·糖尿病性肾脏疾病·

　　乐岭 向光大 赵林双 孙慧伶

　　作者单位：430070武汉，广州军区武汉总医院内分泌科

　　【摘要】目的探讨糖尿病性肾脏疾病(DKD)IV期患者的血管内皮功能及其影响因素。方法选取2006—2008年在我院住院的T2DM肾病IV期患者70例，记录病程，检测FPG、FIns、HbA1c、血脂，超声测定肱动脉血管内径、基础血流、内皮依赖性血管舒张功能及硝酸甘油介导的血管舒张功能，99mTc-二乙三胺五乙酸ECT法测定肾小球滤过率(GFR)，并与同期住院的30例无微血管并发症的T2DM患者(对照组)进行比较。结果DKD IV期患者内皮依赖性血管内径变化为(2.93±0.73)%，低于对照组,其变化与HDL-C、HOMA-β、GFR呈正相关，与饮食中蛋白质含量、糖尿病病程、HbA1c、24h UAlb、HOMA-IR呈负相关。结论DKD IV期已存在明显的内皮功能受损，高蛋白饮食是其重要的影响因素之一。

　　【关键词】糖尿病性肾脏疾病;舒张功能;高蛋白饮食

　　doi:10.3969/j.issn.1006-6187.2012.02.007

　　Changes of vascular endothelial function in diabetic kidney disease and its influential factorsYUE Ling， XIANG Guang-da， ZHAO Lin-shuang，et al.Department of Endocrinology, Wuhan General Hospital of Guangzhou Millitary Command, Wuhan 430070 , China

　　【Abstract】ObjectiveTo observe the vascular endothelial function in patients with stage IV type 2 diabetic kidney disease (DKD) and its influential factors. Method70 patients with stage IV DKD (Ⅳ-DKD) in our hospital from 2006-2008 were chosen， for collecting the course of diseases, fasting blood glucose, serum insulin, glycosylated hemoglobin and blood lipids. The vessel diameter of brachial artery, baseline blood flow, endothelium-dependent vascular relaxing function and nitroglycerin-mediated vascular relaxing function were determined by ultrasound. Then these parameters were compared between Ⅳ-DKD and 30 control patients with type 2 diabetes but without vascular complications.ResultThe EDVD (Endotheliun-dependent vasodilation) was impaired in Ⅳ-DKD versus control group [(2.93±0.73)% vs(4.61±0.52)%, P<0.01], and was positively correlated with HDL-C, HOMA-β and eGFR, negatively correlated with diatary protein content, course of diabetes, HbA1c, UAER and HOMA-IR. ConclusionThere exists obvious endothelial function impairment in stage IV type 2 diabetic kidney disease. High protein diet is one of important impairing factors.

　　【Key words】Diabetic kidney disease; Diastolic function; High protein diet