血、尿TGF β1水平与糖尿病肾病尿蛋白变化及中医证型相关性研究
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摘要
[目的]通过临床对比研究正常健康人群、DM患者、DN患者血、尿TGF β1的水平并探讨血、尿TGF β1作为糖尿病肾病气阴两虚客观性辨证指标的可能性。
[方法]收集自2011-2012年期间,江苏省中医院及江苏省省级机关医院门诊及住院的符合纳入标准的T2DM患者67例,按蛋白尿水平分为三组：尿蛋白正常组30例,微量蛋白尿组23例,大量蛋白尿组14例,尿蛋白正常组为DM组,余两组合称为DN组；按中医辨证分为气阴两虚证30例,非气阴两虚证37例；另募集正常健康人群21例。临床观察糖代谢指标：空腹血糖(FBG)、糖化血红蛋白(HbA1C);脂代谢指标：总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)。血、尿TGFβ1均采用酶联免疫吸附法测定(ELISA),血、尿TGFβ1试剂盒均购自武汉依科赛生物制品有限公司。
[结果]1.DN组气阴两虚发生率明显高于DM组(P=0.012)。2.DM气阴两虚证组年龄、血TGFβ1、尿TGFβ1、尿ACR、血肌酐均高于非气阴两虚证组,(P=0.031；P=0.008；P=0.000；P=0.000；P=0.003)。3.DN气阴两虚证组血TGFβ1、尿TGFβ1、尿ACR、血肌酐均高于非气阴两虚证组,(P=0.008；P=0.000；P=0.000；P=0.003)。4.四组血TGFβ1水平从高到低顺序为DN气阴两虚证组、DN非气阴两虚证组、DM气阴两虚证组、DM非气阴两虚证证组；尿TGFβ1从高到低顺序为DN气阴两虚证组、DM气阴两虚证组、DN非气阴两虚证组、DM非气阴两虚证组。5.DN气阴两虚证患者血清TGFβ1与尿ACR呈正相关(r=0.42,P=0.036)。DN非气阴两虚证患者血清TGFβ1、尿TGFβ1与临床指标未见明显相关性。6.DM组血TGFβ1虽较正常健康对照组升高,但无明显统计学差异(P=0.303>0.05)。尿TGFβ1较高,有显著统计学差异(P=0.022)。7.DN组血TGFβ1、尿TGFβ1、尿ACR、Cr、均显著高于DM组(P均<0.01)。DN组血清TGFβ1与尿ACR、Cr、尿TGFβ1呈正相关(r=0.631,P=0.000：r=0.709,P=0.000：r=0.653,P=0.000)。DN组尿TGFβ1与年龄、尿ACR、Cr呈正相关(r=0.281,P=0.021；r=0.906,P=0.000；r=0.842,P=0.000)。
[结论]1.DN组气阴两虚发生率明显高于DM组,气阴两虚可能提示病情的发展。2.由统计结果得出尿TGFβ1数值气阴两虚证组高于非气阴两虚证组,提示：尿TGFβ1与气阴两虚证关系密切,可作为该证辨证的客观性指标之一。3.尿TGFβ1在DM组已有明显升高,血TGFβ1较正常纠虽有升高,但无显著差异。提示尿TGFβ1升高可能与代谢紊乱导致的肾脏局部炎症有关,应早期干预,以防止DN的发生。
[Objective] Clinical comparative study of normal healthy population, the DM patients and DN patients with blood,urinary TGFFβ1level and to explore the blood, urine TGFβ1as indicators of diabetic nephropathy Qiyinliangxu objectivity of dialectical possibility.
[Methods] Collected during the period from2011to2012, the Chinese Medicine Hospital of Jiangsu Province and Jiangsu provincial authorities hospital outpatient and inpatient meet the inclusion criteria,67cases of patients with T2DM, according to the level of proteinuria is divided into three groups:30cases of patients with normal albuminuria, a small amount of protein urine in patients with23cases,14cases of massive proteinuria in patients.TCMdivided into30cases of Qi Deficiency;37cases of non-Qi Deficiency; another raise of21cases of normal healthy people. Clinical observation of indicators of glucose metabolism:fasting blood glucose (FBG), glycated hemoglobin (HbA1C); indicators of lipid metabolism:total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C). Blood, urine TGFβ1enzyme-linked immunosorbent assay (ELISA), blood, urine TGFβ1kit were purchased from Wuhan according to Kesai Biological Products Company.
