【作者】 周密；

【导师】 龙兆丰；

【作者基本信息】 中南大学 ， 老年医学， 2011， 硕士

【摘要】 研究目的：本研究旨在测定老年糖尿病患者中血清脂肪酸结合蛋白(FABP)水平,分析糖尿病肾病患者FABP的变化及其他相关指标间的关系。探讨其对糖尿病肾病的预测的价值。材料和方法：选取2009年05月至2010年10月我院老年科住院的2型糖尿病患者51例,对照组15例。将51例糖尿病患者按照不同尿蛋白排泄率水平分为3组,临床蛋白尿组11例(UAER>200μg/min)、微量蛋白尿组19例(20μg≤UAER≤200μg/min)、正常蛋白尿组21例(UAER< 20μg/min),15例非糖尿病为对照组,酶联免疫分析法(ELISA法)测定脂肪酸结合蛋白(FABP),分析FABP的变化及与体重指数(BMI)、血脂、游离脂肪酸(N-EFA)、空腹血糖(FBS)、空腹胰岛素(FINS).血肌酐(Scr)、胰岛素抵抗指数(HOMA-IR),尿蛋白排泄率(UAER),内生肌酐清除率(Ccr)、肾小球滤过率(GFR)的关系。结果：1、一般资料比较：糖尿病各组及对照组一般资料均无统计学差异(P>0.05)。2、不同尿蛋白排泄率水平组FABP有统计学差异(P<0.05)。FABP与UAER呈正相关(P<0.05)。3、FABP与体重指数呈正相关(P<0.05),FABP与年龄、糖尿病病程、收缩压、舒张压均无相关性(P>0.05)。4、糖尿病各组及对照组比较,TG、N-EFA均有统计学差异(P<0.05)。糖尿病各组FBS无统计学差异。各组患者TC、HDLLDL无统计学差异(P>0.05)。FABP与N-EFA、TG呈正相关,与HDL呈负相关(P<0.05),与FBS、TC、LDL无相关性(P>0.05)。5、各组Scr、Ccr、GFR比较均有统计学差异(P<0.05)。FABP与Scr、Ccr、FR均无相关性(P>0.05)。6、各组FINS、HOMA-IR比较均有统计学差异(P<0.05),FABP与FINS、HOMA-IR呈正相关(P<0.05)。7、多元线性回归分析显示：FABP与NEFA、TG、BMI的关系密切,标准化回归系数分别为：0.608,0.277,0.105,P值0.000,0.009,0.045。UAER与N-EFA、FBS、HOMA-IR关系密切,标准化回归系数分别为：0.387,0.295,0.495,P值0.040,,0.032,0.000。8、相对危险度分析显示：该人群FABP中位数为13.175ng/ml, FABP高值组(FABP>13.175ng/ml)患糖尿病肾病风险是低值组(FABP<13.175 ng/ml)患糖尿病肾病风险的4.033倍(95%CI=1.445-11.257,P=0.008)。结论：1、糖尿病肾病患者FABP浓度升高,FABP与游离脂肪酸、肥胖、脂质代谢紊乱、胰岛素抵抗等相关。2、FABP浓度的升高可能增加了老年糖尿病患者肾病的风险。更多还原

【Abstract】 ObjectivesTo determine the expression of serum FABP in elderly patients with diabetes, locate the contacts of the change of FABP and diabetic nephropathy related biochemical indicators and discuss the prediction value in diabetic nephropathy.Materials and Methods51 cases of elderly endocrinologlst hospitalized patients with type 2 diabetes were recruited from May 2009 to October 2010, and 15 cases without diabetes as the control group.51 cases of diabetes were divided into three groups in accordance with different urinary albumin excretion rates,11 cases with clinical proteinuria (UAER>200μg/min),19 cases with microalbuminuria (20μg/min≤UAER≤200μg/min),21 cases with normal albuminuria (UAER<20μg/min),15 cases of patients without diabetes as the control group. Determined the Fatty acid binding protein(FABP) by Enzyme-linked immunosorbent assay(ELISA), analysis the relationship between FABP and Body mass index(BMI), Blood fat, Non-esterified fatty acid (NEFA), Fast blood sugar(FBS), Fasting insulin(FINS), Insulin resistance index(HOMA-IR), Urinary albumin excretion rate(UAER), Serum creatinine (Scr), creatinine clearance (Ccr) and Glomerular filtration rate (GFR),Results:(1) General information Comparison:The general information among three diabetic groups and control group are not significant. (P>0.05).(2) The FABP among four groups is statistically significant (P<0.05). FABP is positively correlated with UAER(P<0.05).(3) FABP is positively correlated with BMI (P<0.05). FABP has no correlations with age, duration of diabetes, Systolic blood pressure and diastolic pressure (P> 0.05).(4) The TG, N-EFA among three diabetics and control group are statistically significant (P<0.05). The FBS is not significant among three diabetics. The TC, HDL, LDL are not statistically significant among four groups(P>0.05). FABP is positively correlated with TG, N-EFA(P<0.05), and HDL-C negatively correlated (P<0.05), FABP has no significant correlations with TC, LDL-C (P> 0.05).(5) The Scr. Ccr. GFR are statistically significant (P<0.05).FABP has no significant correlations with Scr, Ccr, GFR(P>0.05).(6) The FINS, HOMA-IR are statistically significant (P<0.05). FABP is positively correlated with FINS, HOMA-IR(P< 0.05).(7) Multiple linear regression analysis shows that:FABP is closely related to NEFA, TG, BMI. Standardized regression coefficients are respectively:0.608,0.277,0.105, P value:0.000,0.009,0.045. UAER is closely related EFA, FBS, HOMA-IR. Standardized regression coefficients are respectively:0.387,0.295,0.495, P value:0.040,0.032, 0.000.(8) Relative risk analysis shows that:The median of FABP is 13.175ng/ml in this population. The risk of FABP high-value group (FABP>13.175ng/ml) suffer diabetic nephropathy is 4.033 times than low-value group(FABP<13.175ng/ml).(95%CI=1.445-11.257, P=0.008)Conclusions:(1) FABP elevates in diabetic patients with diabetic nephropathy, FABP has close relations with the free fatty acid, obesity, lipid metabolism, insulin resistance, etc.(2) As the risk factors increases, the increase of fatty acid binding protein increases the risk of diabetic nephropathy of elderly diabetic patients.更多还原