·糖尿病性肾脏疾病·

　　【摘要】 目的 探讨血糖稳定性对新诊断T2DM患者早期糖尿病慢性肾脏疾病(CKD)的影响。 方法 对105例新诊断T2DM患者采用99mTc-DTPA肾动态显像法检测肾小球滤过率(GFR)，并结合UAlb检测结果分为高GFR无UAlb(HG)组、高GFR伴UAlb(HG+UAlb)组、正常GFR伴UAlb(NG+UAlb)组、正常GFR无UAlb(Con)组，检测各组相关指标并比较。 结果 (1)NG+UAlb组DBP高于其他各组(P<0.05);HbA1c在Con、NG+UAlb、HG、HG+UAlb组逐渐升高(P<0.05);HOMA-IR在Con、NG+UAlb、HG+UAlb、HG组逐渐升高(P<0.05);血糖水平标准差(SDBG)、日内平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)在Con、HG、HG+UAlb、NG+UAlb组逐渐升高(P<0.05)。(2)相关分析示，CKD患者GFR与HOMA-IR、HbA1c呈正相关(r=0.541、0.472，P<0.05)，与SDBG、MAGE、MODD呈负相关(r=-0.600、-0.913、-0.850，P<0.05)。(3)回归分析示，CKD患者GFR的影响因素是HOMA-IR、HbA1c、MAGE、MODD(β=0.425、0.242、-0.252、-0.217，P=0.001、0.001、0.004、0.030)。 结论 早期CKD患者中HbA1c、HOMA-IR与GFR呈正相关，而MAGE、MODD与GFR呈负相关。

　　【关键词】 糖尿病慢性肾脏疾病;肾小球滤过率;血糖稳定性;糖尿病，2型

Influence of glycemic stability on early diabetic chronic kindey disease in newly diagnosed type 2 diabetes mellitus LI Hong, TANG Zheng-yi .Department of Endocrinology, Zhangjiagang Hospital Of Traditional Chinese Medicine, Nanjing226001, China

Corresponding author: TANG Zheng-yi

　　【Abstract】 Objective To discuss the effect of glycemic stability on early status of diabetic chronic kindey disease (CKD) in newly diagnosed type 2 diabetes mellitus. Methods Glomerular filtration rate(GFR) were measured by 99mTc-DTPA, renal dynamic imaging, and urinary albumin(MA) were also tested. 105 newly diagnosed T2DM were categorized into NG, HG, HG+MA and NG+MA group, with 28 cases, 25 cases, 20 cases, 32 cases respectively. The detective values of relevant indicators were compared. Result (1)After comparison, there were no differences in age, SBP, BMI, TC, TG, HDL-C, LDL-C among four groups(P>0.05), but DBP was highest in NG+MA group than in any othor groups (P<0.05); HbA1c was increased progressively from Control to NG+MA to HG to HG+MA group(P<0.05); HOMA-IR was increased progressively from Con to NG+MA to HG+MA to HG group(P<0.05); SDBG、MAGE、MODD were increased progressively from Conto HG to HG+MA to NG+MA group(P<0.05), but SDBG between group HG+MA and NG had no difference. (2)The correlation analysis indicated that HOMA-IR and HbA1c were positively correlated with GFR of CKD patients(P<0.05), and SDBG、MAGE、MODD were negatively related with GFR(P<0.05); (3) Stepwise multivariable regression analysis showed that HOMA-IR、HbA1c、MAGE、MODD were independent correlation factors of GFR in CKD(β=0.425,0.242,-0.252,-0.217，P=0.001,0.001,0.004,0.030), respectively. Conclusion In early CKD patients , HbA1cand HOMA-IR have positive correlation with GFR, but MAGE and MODD are negatively related to GFR.

　　【Key word】 Diabetic kidney disease;Glomerular filtration rate;Glycemic stability;Diabetes mellitus,type 2