[Results]1.DN group Qiyinliangxu incidence was significantly higher than the DM group (P=0.012).2.DM Qi Deficiency age group, the blood of TGFβ1, the urine of TGFβ1, the urine ACR, serum creatinine were higher than Qi Deficiency group (P=0.031; P=0.008; P=0.000; P=.000; P=0.003).3.DN Qi Deficiency group of TGFβ1blood, urine of TGFβ1, the ACR in urine, serum creatinine were higher than Qi Deficiency group (P=0.008; P=0.000; P=0.000; P=0.003).4. four groups of blood TGFβ1in descending order of DN Qi Deficiency group, the DN non-Qi and Yin deficiency syndrome group, DM Qi Deficiency group, the DM non-Qi Deficiency syndrome group; urinary TGFβ1descending order for the DN Qi Deficiency group, DM Qi Deficiency group, the DN non-Qi Deficiency group, the DM non-Qi Deficiency group.5.Qi Deficiency serum TGFβ1and urine ACR5.DN was positively correlated (r=0.42, P=0.036). DN non-Qi Deficiency of serum TGFβ1, no significant correlation between urinary TGFβ1and clinical indicators.6.DM group of blood TGFβ1, although increased compared with normal healthy control group, but no statistically significant difference (P=0.303>0.05). High urinary TGFβ1had a significant difference (P=0.022).7. DN group of blood, urine of TGFβ1, urine ACR, Cr, were significantly higher than the DM group (P<0.01). DN group, serum TGFβ1and urine the ACR, Cr, urine TGFβ1was positively correlated (r=0.631, P=0.000; r=0.709, P=0.000; r=.653,P=0.000). DN group urinary TGFβ1and age of urine to the ACR, Cr were positively correlated (r=0.281, P=0.021; r=0.906, P =0.000;r=0.842,P=0.000).
[Conclusions]1.the DN Qiyinliangxu incidence was significantly higher than the DM group, prompt Qiyinliangxu may be prompted to the development of the disease.2.Urine the TGFβ1value Qi Deficiency group than the non-Qi Deficiency group, derived from the statistical results Tip:urinary TGFpl and are closely related to Qi Deficiency, dialectical objectivity of one of the indicators can be used as the certificate.3.Urinary TGFβ1in DM have been significantly increased blood TGFβ1compared with the normal group, although elevated, but no significant difference. Prompted elevated urinary TGFβ1reflect kidney inflammation caused by metabolic disorders, early intervention, to prevent the occurrence of the DN.
[方法]收集自2011-2012年期间,江苏省中医院及江苏省省级机关医院门诊及住院的符合纳入标准的T2DM患者67例,按蛋白尿水平分为三组：尿蛋白正常组30例,微量蛋白尿组23例,大量蛋白尿组14例,尿蛋白正常组为DM组,余两组合称为DN组；按中医辨证分为气阴两虚证30例,非气阴两虚证37例；另募集正常健康人群21例。临床观察糖代谢指标：空腹血糖(FBG)、糖化血红蛋白(HbA1C);脂代谢指标：总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)。血、尿TGFβ1均采用酶联免疫吸附法测定(ELISA),血、尿TGFβ1试剂盒均购自武汉依科赛生物制品有限公司。
[结果]1.DN组气阴两虚发生率明显高于DM组(P=0.012)。2.DM气阴两虚证组年龄、血TGFβ1、尿TGFβ1、尿ACR、血肌酐均高于非气阴两虚证组,(P=0.031；P=0.008；P=0.000；P=0.000；P=0.003)。3.DN气阴两虚证组血TGFβ1、尿TGFβ1、尿ACR、血肌酐均高于非气阴两虚证组,(P=0.008；P=0.000；P=0.000；P=0.003)。4.四组血TGFβ1水平从高到低顺序为DN气阴两虚证组、DN非气阴两虚证组、DM气阴两虚证组、DM非气阴两虚证证组；尿TGFβ1从高到低顺序为DN气阴两虚证组、DM气阴两虚证组、DN非气阴两虚证组、DM非气阴两虚证组。5.DN气阴两虚证患者血清TGFβ1与尿ACR呈正相关(r=0.42,P=0.036)。DN非气阴两虚证患者血清TGFβ1、尿TGFβ1与临床指标未见明显相关性。6.DM组血TGFβ1虽较正常健康对照组升高,但无明显统计学差异(P=0.303>0.05)。尿TGFβ1较高,有显著统计学差异(P=0.022)。7.DN组血TGFβ1、尿TGFβ1、尿ACR、Cr、均显著高于DM组(P均<0.01)。DN组血清TGFβ1与尿ACR、Cr、尿TGFβ1呈正相关(r=0.631,P=0.000：r=0.709,P=0.000：r=0.653,P=0.000)。DN组尿TGFβ1与年龄、尿ACR、Cr呈正相关(r=0.281,P=0.021；r=0.906,P=0.000；r=0.842,P=0.000)。
[结论]1.DN组气阴两虚发生率明显高于DM组,气阴两虚可能提示病情的发展。2.由统计结果得出尿TGFβ1数值气阴两虚证组高于非气阴两虚证组,提示：尿TGFβ1与气阴两虚证关系密切,可作为该证辨证的客观性指标之一。3.尿TGFβ1在DM组已有明显升高,血TGFβ1较正常纠虽有升高,但无显著差异。提示尿TGFβ1升高可能与代谢紊乱导致的肾脏局部炎症有关,应早期干预,以防止DN的发生。
[Objective] Clinical comparative study of normal healthy population, the DM patients and DN patients with blood,urinary TGFFβ1level and to explore the blood, urine TGFβ1as indicators of diabetic nephropathy Qiyinliangxu objectivity of dialectical possibility.
