糖尿病患者尿微量白蛋白/肌酐控制相关因素研究

Study on related factors of urinary albumin/creatinine control in patients with type 2 diabetes mellitus

目的了解上海市闵行区内2型糖尿病(T2DM)患者的尿微量白蛋白/肌酐(ACR)控制情况,分析其影响因素,为该区管理对象的糖尿病肾病的预测和预防提供依据。方法选取上海市闵行区居民电子健康档案系统(EHRs)中已建卡管理的糖尿病患者数据库中,经ACR检测并确诊为T2DM的3 631例患者为研究对象,测量血压、身高、体重,计算体质指数(BMI),并对糖化血红蛋白(Hb A1C)、血脂、ACR等进行实验室检测。结果在3 631例入选对象中,男性ACR控制不良率(36.03%)明显高于女性(17.11%),差异有统计学意义(P<0.01);男、女性控制良好组的ACR水平分别为(8.88±6.40)、(12.67±8.85)mg/g,男性控制不良组ACR水平为(69.04±118.27)mg/g,女性控制不良组ACR水平为(90.77±94.85)mg/g。性别、服药情况、Hb A1C、BMI和收缩压(SBP)是ACR的影响因素,男性、不规律服药、高Hb A1C、高BMI、高SBP是ACR控制不良的危险因素。结论糖尿病患者ACR控制不良率较高,ACR是患者糖尿病早期肾损伤的敏感指标,因此,社区糖尿病患者肾病防治中要积极控制体重、血压、血糖,改变不良行为因素,从管理策略和措施上予以干预,以期延缓肾脏损害,对糖尿病肾病进行早发现、早治疗,改善患者生命质量。

Objective To investigate the control level of urinary albumin/creatinine（ACR） in patients with type 2 diabetes mellitus（T2DM） to analyze its influencing factors and to provide the base for the prediction and prevention of diabetic nephropathy.Methods From the electronic health records system（EHRs） of Minhang District in Shanghai, 3 631 T2 DM patients were selected with detecting ACR and served as the subjects. The blood pressure（BP）, body mass index（BMI）, glycosylated hemoglobin（Hb A1C）,blood lipids and ACR of all subjects were measured. Results The poor control rate（36.03%） of ACR in males was significantly higher than that（17.11%） in females（P〈0.01）.The levels of ACR in male good control group and female good control group were（8.88±6.40） and（12.67±8.85） mg/g. The level of ACR in male poor control group was（69.04±118.27） mg/g. The level of ACR in female poor control group was（90.77 ±94.85） mg/g. Gender, medication, Hb A1 C, BMI and systolic blood pressure（SBP） were the influencing factors of ACR. The male, irregular medication, high Hb A1 C, high BMI and high SBP were risk factors for poor control of ACR. Conclusion The poor control rate of ACR in T2 DM patients is higher. ACR is a sensitive indicator of T2 DM patients with early renal injury. Therefore, to delay the progression of renal impairment and to improve the quality of life in T2 DM patients, the management and intervention measures should be taken early. Diabetic nephropathy should be diagnosed and treated early to improve the quality of life for T2 DM patients.