2型糖尿病患者蛋白尿程度与振动感觉阈值的关系

Relationship between the severity of albuminuria and vibration perception threshold in patients with type 2 diabetics

目的探讨2型糖尿病患者尿白蛋白/肌酐比值(urinary albumin creatinine ratio,UACR)的影响因素及其与振动感觉阈值(vibration perception threshold,VPT)的相关性。方法测定538例2型糖尿病门诊患者的UACR和VPT,根据UACR分为无蛋白尿组(NA,n=395)、微量蛋白尿组(MA,n=110)和大量蛋白尿组(OA,n=33)。比较3组的基本情况、血糖、肾功能及VPT,分析UACR的影响因素。结果 3组在年龄、糖尿病病程、收缩压、舒张压、糖化血红蛋白(glycolated hemoglobin,HbA1c)、糖化血清白蛋白(glycolated serum albumin,GA)、血尿素氮、血肌酐、UACR和VPT之间的差异有统计学意义。NA、MA、OA组中VPT异常者分别占14.18%、25.45%、48.48%(两两比较,P均<0.05)。UACR与年龄、糖尿病病程、体重指数、收缩压、舒张压、HbA1c、GA、空腹血糖、餐后2 h血糖(2 h postprandial blood glucose,PPG)、血尿素氮、血肌酐和VPT呈正相关(P均<0.05)。多元回归分析显示糖尿病病程(r=0.152,P=0.001)、收缩压(r=0.072,P=0.011)是UACR的独立影响因素。不同糖尿病病程的亚组分析显示UACR、VPT的差异有统计学意义,合并肾病和VPT异常的比例也逐渐升高。结论糖尿病病程、收缩压是UACR的独立影响因素;随着蛋白尿程度加重,合并VPT异常的发生率增加。

Objective To investigate risk factors of urinary albumin creatinine ratio（UACR） and its correlation with vibration perception threshold（VPT） in patients with type 2 diabetes mellitus（T2DM）. Methods UACR and VPT in 538 T2DM out-patients were examined,and they were assigned to no albuminuria group（NA,n=395）,micro-albuminuria group（MA,n=110） and overt-albuminuria group（OA,n=33） according to their UACR values.The clinical characteristics,biochemical parameters and VPT were compared among the three groups,and the associated factors of UACR were analyzed. Results There were significant differences in age,diabetic duration,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,glycolated hemoglobin（HbA1c）,glycolated serum albumin（GA）,blood urea nitrogen（BUN）,serum creatinine（Cr）,UACR and VPT among the 3 groups.The proportions of patients with abnormal VPT in NA,MA and OA groups were 14.18%,25.45% and 48.48%,respectively.The Spearman correlation analysis showed that UACR was positively associated with age,diabetic duration,body mass index（BMI）,SBP,SDP,HbA1c,GA,fasting blood glucose（FPG）,2 h postprandial blood glucose（PPG）,BUN,Cr and VPT（All P〈0.05）.In multiple stepwise regression analysis,diabetes duration（r=0.152,P=0.001） and SBP（r=0.072,P=0.011） were independent risk factors of UACR.In 3 subgroups with diabetes duration〈10 y,11-20 y and 〉20 y,the values of UACR and VPT increased significantly（all P〈0.05）,and the proportion with albuminuria or vibration insensation augmented gradually. Conclusions Diabetic duration and SBP are independent risk factors to UACR.The incidence of vibration insensation in lower extremity increases with the elevating of albuminuria severity.