| Objective:To investigate the relationship between the changes of glucagon,plasma level and multiple renal function indexes in patients with type 2 diabetes mellitus after Oral Glucose Tolerance Test under the clinical condition.Method:(1)Collected 1766 cases of type two diabetes in hospitalization.(2)The patients were sacrificed at 75 g glucose tolerance test,and the levels of plasma glucagon and blood glucose were measured at 30,60,120 and 180 minutes after fasting and glucose loading respectively.Renal function and other related indicators,to take 24-hour urine specimens.(3)According to the formula to calculate the creatinine clearance rate(eGFR),the area of 3 hours of glucagon curve,and according to the eGFR,urine albumin excretion rate,serum creatinine,blood urea nitrogen,serum cystatin C levels of each group,respectively BMI,HbA1 c,age,duration,fasting blood glucose,fasting plasma glucagon,plasma glucagon in 30 minutes and 60 minutes of plasma glucagon,plasma glucagon in 120 minutes and 180 minutes of plasma glucagon,0-180 minutes plasma glucagon area under the curve analysis of correlation between different groups.Result:1.According to eGFR after four groups,the GLA level and AUCGLA0-180 min in the normal group and the decreased renal function group were higher than those in the glomerular filtration group.Four groups of fasting GLA level,the highest in the normal renal function group,the highest glomerular filtration rate was the lowest,but there was no significant difference between the groups(P >0.05).Each time point GLA level and fasting glucose load,four groups were in the 60 minute of secretion peak,moderate and severe renal dysfunction group and the highest peak,the peak is higher than the other three groups,the difference was statistically significant(P <0.05).The AUCGLA0-180 min value of the middle and severe renal function group was the highest,and the difference between the three groups was statistically significant(P <0.05).2.According to UAER divided into three groups,with the increase of UAER,the level of eGFR showed a downward trend,and compared with the normal albuminuria group,the clinical proteinuria group and microalbuminuria group had statistical significance(P <0.01).Three groups of fasting GLA level,the highest in the normal albuminuria group,microalbuminuria group was the lowest,but there was no significant difference between the groups(P >0.05).Each time point GLA level and fasting glucose load,three groups were in the 60 minute of secretion peak,clinical albuminuria group peak is the highest level,were not statistically significant differences in 120 minutes and 180 minutes compared with normal albuminuria group and microalbuminuria group(P <0.05).The AUCGLA0-180 min value of clinical proteinuria group was the highest,but there was no significant difference between the other two groups(P >0.05).3.According to the Scr quartile in four groups,with the increase of Scr level,the level of eGFR decreased,and the difference between the four groups was statistically significant(all P <0.01).The level of fasting GLA in group four was the highest in group Scr-G4 and the lowest in group Scr-G2,but there was no significant difference between the two groups(P> 0.05).The level of GLA in the four groups was higher than that in the control group(P <0.05),but the difference was statistically significant(P <0.05).Scr-G4 group AUCGLA0-180 min the highest value,but the difference between the other three groups was not statistically significant(all P> 0.05).4.According to BUN quartile in four groups,with the rise of BUN,four groups of age,duration,180 minutes GLA showed an upward trend.Compared with the other three groups,the difference was statistically significant(P <0.01).Compared with BUN-G1 group and BUN-G4 group,the difference was statistically significant(P <0.05).The level of fasting GLA in group four was the highest in BUN-G1 group and the lowest in BUN-G2 group,but there was no significant difference between the two groups(P> 0.05).The level of GLA in the four groups was higher than that in the BUN-G1 and BUN-G2 groups(P <0.05).The peak level of the BUN-G4 group was higher than that of the BUN-G1 and BUN-G2 groups(P <0.05).The number of AUCGLA0-180 min in BUN-G4 group was the highest,but only the difference between the BUN-G2 group was statistically significant(P <0.05).5.According to Cys-C quartile in four groups,four groups of fasting GLA levels,Cys-C-N2 group the highest,Cys-C-N3 group lowest,only Cys-C-N4 group compared with Cys-C-N3 group was statistically significant(P <0.05).The level of GLA in the C4 group was significantly higher than that in the Cys-C-N3 group at 30 minutes,120 minutes and 180 minutes(P <0.05),and the GLA level in the Cys-C-N4 group was significantly higher than that in the Cys-C-N3 group(P <0.05).Cys-C-N4 group AUCGLA0-180 min the highest value,but there was no significant difference between the other three groups(all P> 0.05).6.Pearson correlation analysis of all type two diabetes patients included in this study showed that the AUCGLA0-180 min and the course of disease(r = 0.061,P <0.05),Scr(r = 0.069,P <0(R =-0.05,P <0.05),and negatively correlated with HbA1C(r =-0.051,P <0.05),eGFR(r =-0.105,P <0.01),BUN(r = 0.062,P <0.05).The multivariate stepwise regression analysis showed that the AUCGLA0-180 min was negatively correlated with eGFR(?=-0.863,t =-3.586,P <0.01).Conclusion:1.With UAER,BUN,Scr,Cys-C increased,can be observed after the sugar load increased glucagon levels,eGFR levels decreased.2.With the course and age of T2DM patients increasing,urinary albumin excretion rate,serum urea nitrogen,creatinine,Cystatin C increased,the decrease of eGFR was related to elevated GLA levels after glucose stress.3.In the condition of different groups,the plasma GLA level after glucose load in 60 minutes when the secretion reached a peak;moderate and severe renal dysfunction group and clinical proteinuria group,Scr-G4 group(Scr > 68umol/L),BUN-G4 group(BUN>7.24mmol/l),Cys-C-G4 group(Cys-C>0.97mg/L)were all the highest level. |
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