血清同型半胱氨酸、超敏C反应蛋白、胆红素水平与2型糖尿病肾病的相关性
| 作者: |
1代闪,
1陈琰,
1白倩,
1吕玲,
1王彦君
1 吉林大学第二医院内分泌科，长春 130000 |
| 通讯: |
王彦君
Email: jdeywyj1966@126.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.09.011 |
| 基金: | 吉林省科技厅优秀青年基金(20180520122JH)。 |
摘要
目的：分析血清同型半胱氨酸(homocysteine，Hcy)、超敏C反应蛋白(high-sensitivity C-reactive protein，hs-CRP)及胆红素(bilirubin，Bil)水平与2型糖尿病肾病(diabetic kidney disease，DKD)的关系及其临床意义。方法：将173例2型糖尿病患者根据尿微量白蛋白/尿肌酐(urinary albumin/creatinine ratio，UACR)水平分为正常白蛋白尿组(<30 mg/g，n=81)、微量白蛋白尿组(30 mg/g≤UACR<300 mg/g，n=55)和大量白蛋白尿组(≥300 mg/g，n=37)。比较入组患者的一般临床资料及相关血清生化指标[空腹血糖(fasting blood-glucose，FPG)、糖化血红蛋白(HbA1c)、三酰甘油(triglyceride，TG)、总胆固醇(total cholesterol，TC)，高密度脂蛋白胆固醇(high-density lipoprotein cholesterol，HDL-C)、低密度脂蛋白胆固醇(low-density-lipoprotein cholesterol，LDL-C)、Hcy，hs-CRP，Bil]。应用非条件logistic回归模型分析DKD的危险因素。应用Pearson相关分析血清总胆红素(total bilirubin，TBil)，hs-CRP，Hcy之间的相关性，以及三者与UACR的相关性。结果：单因素分析结果显示：随着UACR水平的增加，Hcy，hs-CRP水平逐渐升高，而TBil水平逐渐下降，差异有统计学意义(P<0.05)。Pearson相关分析结果显示：TBil与UACR呈负相关(分别r=−0.225，P=0.025)，而Hcy，hs-CRP与UACR呈正相关(分别r=0.208，r=0.259；P=0.006，P=0.001)；TBil与hs-CRP，Hcy呈负相关(r=−0.184，r=−0.188；P=0.016，P=0.013)；hs-CRP与Hcy呈正相关(r=0.170，P=0.025)。非条件logistic回归分析结果显示：TBil是DKD的保护性因素(OR=0.921，P=0.035)，LDL-C，HbA1c，hs-CRP是DKD的独立危险因素(OR=1.43，OR=1.313，OR=1.135；P=0.029，P=0.040，P=0.043)。结论：血清Hcy，hs-CRP，TBil可能会成为预测早期DKD发生的敏感指标。
关键词：
2型糖尿病；糖尿病肾病；同型半胱氨酸；超敏C反应蛋白；胆红素
Serum homocysteine, high-sensitivity C-reactive protein, bilirubin level and type 2 diabetic kidney disease
CorrespondingAuthor: WANG Yanjun Email: jdeywyj1966@126.com
DOI: 10.3978/j.issn.2095-6959.2019.09.011
Foundation: This work was supported by the Excellent Youth Fund Project of Jilin Science and Technology Department, China (20180520122JH).
Abstract
Objective: To analyze the relationship between serum homocysteine (Hcy), hypersensitivity c reactive protein (hs-CRP), bilirubin (Bil) and type 2 diabetic kidney disease (DKD) and these three indexes clinical significance. Methods: A total of 173 patients with type 2 diabetes mellitus were selected as research subjects. According to the level of urinary microalbuminuria/creatinine (UACR), research subjects were divided into a normal albuminuria group (UACR <30 mg/g, n=81), a microalbuminuria group (30 mg/g ≤ UACR <300 mg/g, n=55) and a hyper albuminuria group (UACR ≥300 mg/g, n=37). The general clinical data and serum biochemical indexes [fasting blood-glucose (FPG), HbA1c, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density-lipoprotein cholesterol (LDL-C), Hcy, hs-CRP, Bil] of all patients were compared by SPSS 22.0. Non-conditional logistic regression model was used to analyze the risk factors of DKD. The correlations of serum total bilirubin (TBil), hs-CRP and Hcy and their correlations with UACR were analyzed by Pearson correlation analysis. Results: The results of univariate analysis showed that the level of Hcy, hs-CRP increased and the level of TBil decreased with the increase of UACR level, the difference was statistically significant (P<0.05). Pearson correlation analysis showed that there was a negative correlation between TBil and UACR (r=−0.225, P=0.025), while positive correlations were found between Hcy, hs-CRP and UACR (r=0.208, r=0.259; P=0.006, P=0.001). There were negative correlations between TBil and hs-CRP, Hcy (r=−0.184, r=−0.188; P=0.016, P=0.013), and a positive correlation between hs-CRP and Hcy (r=0.170, P=0.025). Non-conditional logistic regression analysis showed that TBil was the protective factor (OR=0.921, P=0.035) of DKD and LDL, HbA1c, hs-CRP were the independent risk factors (OR=1.43, OR=1.313, OR=1.135; P=0.029, P=0.040, P=0.043) of DKD. Conclusion: Serum Hcy, hs-CRP, TBil may be the sensitive indexes of early DKD, which provides a theoretical basis for the early diagnosis and treatment of DKD.
Keywords：
type 2 diabetes mellitus; diabetic kidney disease; homocysteine; hypersensitive C-reactive protein; bilirubin