negatively correlated with 24h mean diastolic blood pressure, nocturnal blood pressure, urinary albumin excretion, urinary β2-microglobulin, urine α1-microglobulin and urinary-acetyl-β-D- Glucosaminidase was positively correlated. Conclusion Insulin resistance and ambulatory blood pressure affect the development of type 2 diabetic nephropathy via type Ⅳ collagen.