老年糖尿病患者尿微量白蛋白与尿肌酐比值和肱动脉内皮功能及颈动脉内膜中层厚度的相关性

The correlation of urine microalbumin and creatinine ratio to brachial artery endothelial function and carotid intima-media thickness in elderly patients with type 2 diabetes mellitus

目的探讨老年2型糖尿病(T2DM)患者尿微量白蛋白与尿肌酐比值(UACR)和肱动脉内皮功能、颈动脉内膜中层厚度(IMT)的关系,分析UACR与动脉粥样硬化程度的相关性,为临床防治糖尿病心脑血管并发症提供依据。方法选择2012年2月至2015年10月在徐州医学院附属医院老年科住院新诊断为T2DM的145例患者为研究对象,根据UACR将患者分为UACR正常组(54例)、微量蛋白尿组(48例)和临床蛋白尿组(43例),检测3组患者的身高、体重、血压、空腹血糖(FPG)、空腹胰岛素(FINS)、餐后2 h血糖(2 h PG)、餐后2 h胰岛素(2 h INS)、糖化血红蛋白(HbA1C)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血肌酐(SCr)、超敏C反应蛋白(hs-CRP)、肱动脉内皮依赖性舒张功能(EDD)和颈动脉IMT。用SPSS 19.0软件进行方差分析和多元逐步回归分析,分析UACR与肱动脉EDD和颈动脉IMT关系。结果与UACR正常组比较,微量蛋白尿组和临床蛋白尿组患者的EDD减低(分别为5.78%±0.76%、5.02%±0.83%和4.37%±0.92%),IMT升高[分别为(0.87±0.08)、(1.01±0.11)和(1.13±0.13)mm],差异有统计学意义(P<0.05,P<0.01);与微量蛋白尿组比较,临床蛋白尿组患者的EDD减低,IMT升高,差异有统计学意义(P<0.05)。多元线性逐步回归分析结果显示,EDD与FPG、2 h PG、2 h INS、HbA1C和UACR呈明显负相关(r值分别为-0.612、-0.665、-0.548、-0.622和-0.586);IMT与TC、TG、LDL-C、hs-CRP和UACR呈明显正相关(r值分别为0.646、0.569、0.710、0.665和0.604),差异均有统计学意义(P<0.05)。结论 UACR与糖尿病患者的动脉粥样硬化程度有相关性,应常规检测UACR,对及早评估动脉粥样硬化与筛查糖尿病心脑血管并发症有着重要意义。

Objective To explore the relationship of urine microalbumin/creatinine ratio （UACR） to brachial artery endothelial function and carotid intima-media thickness （IMT） in elderly patients with type 2 diabetes mellitus （T2DM）, and to analyze correlation of UACR with the degree of atherosclerosis. Methods One hundred and forty five newly diagnosed elderly patients with T2DM were served as the subjects and divided into three groups according to UACR： normal control group （54 cases）, microalbumin group （48 cases） and clinic albuminuria group （43 cases）. Height, weight, blood pressure, fasting plasma glucose （FPG）, fasting insulin （FINS）, 2 h PG, 2 h INS, HbAlc, blood lipid （TC, TG, LDL-C, HDL-C）, serum creatinine （SCr）, high- sensitivity C-reactive protein （hs-CRP）, brachial artery endothelium-dependent dilation （EDD） and carotid IMT were measured. The variance analysis and multiple stepwise regression analysis were conducted with SPSS 19.0 to analyze the association of UACR with EDD and IMT. Results As compared with the brachial artery EDD （5.78%±0.76%） and IMT （0.87±0.08 ram） of control group, the brachial artery EDD （5.02%±0.83% and 4.37%±0.92%） of microalbumin group and clinic albuminuria group significantly reduced, and IMT （1.01±0.11 and 1.13-±0.13 ram） of microalbumin group and clinic albuminuria group significantly increased （P〈0.05 or P〈0.01 ）; also there were significant diKerences of EDD and IMT between microalbumin group and clinic albuminuria group （P〈0.05）. The multiple linear stepwise regression analysis showed that EDD was correlated negatively to FPG, 2 h PG, 2 h INS, HbAlc and UACR （r values were -0.612, -0.665, -0.548, -0.622 and -0.586, respectively, P〈0.05）; IMT was positively related to TC, TG, LDL-C, hs-CRP and UACR （r values were 0.646, 0.569, 0.710, 0.665 and 0.604, respectively, P〈 0.05）. Conclusion UACR is correlated with the degree of atherosclerosis in the elderly patients with T2DM. UACR should be measured. It is important significance to evaluate atherosclerosis and screen cardiovascular and cerebrovascular complication.