早期2型糖尿病患者肾储备观察.docVIP

早期2型糖尿病患者肾储备观察 　 作者：司徒碧颖，孙敏，孙建设，张斌 【关键词】 肾储备功能 【摘要】 目的 评估早期无微量白蛋白尿的2型糖尿病患者的肾功能对氨基酸负荷的反映（即所谓肾功能储备）。方法 选取10例早期2糖尿型病患者和8例健康人，并分别将其分为成年组（＜60岁）和老年组（≥60岁），在静脉滴注负荷量氨基酸前后分别用放射性同位素法99mTc-DTPA测定肾小球滤过率（glomerular filtration rate,GFR），同时检测血清肌酐、尿素氮。结果 在成年人和老年人中，分别较各自的健康组有显著降低［成年组（18.2±3.3）vs（34.9±6.4）ml/min，老年组（8.1±5.9）vs（19.0±2.5）ml/min，P＜0.01］。此外，2个健康组之间，肾储备存在显著的年龄差异［（19.0±2.5）vs（34.9±6.4）ml/min，P＜0.01］，而4个组的血清肌酐未能体现上述差异。结论 2型糖尿病患者的肾储备在早期即受损害。肾储备的降低可能是糖尿病肾病的一个早期诊断指标，但还应该考虑到健康标准存在的年龄差异。 　　【关键词】 肾储备功能；糖尿病 　　Renal functional reserve in patients with early type 2 diabetes mellitus 　　【Abstract】 Objective To evaluate the functional response of the kidney to an amino acid challenge (so called renal functional reserve) in patients with early type 2 diabetes without microalbuminuria.Methods We studied 10 type 2 DM patients,and 8 healthy individuals,both of them were divided into two groups:the adult group (＜60 years) and the elderly group (≥60 years),respectively.Glomerular filtration rate (GFR) was determined using 99mTc-DTPA methods before and after an intravenous amino acid load.Serum creatinine and urea nitrogen were check at the same time.Results Compared to “healthy” subjects,mean RFR were significantly lower in the early type 2 diabetic corresponding groups.(18.2±3.3) vs (34.9±6.4)ml/min in adult and (8.1±5.9) vs (19.0±2.5)ml/min in elderly group,respectively,P＜0.01) There was also a rather striking agerelated difference between the two “healthy” subjects ［(19.0±2.5) vs (34.9±6.4)ml/min，P＜0.01)］，while no significantly differences of the SCr were showed in the four groups.Conclusion The result indicates that renal functional reserve is impaired in patients with type 2 diabetes without signs of kidney involvement.The reduction of renal function reserve (RFR) might be a maker for incipient diabetic nephropathy,but age related difference of the standard should be considered. 　　【Key words】 renal functional reserve;diabetes 　　类似于心功能储备，正常人肾脏一般情况下无需发挥最大的滤过功能便能满足机体需要，但随着生理要求增高或肾脏疾病的进