尿微量清蛋白/尿肌酐与糖尿病前期冠状动脉病变的关系研究

Relationship of Urinary Microalbumin /Creatinine Ratio to Coronary Artery Disease in Patients with Pre-diabetes

目的探讨尿微量清蛋白/尿肌酐(UACR)与糖尿病前期患者冠状动脉病变之间的关系。方法选取2011年7月—2012年12月因胸闷、胸痛入住我院的128例糖尿病前期患者,根据冠状动脉造影或冠状动脉CT血管造影(CTA)结果分为至少单支冠状动脉主干或其主要分支内径狭窄≥50%(冠心病组,68例)和冠状动脉管腔狭窄≤20%(对照组,60例)。采用速率散射比浊法测定两组患者的晨尿UACR;根据冠状动脉病变支数分为单支病变、双支病变和三支病变;采用Gensini积分评价冠状动脉病变程度;采用受试者工作特征(ROC)曲线分析UACR预测冠心病的最佳切点。结果 (1)冠心病组的收缩压(SBP)、低密度脂蛋白胆固醇(LDL-C)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)及UACR水平均高于对照组,差异有统计学意义(P<0.05)。(2)冠心病组单支(n=18)、双支(n=36)、三支(n=14)血管病变患者的UACR分别为(3.19±1.78)、(4.32±1.97)、(6.39±3.33)mg/mmol(F=7.961,P=0.001);多元线性回归分析显示,UACR与冠状动脉病变支数存在回归关系(t=3.283,P=0.002)。(3)UACR与Gensini积分亦存在相关性(rs=0.393,P<0.001)。UACR的ROC曲线下面积为0.825〔95%CI(0.754,0.896),P<0.001〕,UACR预测冠状动脉病变的最佳切点对应于2.75 mg/mmol(敏感度76.5%,特异度75.0%)。结论升高的UACR与糖尿病前期冠状动脉病变的发生、发展和严重程度相关。

Objective To explore the relationship of urinary microalbimin/creatinine ratio （UACR） to coronary ar- tery disease （CAD） in patients with pre - diabetes. Methods A total of 128 pre - diabetic patients from July 2011 to Decem- ber 2012 hospitalized Clue to angina or chest distress were divided, according to coronary arteriongraphy or CT angiography, into group A （ the internal diameter stenosis of at least 1 main CA or its main branches 〉50%, n = 68 ）, B （ CA luminal stenosis 〈 20% , control group, n = 60）. The UACR of urina sanguinis were determined by rate nephelometry; group A were divided, ac- cording to number of lesion CA, into subgroups a （ with 1 - vessel lesion）, b （ with 2 - vessel lesion）, e （ with 3 - vessel le- sion） ; the stenosis degree of CA were evaluated by Gensini score. UACR, the optimal cutting value predicting CHD were ana- lyzed by receiver operating chatacteristic curve （ ROC ）. Results The SBP, LDL - C, 2 h postprandial glucose （ ：2 h PG） , glyeated hemoglobin （ HbAlc ） and UACR were higher in group A than in group B, the difference was significant （ P 〈 0. 05 ）. The UACR level of subgroups a （n=18）, b （n=36）, e （n=14）were （3.19＋1.78）, （4.32＋1.97）, （6.39＋3.33） mg/mmol, respectively （F = 7. 961, P = 0. 001 ） , and multiple linear regression analysis after correction showed that the UACR was correlated with number o lesion CA （ t = 3. 283, P = 0. 002）. UACR with Gensini score was correlated （ rs = 0. 393, P 〈 O. 001 ）. By ROC analysis, the area under UACR curve was 0. 825 95% C] （0. 754, 0. 896）, P 〈0. 001 , the optimal cut- ting value predicting CAD was 2. 75 mg/mmol （ sensitivity 76. 5%, specificity 75.0% ）. Conclusion Increased UACR is cor- related with the occurrence, development, severity of pre - diabetic CAD.