2型糖尿病患者糖化血红蛋白变异指数与白蛋白尿的相关性

Relationship between hemoglobin glycation index and albuminuria in patients with type 2 diabetes mellitus

目的探究2型糖尿病(type 2 diabetes mellitus,T2DM)患者糖化血红蛋白变异指数(hemoglobin glycation index,HGI)与白蛋白尿的相关性。方法选取2016年3月至2019年11月江苏大学附属医院收治的601例T2DM患者作为研究对象,收集患者临床资料,检测空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(glycated hemoglobin A_(1c),HbA_(1c))、尿白蛋白/肌酐比值(urinary albumin/creatinine ratio,UACR)等相关实验室检查指标,并计算HGI。根据HGI值,将患者分为低HGI(L-HGI)组(200例)、中HGI(M-HGI)组(200例)和高HGI(H-HGI)组(201例)。根据UACR将患者分为正常白蛋白尿组(315例)、微量白蛋白尿组(232例)和大量白蛋白尿组(54例)。采用多因素logistic回归分析T2DM患者HGI与白蛋白尿的关系。结果L-HGI组、M-HGI组和H-HGI组异常白蛋白尿发生率分别为35.50%、49.50%和57.71%,三组间异常蛋白尿发生率比较,差异有统计学意义(P<0.01),且随HGI等级增高,异常蛋白尿发生率逐渐升高。多因素logistic回归分析结果显示,在校正性别、年龄、病程、体质量指数(body mass index,BMI)、甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)、肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)、尿酸等混杂因素后,HGI为T2DM患者发生异常白蛋白尿的独立危险因素(OR=1.26,95%CI 1.12~1.42,P<0.01)。HGI预测T2DM患者发生白蛋白尿的受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.602,灵敏度为62.80%,特异度为57.10%。结论T2DM患者HGI与UACR密切相关,HGI升高增加了白蛋白尿的发生风险。HGI有望用于评估T2DM患者发生白蛋白尿的风险,成为糖尿病肾病的早期预测指标。

Objective To determine the relationship between the hemoglobin glycation index(HGI)and albuminuria in patients with type 2 diabetes mellitus(T2DM).Methods A total of 601 subjects with T2DM who were treated at the Affiliated Hospital of Jiangsu University from March 2016 to November 2019 were enrolled in this study.Clinical data and laboratory examination indicators,including the fasting plasma glucose level,percent glycated hemoglobin A_(1c),and the urinary albumin-to-creatinine ratio(UACR),were collected.According to the calculated HGI values,patients were divided into low HGI(L-HGI;n=200),medium HGI(M-HGI;n=200),and high HGI(H-HGI;n=201)groups.Patients were also divided into normal albuminuria(n=315),microalbuminuria(n=232),and macroalbuminuria groups(n=54),according to the UACR.Multivariate logistic regression was used to determine the relationship between the HGI and albuminuria.Results The incidence of albuminuria in the L-HGI,M-HGI,and H-HGI groups was 35.50%,49.50%,and 57.71%,respectively.The incidence of albuminuria increased as the HGI level increased;there was a statistically significant difference between the three groups(P<0.01).Multivariate logistic regression analysis showed that after adjusting for gender,age,diabetic duration,body mass index,triglycerides,cholesterol,creatinine,urea nitrogen,serum uric acid,and other confounding factors,the HGI level was an independent risk factor for abnormal albuminuria in T2DM patients(OR=1.26,95%CI 1.12-1.42,P<0.01).The area under the receiver operating characteristic(ROC)curve for the HGI level to predict albuminuria in patients with T2DM was 0.602,with a sensitivity of 62.80%and a specificity of 57.10%.Conclusions The HGI level is shown to be closely related to the occurrence of albuminuria in patients with T2DM.An elevated HGI level increases the risk of albuminuria,which may serve as a new biological predictor of diabetic kidney disease.