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目的:观察不同期DN患者肾小球电荷屏障的变化及与Hb A1c相关性。方法:80例DM住院患者分为4组:DM正常白蛋白尿组(n=20)、DNⅢ期组(n=20),DNⅣ期组(n=20)和DNⅤ期组(n=20),另选性别、年龄大致相匹配的健康志愿者作为健康对照组(n=20)。测定各组血清和尿液中胰淀粉酶、唾液粉酶含量,比较各组胰淀粉酶清除率(CPAM)与唾液淀粉酶清除率(CSAM)的比值(CPAM/CSAM),评估各组肾小球电荷屏障的变化情况。应用双变量线性相关分析CPAM/CSAM与Hb A1c的相关性。结果:各组中CPAM/CSAM值DM正常白蛋白尿组、DNⅢ期组和DNⅣ组间两两比较差异均有统计学意义(P<0.05);DM正常白蛋白尿组与健康对照组间差异无统计学意义(P>0.05),DNⅣ期组与DNⅤ期组间差异无统计学意义(P>0.05)。CPAM/CSAM值与Hb A1c具有负相关性(r=-0.78,P<0.05)。结论:DM患者随着DN病程的进展,肾小球电荷屏障损伤逐渐加重,降低Hb A1c或能延缓肾小球电荷屏障的损伤。
OBJECTIVE: To observe the changes of glomerular charge barrier and the relationship with Hb A1c in patients with different stages of DN. Methods: Eighty hospitalized patients with DM were divided into four groups: DM normal albuminuria group (n = 20), DNⅢphase group (n = 20), DNⅣphase group (n = 20) and DNV group (n = 20) , Healthy volunteers of different sex and age were matched as healthy control group (n = 20). The contents of pancreatic amylase and salivary amylase in serum and urine of each group were measured, and the ratio of CPAM to salivary amylase clearance (CPAM / CSAM) Ball charge barrier changes. Bivariate linear correlation analysis of correlation between CPAM / CSAM and Hb A1c. Results: There were significant differences in any pair of DM normal albuminuria group, DNⅢperiod group and DNⅣ group between CPAM / CSAM value groups in each group (P <0.05); DM normal albuminuria group and healthy control group differences There was no statistical significance (P> 0.05). There was no significant difference between DNⅣ group and DNV group (P> 0.05). CPAM / CSAM values were negatively correlated with Hb A1c (r = -0.78, P <0.05). Conclusion: With the progression of DN, the damage of glomerular charge barrier gradually aggravates, and the decrease of Hb A1c can delay the damage of glomerular charge barrier.