初诊2型糖尿病患者尿微量白蛋白/肌酐比值异常的发生率及危险因素分析

Prevalence and risk factors of abnormal urine albumin/creatinine ratio in new-diagnosed type 2 diabetes mellitus patients

目的分析初诊2型糖尿病患者尿微量白蛋白/肌酐比值（ACR）异常的发生率及危险因素。方法 2008年9月至2009年12月我院内分泌科收治的初诊2型糖尿病患者245例,测定空腹血糖（FPG）,葡萄糖耐量试验、血脂、肾功能及尿ACR等。分别根据患者年龄、糖化血红蛋白（HbA1c）及尿ACR水平进行分层。采用t检验、方差分析、多元逐步回归分析等方法进行统计学分析。结果①本研究人群中,尿ACR的异常率为21.6%,其中微量白蛋白尿20.4%,大量白蛋白尿1.2%。②不同年龄组患者尿ACR水平〈40岁组（26.4±34.2）mg/g、≥40~50岁组（33.7±68.5）mg/g、≥50~59岁组（38.6±94.9）mg/g、≥60~69岁组（33.9±60.8）mg/g、≥70岁组（48.9±62.4）mg/g,差异无统计学意义（F=0.400,P〉0.05）。③异常尿ACR组FPG、收缩压（SBP）、甘油三酯（TG）、体质量指数（BMI）显著高于正常尿ACR组患者（t值分别为-2.547、-2.144、-2.113、-4.663,P〈0.05或〈0.01）,高密度胆固醇（HDL-C）显著低于正常尿ACR组（t=2.216,P〈0.05）。④HbA1c≥6.5%组的尿ACR水平与HbA1c〈6.5%组的差异无统计学意义（t=0.475,P〉0.05）,HbA1c≥6.5%组患者合并高血压的尿ACR水平显著高于血压正常患者（t=-2.472,P〈0.05）。HbA1c〈6.5%组患者尿ACR比值水平与BMI、FPG呈正相关（r值分别为0.564、0.559,均P〈0.05）;HbA1c≥6.5%组尿ACR水平与SBP、舒张压（DBP）和FPG呈正相关（r值分别为0.186、0.169、0.182,均P〈0.05）;⑤多元逐步线性回归分析结果,影响尿ACR的主要因素包括FPG、SBP、肌酐（Cr）。结论初诊2型糖尿病患者尿ACR水平异常的发生不受年龄的影响,与血压及FPG有关。

Objective To analyze the prevalence and risk factors of abnormal urine albumin/creatinine ratio（ACR） in new-diagnosed type 2 diabetes mellitus patients.Methods The fasting plasma glucose（FPG）,OGTT,lipid profile,renal function,urine ACR were measured in 245 new-diagnosed type 2 diabetes mellitus patients from September 2008 to December 2009.The subjects were divided into different groups according to age,HbA1c and ACR.Statistic t test,one-way ANOVA and multiple stepwise regression analyses were used for data analysis.Results ①The prevalence of abnormal urine ACR in this cohort was 21.6%,and microalbuminuria was 20.4%,macroalbuminuria was 1.2%.②There was no significant difference in urinary ACR level among different age groups,40 age group ACR（26.4±34.2） mg/g,≥40-50 age group（33.7±68.5） mg/g,≥50-59 age group（38.6±94.9） mg/g,≥60-69 age group（33.9±60.8） mg/g,≥70 age group（48.9±62.4） mg/g（F=0.400,P0.05）.③The FPG,systolic blood pressure（SBP）,triglyceride（TG）,body mass index（BMI） in abnormal ACR group were significantly higher than those of normal ACR group（t=-2.547,-2.144,-2.113,-4.663,P0.05 or 0.01）,and the level of high-density lipoprotein cholesterol（HDL-C） was significantly lower than that of normal ACR group（t=2.216,P0.05）.④There was no significant difference in urinary ACR level between HbA1c≥6.5% and HbA1c6.5% group（t=0.475,P0.05）,and ACR level of HbA1c≥6.5% group with hyertension was significantly higher than that of normal blood pressure（t=-2.472,P0.05）.Urinary ACR showed positive correlations with BMI,FPG in HbA1c6.5% group（r=0.564,0.559,both P0.05） and with SBP,diastolic blood pressure（DBP） and FPG in HbA1c≥6.5% group（r=0.186,0.169,0.182,all P0.05）.⑤FPG,SBP and creatinine were independent risk factors for urinary ACR according to multiple stepwise regression analysis.Conclusion Urinary ACR level in new-diagnosed type 2 diabetes mellitus patients might be associated with BP and FPG regardless of age.