【摘要】 目的探讨胰岛素敏感性及血浆纤溶系统与肥胖2型糖尿病(T2DM)肾病患者相关性。方法对108例肥胖T2DM患者及31例健康体检者进行体格检查,采用生物电阻抗法测定其体脂含量,测定其24h尿白蛋白排泄量、血脂、空腹血糖、糖基化血红蛋白(HbA1c)及胰岛素水平、血浆组织型纤溶酶原激活物(t-PA)及其抑制物-1(PAI-1)活性和D-二聚体(D-D)水平。结果大量白蛋白尿组肥胖度、HbA1c和胰岛素敏感性指数(ISI)分别大于和小于微量白蛋白尿组和尿白蛋白正常组(均P<0.05)与正常对照者比较,肥胖T2DM患者血浆PAI-1活性明显升高(均P<0.05),大量白蛋白尿组更明显;糖尿病肾病患者血浆t-PA活性及大量白蛋白尿组D-D水平大于正常对照者(P<0.05,P<0.01)。多因素逐步回归分析显示,PAI-1活性与BMI、腰围及血清TG水平呈正相关,与ISI呈负相关。结论肥胖T2DM肾病患者尤其是向心性者血浆PAI-1活性及D-D水平明显增加,而t-PA活性减低,并随着肾病的加重而增加,与肥胖程度呈正相关、与ISI呈负相关。更多还原

【Abstract】 Objective To investigate the relationship between minim albumin insulin sensitivity and fibrinolysis system in patients with obese type 2 diabetic (OBDM)nephropathy.Methods Total 108 patients with OBDM and 31 cases of healthy control were accepted physical examination.Total excretion of urine albumin of all day (24 h UAE),fast serum glucose,blood lipid, HbA1c levels,plasma tissue plasminogen activator (t-PA) activity,plasminogen activator inhibitor-1 (PAI-1) activity and D-dimer (D-D) concentration were assayed in all the cases.Results The degree of obesity (especially central obesity),concentration of HbA1c and insulin sensitivity index (ISI) in OBDM nephropathy patients with mass-excretion of urine albumin were more and less than those in OBDM nephropathy patients with a little and normal excretion of urine albumin (P<0.05,respectively).Plasma PAI-1 activity in patients with OBDM was more than that in normal control group (P<0.05,respectively),especially in group with mass-excretion of urine albumin.Plasma t-PA activity of OBDM patients and D-D levels of patients with mass-excretion of urine albumin were higher than that of normal control group (P<0.05,P<0.01).Stepwise multivariate analysis showed that plasma PAI-1 activity was correlated positively with body mass index (BMI),waistline and serum triglyceride levels,negatively with ISI respectively.Conclusion PAI-1 activity and D-D levels increase but t-PA activity decrease significantly in patients with OBDM,especially in the central OBDM,and the tendency parallel with the course of diabetic nephropathy and the degree of central obesity,but plasma PAI-1 activity correlates negatively with ISI.更多还原