胰岛素抵抗和血脂异常在老年2型糖尿病早期肾病中作用的研究

目的：探讨胰岛素抵抗（IR）、血脂异常对老年2型糖尿病（T2DM）患者早期糖尿病肾病（DN）的影响。方法：根据尿微量白蛋白排泄量（mUAE）将150例老年T2DM患者分为两组：早期DN组（病例组）和单纯糖尿病组（对照组）。对两组的mUAE、胰岛素敏感指数（ISI）、血脂等指标进行比较。结果：病例组的mUAE（115±81）mg／24h高于对照组（17±12）mg／24h（P〈0．01）。病例组的ISI（-5．49±1．07）低于对照组（-5．00±0．62）（P〈0．01）。病例组总胆固醇、甘油三酯、LDL—C分别为（4．76±1．43）mmol／L、（1．78±1．10）mmol／L、（2．39±1．00）mmo]／L，对照组的依次为（3．64±0．94）mmoL／L、（1．23±0．55）mmol／L、（2．08±0．78）mmol／L，两组上述指标比较差异具统计学意义（P〈0．01或0．05）。多元逐步Logistic回归分析显示，IR、总胆固醇、甘油三酯是老年T2DM早期DN发生的独立危险因素。结论：IR、血脂异常影响老年T2DM早期DN的发生与发展。

The effects of insulin resistance and blood lipid abnormity on early nephropathy in patients with geriatric type 2 diabetes mellitus

Objective： To study the effects of insulin resistance and blood lipid abnormity on the early nephropathy in patients with geriatric type 2 diabetes mellitus （T2DM）. Methods： One hundred and fifty patients of geriatric T2DM were divided into early nephropathy group （DN group） and non-nephropathy group （DM group）. The microalbuminuria urine albumin excretion （mUAE）, insulin sensitivity index （ISI） and blood lipid were analyzed. Results： The mUAE of DN group [ （ 115 ＋ 81 ） mg/24 h） ] was significantly higher than that of DM group [ （ 17 ± 12） mg/24 h, P 〈0. 01 ]. Meanwhile, the ISI of DN group （ -5.49 ± 1.07） was significantly lower than that of DM group （-5.00 ±0. 62, P 〈0. 01 ）. The total cholesterol （TC）, triglyceride （TG） and low density lipoprotein cholesterol （LDL-C） were （4. 76 ± 1.43） mmol/L, （ 1.78 ± 1.10） mmol/L and （2. 39 ± 1.00） mmol/L in DN group, respectively, while they were （3.64 ± 0. 94） mmol/L, （ 1.23 ± 0. 55 ） mmol/L and （2. 08 ± 0. 78 ） mmol/L, respectively, in the DM group, with significant differences between the 2 groups （ P 〈 0. 05 ）. According to multivariate stepwise logistic regression analysis, the IR, TC and TG were the independent risk factors associated with early nephropathy in geriatric T2DM. Conclusion： Insulin resistance and blood lipid abnormity affect the pathogenesis Of early nephropathy in geriatric T2DM.