【摘要】  目的    观察二甲双胍(Met)对T2DM患者尿单核细胞趋化蛋-1(MCP-1)排泄的影响，探讨其肾脏保护作用。 方法 121例T2DM患者(T2DM组)根据抗糖尿病治疗方案分为胰岛素治疗(Ins)治疗组和磺脲类治疗(SUs)治疗组，上述两组再根据分别分为Ins治疗亚组和Ins联合Met治疗亚组,以及SUs 治疗亚组和SUs联合Met治疗亚组，另选择24名健康对照(NGT) 组，比较各组FPG、2 hPG、HbA1c、UACR和尿MCP-1/肌酐比(UMCR)等指标。  结果   与NC组比较，T2DM组FPG [（4.85±0.10) vs (7.21±0.14） mmol/L]、2 hPG [（5.24±0.22) vs (9.71±0.31） mmol/L]、HbA1c[（5.22±0.06) % vs (7.03±0.10）%]、尿白蛋白/肌酐(UAlb/Cr) [（13.63±1.03) vs (27.68±3.99）mg/g]和UMCR [（30.71±1.83) vs (95.96±17.10）pg/ng]升高(P<0.05)；与Ins治疗亚组比较，Ins联合Met治疗亚组UACR[（42.96±6.24) vs (10.48±1.98）mg/g]和UMCR[（116.2±10.47) vs (27.42±4.45）pg/ng]降低(P<0.05)；与SUs 治疗亚组比较，SUs联合Met治疗亚组UACR [（52.43±7.80) vs (18.31±5.70）mg/g]和UMCR [（240.8±12.77) vs (53.58±8.11） pg/ng]降低 (P<0.05)。相关分析显示，T2DM患者UMCR与UACR呈正相关(r=0.79, P<0.01)。 结论   Met可减少T2DM患者尿MCP-1的排泄，该作用可能与其肾脏保护有关。

    【关键词】  二甲双胍；糖尿病,2型；糖尿病肾病；单核细胞趋化蛋-1

   The effect of Metformin on urinary MCP-1 excretion in patients with type 2 Diabetes 

  【Abstract】 Objective  To investigate the effect of Metformin on urinary MCP-1 excretion in patients with T2DM and explore its possible reno-protective mechanisms.  Methods  A total of 121 T2DM patients were enrolled in this study and divided into two groups: insulin treatment group and sulfonylurea treatment group. Then the two groups were further divided into four subgroups according to combination of Metformin: Ins-I(insulin only)，Ins-II (insuin+Met), SUs-I(SUs only) and SUs -II(SUs +Met) subgroup. Healthy subjects were selected as the normal control group (NC group, n=24).FPG,2 hPG,HbA₁c, urinary albumin to creatinine(UACR) and urinary MCP-1 to creatinine (UMCR) were measured in all subjects.  Results  FPG [（4.85±0.10）vs (7.21±0.14) mmol/L], 2 hPG [（5.24±0.22）vs (9.71±0.31) mmol/L], HbA₁c[（5.22±0.06）vs (7.03±0.10) %], UACR [（13.63±1.03）vs (27.68±3.99) mg/g]and UMCR [（30.71±1.83）vs (95.96±17.10) pg/ng] were all increased in T2DM patients than in NC group(P<0.05). UACR(10.48±1.98)vs(42.96±6.24) mg/g and UMCR(27.42±4.45）vs（116.2±10.47)pg/ng were significantly decreased in Ins-II group than in Ins-I group(P<0.05). UACR(18.31±5.70）,（52.43±7.80)mg/g and UMCR(53.58±8.11, 240.8±12.77)pg/ng were significantly decreased in SUs-II group than in SUs-I group. UMCR was positively associated with UACR in T2DM patients (r=0.79,P<0.01). Conclusion  Metformin can reduce the excretion of urinary MCP-1 inpatients with T2DM. This may be associated with its reno-protective effect.