| Objective: Diabetes(diabetes mellitus, DM) population increase gradually, and renal function with the course of elderly patients with diabetes mellitus and the growth of the age decreased significantly, the diabetic nephropathy(diabetic nephropathy, DN) the incidence of a disease is higher and higher. DN is the important cause of chronic renal failure, is the main cause of death in patients with DM. At present, the pathogenesis of DN is not yet clear, may be associated with hyperglycemia in glomerular capillary pathological changes, at the same time have a clinical observation showed that metabolic disorder can cause homocysteine(homocysteine, Hcy) content changes. As a result, the risk factors of this study was to evaluate the DN and Hcy and DN occurrence and development is the relationship between diabetic nephropathy and scholars at home and abroad over concern topic.Our study was to test and compare the pure diabetes, early diabetic nephropathy, and clinical diabetic nephropathy, diabetic nephropathy patients with end-stage homocysteine, creatinine, analyzes its impact on occurrence and development of diabetic nephropathy, to discuss joint inspection of homocysteine, creatinine, the value of clinical diagnosis of diabetic nephropathy. At home and abroad about the correlation between diabetic nephropathy and homocysteine reported more, but rare articles reported patients with diabetic nephropathy periods of homocysteine levels, especially diabetic nephropathy in patients with renal failure caused by homocysteine.Methods:1 Study on object selection 158 cases of hospitalized patients with type 2 diabetes were selected in July 2013 to August 2014 in the first hospital of Shijiazhuang and kidney internal medicine as the research object, the history for nine months to 14 years, conforms to the American diabetes association in 2014 diabetes diagnostic criteria. According to the 24 hurine albumin excretion rate(UAER) and the level of glomerular filtration rate(GFR) divided the patients into 4 groups: group A with diabetes only: UAER < 30 mg / 24 h, GFR above normal; Group B for early diabetic nephropathy: UAER30 ~ 300 mg / 24 h, GFR under normal; For clinical diabetic nephropathy group C: UAER > 300 mg / 24 h, GFR sustained decline; Group D for diabetic nephropathy end-stage: UAER > 300 mg / 24 h, GFR < 10ml/min. Choice in July 2013 to August 2014 in our hospital for medical examination without diabetes 58 cases as control group.2 Indicators and methods All the research object to fast more than 12 h, and extraction in the next morning fasting venous blood 5 ml, used to detect Hcy, FPG, Hb Alc, SCr(TCHO), total cholesterol, triglyceride(TG), urea nitrogen(BUN). 3 consecutive measurement of 24 h urine albumin excretion rate(UAER) and average, 24 h urine test on the day of the retained since morning, blending after 3 ml stand- 20 ℃ refrigerator under test urine trace albumin, gender, age, course of the disease, height, body weight, blood pressure, calculating body mass index(BMI) : BMI = weight/height 2(Kg/m2).3 Statistical methods All data using SPSS13.0 statistical software, to the normal test of all indexes, conform to the normal too distribution of measurement data to average ± standard deviation, according to the samples of two independent t test, counting data, said the percentage or rate by chi-square test; The non-normal distribution data using rank and inspection; Compared using analysis of variance between groups, two more use of LSD test; Double variables are accord with normal distribution of single factor test using Pearson correlation analysis, taking the spearman correlation analysis; Risk factors influencing factors using multiple linear regression analysis, Logistic regression analysis. With P < 0.05 for the difference was statistically significant.Results:1 General clinical data comparison between groupsDiabetes group and normal control group in gender, age, body mass index(BMI), cultural degree, occupation, marital status, diastolic blood pressure(DBP) on the comparative differences had no statistical significance(P > 0.05); In the course of the disease compared with control group, the difference was statistically significant(P < 0.05); In systolic blood pressure(SBP) in diabetes mellitus group compared with control group, the difference was statistically significant(P < 0.05); Early diabetic nephropathy group, clinical diabetic nephropathy, diabetic nephropathy end-stage compared with simple diabetes group, course of diseases and systolic blood pressure were significantly increased(P < 0.05); Clinical diabetic nephropathy, diabetic nephropathy end-stage compared with early diabetic nephropathy group, course of diseases and systolic blood pressure were significantly higher(P < 0.05); Compared with clinical diabetic nephropathy group, diabetic nephropathy end-stage course and systolic blood pressure were significantly higher(P < 0.05), the difference was statistically significant(P < 0.05).2 Comparison between groups of biochemical indicatorsDiabetes group compared with control group, the incidence of Hcy, high Hcy levels(HHe), SCr, TC, TG, FPG, Hb Alc, UAER, BUN on the difference had statistical significance(P < 0.05); Diabetes groups on TC, TG, FPG, Hb Alc comparison, there were no statistically significant difference(P > 0.05); Diabetic nephropathy end-stage with simple diabetes group, early diabetic nephropathy group, the clinical diabetic nephropathy group in Hcy, HHe, SCr, UAER and BUN on the comparison, the difference had statistical significance(P < 0.05); Clinical diabetic nephropathy group and simple diabetes group, the early diabetic nephropathy group in Hcy, HHe, SCr, UAER and BUN on the comparison, the difference had statistical significance(P < 0.05); Early diabetic nephropathy with simple diabetes group in terms of Hcy, HHe, SCr and UAER comparison, the difference had statistical significance(P < 0.05); Each group Hcy, SCr and UAER concentration had significant difference(P < 0.05). The incidence of HHe has significant differences between groups(P < 0.05).3 Patients with diabetic nephropathy Hcy and general information and biochemical index of correlation analysisDiabetes Hcy and age, course of the disease, SBP, BUN was significantly positive correlation, and SCr, UAER as a significant positive correlation, and BMI, DBP, TC, TG, FPG, Hb Alc are related is not obvious.4 Diabetic nephropathy may risk factors regression analysisThe occurrence and development of disease, hypertension, BUN, UAER, Hcy and SCr may be largerwith diabetic nephropathy, risk factors of diabetic nephropathy(P=0.040, 0.049, 0.043, < 0.001, < 0.001, < 0.001), the OR values were 0.865(95% CI 0.526 to 1.108), 0.501(95% CI 0.286 to 1), 0.624(95% CI 0.215 to 0.998), 3.254(95% CI 1.025 to 7.965), 5.021(95% CI 3.215 to 9.658), 26.598(95% CI 9.265 to 78.965). In different stages of diabetic nephropathy as the dependent variable, the serum Hcy and SCr combined detection as independent variables, logistic regression analysis, by Hcy mol/L and SCr < 10 < 133 mol/L =0, Hcy < 10 mol/L and SCr = 133 mol/L Hcy or more than 10 mol/L and SCr < 133 mol/L, then to Hcy more than 10 mol/L and SCr = 133 mol/L, the incidence of diabetic nephropathy increased 35.365 times.Conclusions:1 Diabetic nephropathy patients older than pure high diabetics age, long duration, and SBP, high level of BUN, SCr and UAER.2 Hcy and age, course of the disease, high blood pressure, serum BUN, SCr and UAER were positively correlated, older, sick for a long time, associated with high blood pressure, high level of BUN, SCr and UAER) in patients with diabetes risk of diabetic nephropathy is higher, and Hcy and SCr are high at the same time, diabetic nephropathy was heavier.3 High serum Hcy and high age, long duration, high blood pressure and the level of BUN, SCr and UAER are independent risk factors of early DN, along with the numerical can lead to an increase in DN illness; Hcy and SCr joint detection in the diagnosis of the occurrence and development of diabetic nephropathy has higher clinical value. |
