血清内脂素、视黄醇结合蛋白与2型糖尿病肾病的相关性研究

血清内脂素、视黄醇结合蛋白与2型糖尿病肾病的相关性研究(论文10000字)
 摘 要
目的：
探讨血清内脂素（visfatin）、血清视黄醇结合蛋白（serum retinol binding protein，sRBP）在诊断早期2型糖尿病肾病中的价值。
方法：
1、根据1999年WHO制定的2型糖尿病的诊断及分型标准、纳入标准和排除标准收集2016年9月至2017年9月在本院收治的2型糖尿病患者125例，其中男性88例，女性37例，年龄（56.55±8.764）。依据2013年版《中国2型糖尿病防治指南》糖尿病肾病的诊断分期，将2型糖尿病患者分为正常白蛋白尿组45例，早期糖尿病肾病组40例，临床糖尿病肾病组40例，同时选取健康体检者43例为对照组，其中男性28例，女性15例，年龄（54.21±9.541）。
2、记录各组研究对象的性别，年龄，民族，体重指数，分别测定血清内脂素（visfatin）、血清视黄醇结合蛋白（serum retinol binding protein，sRBP）、糖化血红蛋白（HbAlc）、空腹血糖（Fasting plasma glucose，FBG）、餐后2小时血糖（2 hours Postprandial blood glucose，2hPG）、总胆固醇（total cholesterol,TC）、甘油三脂（triglycerides,TG）、高密度脂蛋白（high-density lipoprotein  cholesterol,HDL-C）、低密度脂蛋白（low-density lipoprotein cholesterol,LDL-C）、尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)、尿白蛋白/肌酐(Urine albumin to creatinine ratio,UACR)，超敏C反应蛋白（hypersensitive C-reactive protien，hs-CRP）。比较不同组别间上述检验结果情况。比较不同组别血清内脂素、血清视黄醇结合蛋白水平变化情况及其相关性。用多元线性逐步回归分析分别研究血清内脂素、血清视黄醇结合蛋白与HbAlc、FBG、2hPG、TC、TG、HDL-C、LDL-C、BUN、SCr、hs-CRP的相关性。分析血清内脂素、血清视黄醇结合蛋白诊断早期2型糖尿病肾病的敏感性和特异性。
3、本研究计量资料采用呈正态分布或近似正态分布采用 ，偏态分布采用M和Q25～Q75描述，统计学方法采用方差分析，秩和检验，多元线性回归；计数资料采用相对数描述，统计学方法采用 检验，统计软件采用SPSS20.0和Stata14.0，检验水准α=0.05。
结果：
1、无蛋白尿组、微量蛋白尿组、大量蛋白尿组中的HbAlc、FBG、2hPG、BUN、 Visfatin、sRBP水平明显高于对照组，P＜0.05为差异有统计学意义，随着2型糖尿病肾病病情的进展，HbAlc、FBG、2hPG、BUN、SCr、hs-CRP、Visfatin、sRBP水平增高（P＜0.05）。
2、以BUN、SCr、sRBP、HbAlc、FPG、2hPG、TC、TG、HDL-C、LDL-C为自变量，Visfatin为因变量进行多元线性逐步回归分析，结果显示，BUN、SCr、sRBP、HbAlc、FPG、2hPG、TC是Visfatin的独立危险因素, P＜0.05为差异有统计学意义；以BUN、SCr、HbAlc、FPG、2hPG、TC、TG、HDL-C、LDL-C、Visfatin为自变量，sRBP为因变量进行多元线性逐步回归分析，结果显示，BUN、SCr、HbAlc、FPG、2hPG、TC、TG、Visfatin是sRBP的独立危险因素, P＜0.05为差异有统计学意义。
3、血清内脂素与血清视黄醇结合蛋白在诊断2型糖尿病肾病时，血清内脂素敏感性更高。
结论：
  血清内脂素、血清视黄醇结合蛋白与２型糖尿病肾病存在一定的相关性，两种血清标志物与糖尿病肾病损伤程度有关，随着糖尿病患者肾损害程度的加重而逐渐升高，两者联合检测不仅对早期糖尿病肾病的诊断具有较高的临床价值，而且对于糖尿病肾病的发生、发展及预后判断具有重要的指导意义。

