早期糖尿病肾病尿蛋白排泄率相关因素及中医证型分析

Analysis on Relationship of Chinese Medicine Syndrome Pattem with Urinary Albumin Excretion Rate and Its Related Factors in Early Stage Diabetic Nephropathy

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中文关键词: 糖尿病肾病尿蛋白排泄率亚甲基四氢叶酸还原酶同型半胱氨酸中医证型

英文关键词:diabetic nephropathy urinary albumin excretion rate methylene tetrahydrofolate reductase homocysteine Chinese medicine syndrome pattern

基金项目:国家自然科学基金资助项目(No.30672763)

作者	单位
林兰	中国中医科学院广安门医院内分泌科
郭小舟	中国中医科学院广安门医院内分泌科
李敏	中国中医科学院广安门医院内分泌科
龚燕冰	中国中医科学院广安门医院内分泌科
王斌	中国中医科学院广安门医院内分泌科
刘颖	中国中医科学院广安门医院内分泌科

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中文摘要:

目的探讨早期糖尿病肾病(diabetic nephropathy,DN)尿蛋白排泄率(urinary albumin excretionrate,UAER)与亚甲基四氢叶酸还原酶(MTHFR)的C677T突变、同型半胱氨酸(Hcy)、叶酸、糖化血红蛋白(HbA1 c)、血糖、血脂及中医证型的关系。方法检测63例早期DN患者MTHFR基因的677碱基多态性情况,测定血浆Hcy、叶酸、空腹血糖、餐后血糖、HbA1 c、UAER及血脂,并记录患者的中医辨证证型。结果 63例早期糖尿病肾病患者中17例辨证为阴虚热盛、24例辨证为气阴两虚、22例辨证为阴阳两虚,其中35例兼血瘀证。63例患者MTHFR基因的677碱基多态性情况:CC型19例,TT型17例,CT型27例。兼血瘀证的患者具有更高的UAER水平,差异有统计学意义(P<0.05)。不同基因型的UAER差异无统计学意义,不同基因型组间两两比较差异也无统计学意义(P>0.05)。UAER与Hcy的水平具有线性回归关系,为正相关(r=0.674,P<0.05),具有统计学意义,与叶酸、血糖、HbA1 c等其他因素相关性无统计学意义(P>0.05)。结论阴虚热盛、气阴两虚、阴阳两虚组间UAER比较差异无统计学意义,兼血瘀证的患者具有更高的UAER水平。UAER与Hcy的水平具有线性回归关系,为正相关。

英文摘要:

Objective To investigate the relationship of Chinese medicine syndrome pattern with urinary albumin excretion rate(UAER) and its related factors In patients with diabetic nephropathy(DN ).Methods Sixty-three early stage DN patients were subjected to the study,the Chinese medicine syndrome patterns were differentiated,and their condition of methylene tetrahydrofolate reductase(MTHFR) C677T mutation was detected(shown by gene polymorphism of 677 base pairs).Meantime,plasma levels of homocysteine(Hcy), folic acid,fasting and postprandial glucose(FG and PG),glycohemoglobin(HbA1c),blood lipids as well as UAER were measured.Results Syndrome pattern was differentiated as yin-deficiency with heat-flourishing in 17 patients,qi-yin deficiency in 24,and yin-yang deficiency in 22;while accompanied blood stasis syndrome(BSS) was found in 35.Gene polymorphism detection indicated that 19 patients were of CC-type,17 of TT-type,and 27 of CT-type.Analysis showed that higher UAER level often revealed in patients with BSS,as compared with that in patients of non-BS pattern,the difference was statistically significant(P<0.05).UAER levels in patients of different genotypes were insignificantly different(P>0.05),but showed a linear regressive relation,namely positively correlated with Hcy level in patients of isogeneic type(r = 0.674,P<0.05).No statistical significance was found between levels of UAER and other related factors(P>0.05).Conclusion UAER level in early stage DN patients of BSS pattern is rather higher,and it shows a linear regression relationship(positive correlation) with Hcy level in patients of isogeneic type.

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