早期糖尿病肾病预测指标及危险因素研究

Study on the predictable markers and risk factors for early diabetic nephropathy

目的探讨糖耐量减低(IGT)患者早期糖尿病肾病的预测指标、患病率及影响因素。方法262例受试者中正常糖耐量(NGT)103人、IGT98人、糖尿病(DM)61人,全部进行即刻尿转铁蛋白/肌酐(UTRF/Cr)和尿白蛋白/肌酐(UAlb/Cr)的检测及临床观察指标的测定。结果(1)UTRF/Cr与UAlb/Cr呈显著正相关,r=0.618,P<0.001。(2)IGT组的UAlb/Cr(中位数,极差)、UTRF/Cr(中位数,极差)高于NGT组(0.015,0.44mg/mg比0.012,0.58mg/mg,t=-1.981,P=0.049;0.064,4.96mg/mg比0.034,7.30mg/mg,t=-2.249,P=0.026)。(3)各组UTRF/Cr比值的阳性率明显高于白蛋白尿的阳性率(41.6%比29.7%,P<0.01)。(4)Logistic回归分析显示白蛋白尿的主要危险因素是DBP,OR=1.064,2hPGOR=1.109,P<0.01;非糖尿病组的主要危险因素是DBP,OR=1.064,P<0.01。结论在IGT阶段已存在早期糖尿病肾脏损害,高血压是其重要的危险因素。尿转铁蛋白/肌酐比值的检测较白蛋白尿/肌酐比值更灵敏,但仍需进一步综合比较二者的敏感性和特异性。

Objective To investigate the prevalence, predictable markers and risk factors for early diabetic nephropathy（DM）. Methods Urinary transferrin-to-creatinine ratio （UTRF/Cr） and urinary albumin-to-creatinine ratio （UALB/Cr） and other clinical parameters such as waist circumference, blood pressure, body mass index（BMI） and lipids were measured in 262 subjects （103 subjects with NGT, 98 with IGT, 61 with DM）. Results 1. UTRF/Cr was positively related with UALB/Cr （r=0. 618,P〈0. 001）. 2. Both UALB/Cr（Median, range） and UTRF/Cr（Median, range） were significantly higher in IGT group than in the NGT group（0.015,0.44 rag/rag vs 0.012,0.58 mg/mg, t=-1. 981, P=0.049; 0.064,4.96mg/mgvs0.034,7.30mg/mg,t=-2.249,P=0.026）. 3. The positive rate of UTRF/Cr was significantly higher than that of microalbuminuria （41.6 % vs 29.7%, P〈0.01）. 4. Logistic regression analysis showed that diastolic blood pressure （OR 1. 064, 95%CI 1.003-1.097,P〈0. 001） and 2h plasma glucose （OR 1.109, 95%CI 1.032-1.191, P〈0.001） were risk factors for the development of microalbuminuria in all groups, while diastolic pressure （OR 1. 064, 95%CI 1. 028-1. 101 ,P〈0.01） was the only risk factor in nondiabetic subjects. Conclusions The prevalence of early diabetic nephropathy is high even in the stage of IGT. Hypertension is a main risk factor for the development of DN. UTRF/Cr is more sensitive than UALB/Cr for detecting diabetic nephropathy.