胰岛素抵抗和动态血压在2型糖尿病肾病中的作用

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。

The effect of insulin resistance and ambulatory blood pressure in type diabetic nephropathy

Objective To study the impact of insulin resistance and ambulatory blood pressure on type 2 diabetic nephropathy through detecting Urinary type IV collagen （IV-C）—a new early diagnostic marker of diabetic nephropathy.Methods Ninety patients with 2 type diabetes were enrolled in this study.The patients were assigned to three groups：no-nephropathy group,early nephropathy group and clinical-stage nephropathy group （n=30 each） based on the urinary microalbumin excretory quantity.Thirty-four healthy subjects were selected as control group.Urinary IV-C was detected by ELISA;urinary microalbumin excretory quantity was detected by immunoturbidimetry;the insulin-sensitivity index（ISI）,some related indexes of renal function and other biochemistry were also measured;ambulatory blood pressure monitoring was made.Mentioned above indexes were compared in the four groups.Results In each diabetic group,ISI was lower than that in control group （all P0.05）.Mean blood pressures including 24-hour,in-day-time and in-night-time were higher in clinical-stage diabetic nephropathy group than those in other three groups（all P0.05）.The urinary IV-C was negatively related with the ISI but was positively related with 24-hour mean diastolic pressure,night-time blood pressure,urinary microalbumin excretory quantity,urinary α1-microglobulin,urinary β2-microglobulin and nitrogen-acetyl-β-D-glucosaminidase. Conclusions The insulin resistance and ambulatory blood pressure might affect progression of type 2 diabetic nephropathy through IV-C.