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目的:观察二甲双胍(metformin,Met)对2型糖尿病(type 2 diabetes mellitus,T2DM)患者尿肿瘤坏死因子(tumor necrosis factor,TNF)-α排泄的影响,探讨其可能的肾脏保护作用。方法 :121例T2DM患者(DM组)根据抗糖尿病治疗方案分为胰岛素(insulin,INS)组和磺脲类(sulfonylurea,SU)组,再根据是否联合Met各分2个亚组(INS-Ⅰ组,INS未联合Met,INS-Ⅱ,INS联合Met;SU-Ⅰ组,SU未联合Met,SU-Ⅱ组,SU联合Met),同期选择安徽医科大学附属省立医院体检中心24例健康体检人员作为正常对照组(NC组),比较DM组和NC组及DM各亚组间空腹血浆葡萄糖(fasting blood glucose,FBG)、OGTT试验2 h葡萄糖(postprandial blood glucose,PBG)、糖化血红蛋白A1c(glycated haemoglobin A1c,Hb A1c)、病程、体重指数、血压、血肌酐、尿白蛋白、尿TNF-α排泄的变化。结果:1DM组FBG、PBG、Hb A1c、尿TNF-α肌酐比(urinary TNF-α/creatinine ratio,UTCR)、尿白蛋白肌酐比(urinary albumin/creatinine ratio,UACR)水平较NC组明显升高;2与INS-Ⅰ组相比,INS-Ⅱ组UTCR和UACR明显降低,差异有统计学意义(P<0.05);与SU-Ⅰ组相比,SU-Ⅱ组UTCR和UACR明显降低(P<0.05);3T2DM患者UTCR与UACR呈显著性正相关(r=0.73,P<0.01)。结论:Met可减少T2DM患者尿TNF-α的排泄,该作用可能与其肾脏保护作用有关。
Objective: To observe the effect of metformin (Metformin) on the excretion of urinary tumor necrosis factor (TNF) -α in type 2 diabetes mellitus (T2DM) patients and explore the possible protective effect of metformin on renal excretion. Methods: One hundred and twelve T2 DM patients (DM group) were divided into insulin group and sulfonylurea group according to anti-diabetic treatment regimen. SU-Ⅰ group, SU not combined with Met, SU-Ⅱ group, SU combined with Met), 24 cases of health examination at the Provincial Medical Center of Anhui Medical University (NC group). The fasting blood glucose (FBG), postprandial blood glucose (PBG), hemoglobin A1c glycated hemoglobin A1c, Hb A1c), course of disease, body mass index, blood pressure, serum creatinine, urinary albumin and urinary TNF-α excretion. Results: The levels of FBG, PBG, Hb A1c, urinary TNF-α / creatinine ratio (UTCR) and urinary albumin / creatinine ratio (UACR) in 1DM group were significantly higher than those in NC group ; 2 Compared with INS-Ⅰ group, the UTC-R and UACR of INS-Ⅱ group were significantly lower than those of INS-Ⅱ group (P <0.05); Compared with SU-Ⅰ group, <0.05). There was a significant positive correlation between UTCR and UACR in 3T2DM patients (r = 0.73, P <0.01). Conclusion: Met can reduce urinary TNF-α excretion in T2DM patients, which may be related to its renal protective effect.