2型糖尿病患者腹腔内脏脂肪面积与尿白蛋白排泄率相关性分析

Association of visceral adiposity with urinary albumin excretion in type 2 diabetics

目的观察2型糖尿病患者腹腔内脏脂肪面积（VA）与24h尿白蛋白排泄率（24h．UAE）的关系。方法收集河北医科大学第三医院内分泌科住院的2型糖尿病患者一般临床资料、VA、腹部皮下脂肪面积（SA）、24h—UAE、血脂、空腹血糖、糖化血红蛋白、胰岛素水平和肿瘤坏死因子（TNF）-α。根据VA的四分位数分为4组：A组（VA〈131cm^2）；B组（131cm^2≤VA〈174cm^2）；C组（174cmx≤VA〈218cm^2）；D组（VA≥218cm^2）。比较4组间24h—UAE水平和大量蛋白尿患病率，同时分析VA与对数[1g（24h-UAE）]的相关强度和线性关系。结果C和D组的24h-UAE大于A和B组，随着VA增加，大量蛋白尿患病率增加；VA与lg（24h-UAE）存在相关（r=0．51）；VA每增加100cm^2，lg（24h-UAE）增加0．26个单位，校正相关因素的影响后VA每增加100cm^2，lg（24h-UAE）增加0．15个单位。在校正性别、甘油三酯的影响后，C组与A组比较，发生大量蛋白尿的危险上升到2．75倍，D组与A组比较，发生大量蛋白尿的危险上升到3．87倍。结论VA增加是24h-UAE增多的危险因素，随着VA的增加，大量蛋白尿患病率增加。

Objective To decipher the association of visceral adiposity （VA） with 24-hour urinary albumin excretion （24 h-UAE ） in type 2 diabetics. Methods We collected the clinical data, VA, subcutaneous adiposity （ SA）, 24 h-UAE, blood lipids, fasting blood glucose, glycosylated hemoglobin, insulin and tumor necrosis factor （TNF）-α of type 2 diabetic inpatients at our hospital. According to the quartile of VA, the subjects were divided into 4 groups. And their profiles were compared with regards to the level of 24 h-UAE and the incidence of heavy proteinuria. And their relative intensities and the linear relationship of VA and lg （24 h-UAE） were analyzed. Results lg （24 h-UAE） of groups C and D was larger than that of groups A and B. With the rising level of VA, the prevalence of heavy proteinuria increased. A moderate correlation existed between VA and lg （24 h-UAE） （ r = 0. 51 ）. lg （ 24 h-UAE） increased 0. 26 units as VA expanded 100 cm^2 , i.e. 0. 15 units after relative factor adjusting. After gender and triglyceride adjusting, the odds ratio of heavy albuminuria in group C was 2. 75 versus that in group A. And the OR was 3.87 in group D. Conclusion Expansion of VA is a risk factor for an elevated risk of 24 h- UAE. With the expansion of VA, the prevalence of heavy albuminuria increases.