血、尿 IGF-1、血清 Hcy 在糖尿病肾病中的相互关系及意义

目的：探讨血、尿胰岛素样生长因子-1（ IGF-1）及血清同型半胱氨酸（ Hcy）在糖尿病肾病（ DN）早期诊断及其相互之间存在的关系。方法根据24h尿微量白蛋白排泄率（ UAER）将100例2型DM患者分为3组：正常白蛋白尿组（ B组36例）、微量白蛋白尿组（ C组30例）、大量白蛋白尿组（ D组34例），同时以35例健康人作为对照组（ A组），测量各组患者血、尿IGF-1及血清Hcy、UAER等指标，对其中的相关性进行分析。结果①实验组血IGF-1检测较A组明显下降，差异有显著性（P＜0．05）；实验组间B组较C组、D组下降明显，有统计学意义（P＜0．05）；C组与D组间未见明显差异（P＞0．05）。②实验组中尿IGF-1较A组明显增加，差异有显著性（P＜0．05），且各实验组间差异明显（P＜0．05），与UAER呈正相关（r＝0．97）。③实验组中血清Hcy测定高于A组，且实验组间存在显著差异（P＜0．05），与UAER呈正相关（r＝0．82）。④血清IGF-1与血清Hcy存在相关性（r＝0．37）。结论①血清、尿IGF-1联合测定，反映随着肾损伤的加重，血清IGF-1分泌增多，但未至正常范围，推测IGF-1可能与肾损害的发生发展有关。②血清Hcy测定可推断其对肾小球微血管有影响，反映肾损伤严重程度。③血、尿IGF-1联合血Hcy测定早期发现肾损伤有重要意义。

A Preliminary Study on the Relationship between the Level of Insulin-like Growth Factor-1 in Serum and Urine and Homocysteine in with Type 2 Diabetic Nephropathy

Objective To evaluate the significance of insulin-like growth factor-1（IGF-1）in serum and urine and homocysteinein （ Hyc） in the early diagnosis of type 2 diabetic nephropathy and the relationship between them.Methods Thirty five healthy people were se-lected as control group,according to UAER,100 patients with type 2 diabetic were divided into three groups,group N-UAlb（ B） with UAER〈20μg/min（n=36）,group M-UAlb（C） with UAER20~200μg/min（n=30）and group L-UAlb with UAER〉200μg/min（n=34）.IGF-1, Hcy,BUN,FPG and HbA1C levels in inserum and IGF-1 and Proteinuria of concentration levels in urine were detected and the correlation was analyzed.Results ①Serum IGF-1 in group N-UAlb,M-UAlb,L-UAlh significantly decreased in comparison with those in control group （P〈0.05）,Serum IGF-1 in group N-UAlb significantly decreased in comparison with that in group M-UAlb,L-UAlh（P〈0.05）,however, there was no significant difference in serum IGF-1 between group M-UAlb and L-UAlb（P〉0.05）.②Urinary IGF-1 in group N-UAlb,M-UAlb,L-UAlh significantly increased in comparison with those in control group（P〈0.05）.Moreover,there were significant difference in uri-nary IGF-1 among group N-UAlb,M-UAlb and L-UAlb（P〈0.05）.Urinary IGF-1 level was correlated positively with UAER（r=0.97）.③Compared with the controls,serum Hyc levels in group N-UAlb,M-UAlb,L-UAlh were significantly increased.Moreover,there were significant difference in serum Hyc among group N-UAlb,M-UAlb and L-UAlb（P〈0.05）.And serum Hyc level was correlated positively with UAER（r=0.87）.④Urinary IGF-1 level was correlated positively with serum Hyc（r=0.37）.Conclusion ①IGF-1 in serum and urine revealed ser-um IGF-1 associated with renal damage.With the aggravation of renal injury,serum IGF-1 will highly secrete,but not to the normal range.②Serum Hyc may have effects on glomerular capillaries that can suggest the severity of renal damage.③The detection of IGF-1 in serum and u-rine and Hyc in serum is