高嘌呤饮食的2型糖尿病患者白蛋白尿危险因素研究

Risk factors of microalbuminuria among type 2 diabetes mellitus patients with high purine food

目的探讨高嘌呤饮食的2型糖尿病(T2DM)患者白蛋白尿的危险因素。方法根据24 h尿微量白蛋白排泄量(24h-UAE)将高嘌呤饮食的T2DM患者分为正常蛋白尿组(24h-UAE<30 mg)和异常蛋白尿组(24h-UAE≥30 mg),计算白蛋白尿的患病率,比较两组性别、吸烟、高血压、体质量指数、血糖、血脂、血尿酸和肾小球滤过率(GFR)等慢性肾脏病危险因素的差异;然后将24h-UAE与上述指标进行单因素相关分析;最后以有无白蛋白尿为因变量,以单因素相关分析所得的危险因素为自变量,进行多因素Logistic回归分析,探讨T2DM患者白蛋白尿的危险因素。结果共有268例高嘌呤饮食的T2DM患者入选本研究,123例患者有白蛋白尿,占45.90%;异常白蛋白尿组高血压的患病率、收缩压、舒张压、病程、胰岛素治疗的比例、GFR和血尿酸水平均高于正常白蛋白尿组,差异有统计学意义(<0.05);年龄、糖尿病病程、收缩压、舒张压、血尿酸与24h-UAE正相关,GFR与24h-UAE呈负相关(<0.05);多因素Logistic回归分析发现收缩压、糖尿病病程和血尿酸是异常白蛋白尿的独立危险因素(<0.05)。结论血尿酸、糖尿病病程和收缩压增高是T2DM患者白蛋白尿的独立危险因素。但高嘌呤饮食并未增加T2DM患者白蛋白尿的患病率。

Objective To investigate the risk factors of microalbuminuria among microalbuminuria with high purine food.Methods According to 24-hour urinary albumin excretion（24h-UAE）,123 patients were divided into the abnormal group（24h-UAE≥30mg）,and 145 patients were divided into the normal group（24h-UAE 30mg）.Morbidity rate of albuminuria was calculated.Gender,smoke,blood pressure,body mass index,blood-glucose,blood fat,blood uric acid,glomerular filtration rate（GFR） in both groups were detected.The difference of these parameters of the both groups were compared.Correlation analysis and Logistic regression analysis were used to explore the risk factora of the T2DM patients with microalbuminuria.Results The incidence rate of microalbuminuria of T2DM patients was 45.90%.There were significant differences in the rate of hypertension,systolic pressure,diastolic pressure,the course of disease,the ratio of insulin therapy and GFR between normal and abnormal groups（ 0.05）.The age,course of disease,systolic pressure,diastolic pressure and blood uric acid were positively correlate with 24h-UAE,but GFR was negatively correlated with 24h-UAE.Systolic pressure,course of disease and blood uric acid were the independent risk factors of abnormal albumin urine according to the Logistic regression analysis.Conclusions The blood uric acid,course of disease and systolic pressure are the independent risk factors of microalbuminuria in patients of T2DM,and high purine food were not in danger of high incidence rate of microalbuminuria.