2型糖尿病胰岛β细胞功能及胰岛素抵抗与微量白蛋白尿的相关性研究

Associations of pancreatic β-cell function and insulin resistance with microalbuminuria in type 2 diabetes

目的：探讨2型糖尿病胰岛β细胞功能及胰岛素抵抗与微量白蛋白尿的相关关系。方法入选2型糖尿病患者524例，测量身高、体质量、腰围及血压。采集静脉血测量空腹血糖（FPG）、血脂、糖化血红蛋白（HbA1c）、空腹 C 肽（FPC），留取24 h 尿测量尿白蛋白排泄率（UAER），胰岛β细胞功能（HOMA-B）及胰岛素抵抗（HOMA-IR）采用 C 肽稳态模型评估，根据 HOMA-B 及 HOMA-IR 四分位数，分别将受试者分为四个亚组，即 q1～q4及 Q1～Q4。采用非参数趋势性检验对 HOMA-B 及 HOMA-IR 四分位分组人群各临床指标进行趋势分析，采用多因素 Logistic 回归分析评价2型糖尿病患者胰岛β细胞功能及胰岛素抵抗与微量白蛋白尿的关系。结果趋势性检验显示，随 HOMA-B 升高，UAER 逐渐减少，q1、q2、q3、q4组分别为8．92（5．53～28．65）、8．55（5．52～20．95）、7．57（4．79～19．83）、7．84（5．23～14．38）μg／min，趋势有统计学意义（z ＝－2．1， P ＜0．05），随 HOMA-IR 升高，UAER 逐渐增加，Q1、Q2、Q3、Q4组分别为6．73（4．85～16．52）、8．61（5．2～20.37）、8．31（4．88～27．04）、8．75（6．03～25．21）μg／min，趋势有统计学意义（z ＝2．41，P ＜0．05）。多因素Logistic 回归分析，HOMA-B 最高四分位比最低四分位人群微量白蛋白尿发病风险降低（校正 OR q4 vs q1＝0.39，95％CI：0．20-0．76，Wald ＝7．59，P ＝0．006），相反，HOMA-IR 最高四分位比最低四分位人群有较高微量白蛋白尿发病风险（校正 OR Q4 vs Q1＝2．00，95％CI：1．08-3．72，Wald ＝4．84，P ＝0．028）。结论胰岛素抵抗与2型糖尿病患者微量白蛋白尿发生增加有关，而较好胰岛β细胞功能与微量白蛋白尿发生降低有关。

Objective To investigate the relationship of pancreatic β-cell function and insulin resistance with microalbuminuria in a cross -sectional study of patients with type 2 diabetes.Methods A total of 524 partici-pants with type 2 diabetes were recruited in this cross -sectional study.All subjects＆#39;height,weight,waist circumfer-ence and blood pressure were measured.Venous blood samples were drawn to measure fasting plasma glucose （FPG）, fasting lipids,glycated hemoglobin A1c （HbA1c）,fasting C -peptide （FPC）.24h -urine was collected to measure urinary albumin excretion rate （UAER）.Homeostasis model assessment of pancreatic β-cell function （HOMA -B） and insulin resistance （HOMA -IR）were estimated using fasting plasma C -peptide.According to HOMA -B quar-tile,the subjects were divided into four groups,including q1 -q4.According to HOMA -IR,the subjects were also divided into four groups,including Q1 -Q4.We assessed the crude associations across quartiles of these data with demographic and clinical parameters using a nonparametric test for trend across ordered groups （trend using Stata software）.Multivariable logistic regression analysis was performed to assess the relationships of pancreatic β-cell function and insulin resistance with microalbuminuria in patients with type 2 diabetes.Results Trend test showed that UAER gradually reduced with increase of HOMA -B.The UAER values in subjects with q1,q2,q3 and q4 were 8.92（5.53 -28.65）,8.55（5.52 -20.95）,7.57（4.79 -19.83）and 7.84（5.23 -14.38）μg/min,respectively,＆amp;nbsp;and the trend was statistically significant（z =-2.1,P 〈0.05 ）.With HOMA -IR increasing,UAER gradually increased.The UAER values in subjects with Q1,Q2,Q3 and Q4 were 6.73（4.85 -16.52）,8.61 （5.2 -20.37）, 8.31（4.88 -27.04）,8.75（6.03 -25.21）μg/min,respectively,and the trend was also statistically significant（z =2.41,P 〈0.05）.Multivariable logistic regression analysis showed that subjects with the highest quartile of HOMA -B had lower possibility of microalbuminuria than patients with the lowest quartile of HOMA -B （adjusted OR q4 vs. q1 =0.39,95% CI：0.20 -0.76,Wald =7.59,P =0.006）.Subjects with the highest quartile of HOMA -IR had higher risk of microalbuminuria than those with the lowest quartile of HOMA -IR （adjusted OR Q4 vs.Q1 =2.00, 95% CI：1.08 -3.72,Wald =4.84,P =0.028）.Conclusion Insulin resistance is associated with an increased prevalence of microalbuminuria in type 2 diabetes,while improved pancreatic β-cell function is linked to decreased rates of microalbuminuria for those patients.