糖尿病肾病患者血清脑利钠肽,同型半胱氨酸水平的变化及其意义

目的]探讨糖尿病（DN）肾病血清脑利钠肽（BNP）,同型半胱氨酸（Hcy）水平与DN病变程度的关系及强化血糖治疗后二者的变化.方法]随机选择DN 88例,按24小时尿微量白蛋白（Umalb）及血清肌酐分为正常蛋白尿组（SDM组,Umalb〈30 mg,28例）,早期肾病组（EDM组,30 mg300 mg,Cr〉110 μmol/L,14例）.另选健康成人28例作为对照组（NC组）,应用双抗夹心免疫荧光法检测BNP,用HT-Ⅱ型酶联法检测Hcy水平并进行比较.结果]EDM组,CDM组,CRF组BNP明显高于SDM组及NC组（P〈0.05）,且与Umalb（r=0.42,P〈0.05）,Cr（r=0.56,P〈0.05）呈明显正相关.EDM组,CDM组,CRF组Hcy明显高于SDM组及NC组（P〈0.05）,且与Umalb（r=0.28,P〈0.05）,Cr（r=0.46,P〈0.05）呈明显正相关.强化血糖控制后BNP,Hcy明显低于治疗前（P〈0.05）.结论]DN患者BNP和Hcy水平显著升高,血清BNP和Hcy水平对预测DN的发生发展,病程有较好的价值.

Relationship Between Serum Levels of Brain Natriuretic Peptide and Homocysteine and Blood Glucose in Patients with Type 2 Diabetic Nephropathy

Objective] To explore the relationship between serum levels of brain natriuretic peptide（BNP）, homocysteine（Hcy） and the degree of diabetic nephropathy（DN）, and to analyze the changes of BNP and Hey after intensive glucose control. Methods] Totally 88 DN patients were randomly chosen. According to 24h-urinary albumin（Umalb） and serum creatine（Cr）, all patients were divided into normal proteinuria group（SDN group, umalbG30mg, n =28）, early DN group（EDN group, 30mg〈umalb〈300mg, n =24）, clinical DN group（CDN group, umalb≥300mg, n =22） and chronic renal failure group（CRF group, umalb〉300mg,Cr〉110μmol/L, n = 14）. Other 28 healthy adults were selected as the control group（NC group）. Double antibody sandwich immunofluorescence was used to detect BNP and HT- Ⅱ enzyme-linked assay was used to measure the Hcy level. Results] The BNP level in EDN group, CDN group and CRF group was obviously higher than that in SDN group and NC group（ P G0.05）. The level of BNP was positively correlated with umalb（r=0.42, P G0.05） and Cr（r=0.56, P G0.05）. The Hcy level in EDN group, CDN group and CRF group was obviously higher than that in SDN group and NC group（ P G0.05）. The level of BNP was positively correlated with umalb（r=0.28, P G0.05） and Cr（r=0.46, P G0.05）. The levels of BNP and Hey after intensive glucose control were significantly lower than those before treatment（ P G0.05）. Conclusion] The levels of BNP and Hey significantly increase in DN patients. Serum levels of BNP and Hcy have good value for predicting the occurrence, development and course of DN.