关键词：
2型糖尿病；血清内脂素，血清视黄醇结合蛋白；糖尿病肾病        
Abstract
Objective：
Investigate the value of the visfatin and serum retinol binding protein s(RBP) in the diagnosis of early type 2 diabetic nephropathy.
Methods：
1、Based on the diagnosis and classification criteria, inclusion criteria and exclusion criteria of type 2 diabetes developed by the WHO in 1999, 125 patients with type 2 diabetes admitted to the hospital from September 2016 to September 2017 were collected. Among them, 88 were males, 37 were females, and the age was (56.55 ±8.764). According to the diagnosis stage of diabetic nephropathy in the 2013 edition of the guide to the prevention and control of type 2 diabetes in China, patients with type 2 diabetes were divided into 45 patients with normal albuminuria group, 40 cases of early diabetic nephropathy group, and 40 cases of clinical diabetic nephropathy group. At the same time, 43 patients were selected as the control group, including 28 males and 15 females, with age (54.21± 9.541).
2、The gender，age， ethnicity， body mass index of each group were recorded. Visfatin， serum retinol binding protein (sRBP)，HbAlc， Fasting plasma glucose (FBG)，2 hour post-load plasma glucose (2hPG)，total cholesterol (TC)， triglycerides (TG)，high-density lipoprotein cholesterol (HDL-C)， low-density lipoprotein cholesterol (LDL-C)， blood urea nitrogen (BUN)，serum creatinine (SCr)，and Urine albumin to creatinine ratio(UACR)，hypersensitive C-reactive protien（hs-CRP）were detected. Compare the results of the above tests between different groups. Compared the changes and dependency of visfatin and serum retinol binding protein levels in different groups were. The correlation between visfatin, serum retinol binding protein and HbAlc， FBG， 2hPG， TC， TG， HDL-C， LDL-C，BUN and SCr were studied by stepwise regression analysis. Analyze the sensitivity and specificity of visfatin and serum retinol binding protein in the diagnosis of early type 2 diabetic nephropathy.
3、The quantitative data of this study are used in normal distribution or approximate normal distribution. . The skewness distribution was described by M and Q25 ~ Q75， and the statistical methods used variance analysis，rank sum test and multiple linear regression. The counting data was described by the relative number，the statistical method was tested， the statistical software was SPSS20.0 and Stata14.0， and the test level was equal to 0.05.
Results:
1、The levels of HbAlc，FBG，2hPG，BUN，Visfatin and sRBP in the proteinuria, microalbuminuria, and alarge number of proteinuria were significantly higher than those in the control group. P＜0.05, the difference was statistically significant. With the progression of type 2 diabetic nephropathy, HbAlc，FBG，2hPG，BUN，SCr， hs-CRP ，Visfatin and sRBP increased. (P＜0.05).
2、With BUN，SCr，sRBP，HbAlc，FPG，2hPG，TC，TG，HDL-C,，and LDL-C as independent variables，Visfatin is a multivariate linear stepwise regression analysis for dependent variables. Results shows that BUN、SCr、sRBP、HbAlc、FPG、2hPG、TC is the independent risk factor of Visfatin. With BUN，SCr，HbAlc，FPG， 2hPG，TC，TG，HDL-C，LDL-Cand Visfatin as independent variables，sRBP as the dependent variable，Multivariate linear stepwise regression analysis was performed. Results shows that BUN、SCr、HbAlc、FPG、2hPG、TC、TG、Visfatin are risk factors for sRBP。
3、Visfatin and serum retinol binding protein were more sensitive in the diagnosis of type 2 diabetic nephropathy.
Conclusion:
 There is a certain correlation between visfatin, serum retinol binding protein and type 2 diabetic nephropathy. The two serum markers were related to the degree of diabetic nephropathy. With the aggravation of kidney damage degree of diabetic patients gradually increased，the joint test not only has high clinical value for the diagnosis of early diabetic nephropathy，but also has important guiding significance for the occurrence，development and prognosis of diabetic nephropathy.
Kay words：
Type 2 diabetes, Visfatin , Serum retinol binding protein, Diabetic nephropathy

目录
第1章  前言    1
第2章  材料与方法    2
2.1  研究对象    2
2.2  诊断标准    2
2.3  排除标准    3
2.4  观察指标及测定方法    3
2.5  统计学处理    4
第3章  结果    5
3.1  一般资料比较    5
3.2  组间临床检验指标比较    5
3.3  多元线性回归分析    6
3.4  各血管并发症的Logistic回归分析    7
第4章  讨论    11
4.1  糖尿病肾病现状    11
4.2  糖尿病肾病的发病机制及病理学特点    11
4.3  血清内脂素对早期糖尿病肾病的诊断价值
第5章  结论    14
参考文献    15