中老年新诊断糖尿病患者前白蛋白检测意义及影响因素

Clinical value of prealbumin in middle-aged and elderly patients with newly-diagnosed diabetes and its influencing factors

目的：探讨在中老年新诊断糖尿病患者中行前白蛋白（PA）检测的意义及影响因素。方法选取2010年1月至2012年12月期间新诊断中老年糖尿病患者共538例，入选者年龄≥45岁，按照PA水平的四分位间距分为4组，并进行体质量指数（BMI）、血压、空腹血糖、血红蛋白、肝肾功能、血脂谱、空腹C肽，糖化血红蛋白（HbAlc），糖化白蛋白（GA）、C反应蛋白（CRP）等检查。结果（1）研究对象男性的PA水平高于女性[（239±55） vs （227±53）mg/L， P＜0.01]，随年龄增加，PA水平逐渐降低（趋势P＜0.05）。（2）研究对象各组的BMI、腰围、舒张压，血红蛋白、白蛋白、γ-谷氨酰转肽酶、总胆红素、总胆固醇、甘油三酯、血肌酐、尿酸、空腹C肽水平随血PA值的升高而增加（趋势P＜0.05），而年龄、HbA1c、GA、CRP则逐级降低（趋势P＜0.01）。（3）在控制年龄，性别、BMI及腰围后行偏相关分析显示，血红蛋白、白蛋白，总胆固醇，甘油三酯，肌酐，尿酸及空腹C肽水平与PA水平正相关（P＜0.01），而HbA1c， GA，CRP与PA水平负相关（P＜0.01）。（4）以PA＜200mg/L作为低PA的标准，研究对象中低PA的发生率为27.7%。多因素logistic回归分析显示，GA（OR＝1.056，95%CI 1.021～1.092；P＜0.01），CRP（OR＝1.273，95%CI 1.092～1.485；P＜0.01）是中老年新诊断糖尿病患者发生低PA的危险因素，而血红蛋白（OR＝0.978，95%CI 0.961～0.997；P＝0.02），血白蛋白（OR＝0.738，95%CI 0.668～0.815；P＜0.01），TC（OR＝0.747，95%CI 0.561～0.994；P＝0.045），空腹C肽（OR＝0.678，95%CI 0.504～0.911；P＝0.01）则是中老年新诊断糖尿病患者发生低PA的保护因素。GA诊断研究对象发生低PA的切点为25%,ROC曲线下面积为0.686（95%CI 0.638～0.735，P＜0.01），其敏感性为76.4%，特异性为53.4%。结论中老年新诊断糖尿病患者中PA水平受到营养状况，血糖水平、血脂水平和炎症状态的影响。中老年新诊断糖尿病患者中PA水平下降可能与血糖升高有关。

Objective To investigate the clinical value of prealbumin （PA） in middle-aged and elderly newly-diagnosed diabetic patients and its influencing factors. Methods A total of 538 patients （≥45 years old） with newly diagnosed diabetes in our department from January 2010 to December 2012 were recruited in this study. They were divided into 4 groups according to the quartiles of their PA levels, and received routine physical examination and biochemical tests, including body mass index （BMI）, blood pressure, fasting blood glucose, hemoglobin （Hgb）, liver and kidney functions, lipid profile, fasting C-peptide, glycosylated hemoglobin （HbAlc）, glycosylated albumin （GA）, C-reactive protein （CRP）, etc. Results The PA level in this cohort was significantly higher in the males than in the females [（239±55） vs （227±53）mg/L, P〈0.01] and in a trend of decrease with the increase of age （P〈0.05）. As the PA rose, the BMI, waist circumference, diastolic blood pressure （DBP）, Hgb, albumin, γ-glutamyl transpeptidase, total bilirubin, total cholesterol （TC）, triglycerides （TG）, creatinine, uric acid （UA） and fasting C-peptide were increased （P〈0.05）, but the age, HbA1c, GA and CRP were decreased （P〈0.05）. After controlling age, gender and BMI, partial correlation analysis showed that PA was positively correlated with Hgb, albumin, TC, TG, creatinine, UA and fasting C-peptide （all P〈0.01）, but negatively correlated with HbA1c, GA and CRP （P〈0.01）. The prevalence of hypo-prealbuminemia （defined as PA 〈200mg/L） was 27.7%in the cohort. Multivariate logistic regression showed＆amp;nbsp;that the GA （OR=1.056, 95%CI=1.021？1.092, P〈0.01） and CRP levels （OR=1.273, 95%CI=1.092？1.485, P〈0.01） were independent risk factors, while Hgb （OR=0.978, 95%CI=0.961？0.997, P=0.02）, albumin （OR=0.738, 95%CI=0.668？0.815, P〈0.01）, TC （OR=0.747, 95%CI=0.561？0.994;P=0.045） and fasting C-peptide （OR=0.678, 95%CI=0.504？0.911, P=0.01） were protective factors for hypo-prealbuminemia in middle-aged and elderly newly-diagnosed diabetic patients. The cutoff values of PA for the hypo-prealbuminemia deduced by receiver operating characteristic （ROC） curve were 25%, the area under the ROC curve was 0.686 （95% CI=0.638？0.735, P〈0.01）, and its sensitivity was 76.4% and specificity 53.4%. Conclusion PA level is affected by nutrition status, inflammatory status, blood glucose and serum lipids in middle-aged and elderly newly-diagnosed diabetic patients. The low level of PA in the subjects might be due to their increased blood glucose.