[Methods] Collected during the period from2011to2012, the Chinese Medicine Hospital of Jiangsu Province and Jiangsu provincial authorities hospital outpatient and inpatient meet the inclusion criteria,67cases of patients with T2DM, according to the level of proteinuria is divided into three groups:30cases of patients with normal albuminuria, a small amount of protein urine in patients with23cases,14cases of massive proteinuria in patients.TCMdivided into30cases of Qi Deficiency;37cases of non-Qi Deficiency; another raise of21cases of normal healthy people. Clinical observation of indicators of glucose metabolism:fasting blood glucose (FBG), glycated hemoglobin (HbA1C); indicators of lipid metabolism:total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C). Blood, urine TGFβ1enzyme-linked immunosorbent assay (ELISA), blood, urine TGFβ1kit were purchased from Wuhan according to Kesai Biological Products Company.
[Results]1.DN group Qiyinliangxu incidence was significantly higher than the DM group (P=0.012).2.DM Qi Deficiency age group, the blood of TGFβ1, the urine of TGFβ1, the urine ACR, serum creatinine were higher than Qi Deficiency group (P=0.031; P=0.008; P=0.000; P=.000; P=0.003).3.DN Qi Deficiency group of TGFβ1blood, urine of TGFβ1, the ACR in urine, serum creatinine were higher than Qi Deficiency group (P=0.008; P=0.000; P=0.000; P=0.003).4. four groups of blood TGFβ1in descending order of DN Qi Deficiency group, the DN non-Qi and Yin deficiency syndrome group, DM Qi Deficiency group, the DM non-Qi Deficiency syndrome group; urinary TGFβ1descending order for the DN Qi Deficiency group, DM Qi Deficiency group, the DN non-Qi Deficiency group, the DM non-Qi Deficiency group.5.Qi Deficiency serum TGFβ1and urine ACR5.DN was positively correlated (r=0.42, P=0.036). DN non-Qi Deficiency of serum TGFβ1, no significant correlation between urinary TGFβ1and clinical indicators.6.DM group of blood TGFβ1, although increased compared with normal healthy control group, but no statistically significant difference (P=0.303>0.05). High urinary TGFβ1had a significant difference (P=0.022).7. DN group of blood, urine of TGFβ1, urine ACR, Cr, were significantly higher than the DM group (P<0.01). DN group, serum TGFβ1and urine the ACR, Cr, urine TGFβ1was positively correlated (r=0.631, P=0.000; r=0.709, P=0.000; r=.653,P=0.000). DN group urinary TGFβ1and age of urine to the ACR, Cr were positively correlated (r=0.281, P=0.021; r=0.906, P =0.000;r=0.842,P=0.000).
[Conclusions]1.the DN Qiyinliangxu incidence was significantly higher than the DM group, prompt Qiyinliangxu may be prompted to the development of the disease.2.Urine the TGFβ1value Qi Deficiency group than the non-Qi Deficiency group, derived from the statistical results Tip:urinary TGFpl and are closely related to Qi Deficiency, dialectical objectivity of one of the indicators can be used as the certificate.3.Urinary TGFβ1in DM have been significantly increased blood TGFβ1compared with the normal group, although elevated, but no significant difference. Prompted elevated urinary TGFβ1reflect kidney inflammation caused by metabolic disorders, early intervention, to prevent the occurrence of the DN.
引文
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