2型糖尿病患者微量白蛋白尿进展为严重肾病的危险因素分析

Analysis of the Risk Factors of Serious Nephronia Evolved from Microalbuminuria in the Patients with Type 2 Diabetes Mellitus

目的:探讨2型糖尿病患者微量白蛋白尿进展为严重肾病的危险因素。方法:随机选取2型糖尿病患者114例,按尿白蛋白/肌酐(UAlb/Cr)分为4组,健康对照组77例,采用免疫比浊法测定尿白蛋白/肌酐,采用高分辨率彩色多普勒超声仪测量颈动脉内膜—中层厚度(IMT),用简化MDRD方程计算肾小球滤过率(GFR),并对各组数据进行统计分析。结果:Logistic回归分析显示:矫正年龄、病程因素后,在微量白蛋白尿期,糖化血红蛋白(HBA1C)、收缩压(SBP)为UAlb/Cr的独立危险因素,Exp(B)分别为1.028(95%CI1.009-1.047P=0.004)、1.314(95%CI1.102-1.567P=0.002);在临床蛋白尿期,SBP、餐后2h血糖(PPG)、胆固醇(TC)、GFR、IMT为UAlb/Cr的独立危险因素,Exp(B)分别为:1.057(95%CI1.017-1.099P=0.005)、1.228(95%CI1.027-1.469,P=0.024)、2.666(95%CI1.296-5.485,P=0.008)、0.95(95%CI0.932-0.978,P=0.00)、22.703(95%CI2.199-234.35,P=0.009)。结论:IMT是促进2型糖尿病肾病进展的极强的危险因素,IMT的增厚是微量蛋白尿向临床蛋白尿转化的关键因素。

Objective：To evaluate the risk factors of serious nephronia evolved from microalbuminuria in the patients with Type 2 Diabetes. Methods： 114 patients with type 2 Diabetes were selected randomly and were divided into 4 groups according to Urinary Albumin/Creatinine（UA1b/Cr）, 77 healthy subjects were selected as control group. UAlb/Cr was determined via immunoturbidimetry, Intimal medial thickness of the carotid artery（IMT） was measured by color Doppler with high resolution, Glomerular filtration rate （GFR） was calculated by simplified MDRD equations. Data from each group was statistically analyzed. Results： HbAlc and systolic blood pressure （SBP） were independent risk factors in the period of microalbuminuria after adjusting age, duration. Exp（B） were 1. 028（95%CI 1. 009-1. 047,P = 0. 004） ,1.314（95% CI 1. 102-1. 567,P = 0. 002）respectively. SBP,postprandial glucose （PPG） total1 cholesterol （TC） ,GFR and IMT were independent risk factors of UAIb/Cr in the period of clinical albuminuria, Exp（B） were 1. 057 （1. 017-1. 099, P = 0. 005 ）, 1. 228 （95 % CI 1. 027-1. 469, P = 0. 024）, 2. 666 （95 % CI 1. 296-5. 485, P = 0. 008）, 0.95 （95 % CI 0. 932-0. 978, P = 0.00）, 22. 703 （95 % CI 2. 199-234.35, P = 0. 009） respectively. Conclusion：IMT is a extremely strong risk factor in promoting the evolvement of nephropathy in Type 2 Diabetes. Thickened IMT is a key factor in the development of microalbuminuria to clinical albuminuria.