无症状脑梗死与2型糖尿病肾病发生发展的相关性研究

Relationship between silent cerebral infarction and the development and progression of nephropathy in patients with type 2 diabetes

目的探讨无症状脑梗死（SCI）与2型糖尿病肾病发生发展的相关性。方法选取2006年1月-2011年1月住院且随访资料完成的2型糖尿病（T2DM）患者327例。根据患者尿白蛋白/肌酐比值（ACR）分为正常蛋白尿组（ACR〈30mg/g,184例）、微量白蛋白尿组（ACR=30～299mg/g,143例）。经头颅CT或MRI诊断SCI。以正常蛋白尿组患者出现微量白蛋白尿,微量白蛋白尿组患者出现大量白蛋白尿（ACR≥300mg/g）为一级终点。应用Kaplan-Meier法计算一级终点累计发生情况。Cox风险模型分析一级终点发生的独立危险因素。结果平均随访39个月后,32例正常蛋白尿组患者和39例微量白蛋白尿组患者达到一级终点。并发SCI患者一级终点达到率明显高于未并发SCI患者（P〈0.05）。多因素Cox模型分析显示,并发SCI患者到达一级终点的风险比为2.19（P〈0.05）。结论 2型糖尿病患者并发SCI与糖尿病肾病的发生发展关系密切。

【Objective】 To assess the relationship between silent cerebral infarction（SCI） and the development and progression of nephropathy in Type 2 diabetes mellitus（T2DM） patients.【Methods】 Totally 327 T2DM patients who were hospitalized in our hospital from January 2006 to January 2011 were included in this study.These patients underwent the assessment of first morning urinary albumin-to-creatinine ratio（ACR）,and then divided into normoalbuminuria group（ACR30 mg/g,n =184） and microalbuminuria group（ACR=30～299 mg/g,n =143）.All patients underwent cranial computed tomography（CT） or magnetic resonance imaging（MRI） to detect SCI.The primary end point was progression from normo-to microalbuminuria or from micro-to microalbuminuria.The cumulative incidence of the primary end point was estimated using the Kaplan-Meier method.Risk estimates for reaching the end point were calculated using Cox proportional hazard model analyses.【Results】 During a median follow-up period of 39 months,32 normoalbuminuria and 39 microalbuminuria patients reached the primary end point.Patients with SCI had a greater incidence of reaching the end point than those without SCI（P〈0.05）,with a hazard ratio of 2.19（P〈0.05） in the multivariate Cox regression model.【Conclusion】 There is a close correlation between prevalent SCI and the development and progression of nephropathy in patients with type 2 diabetes.