2型糖尿病患者尿白蛋白排泄率与心自主神经病变的关系

Relationship Between Cardiac Autonomic Neuropathy and Urinary Albumin Excretion Rate in Type 2 Diabetes Mellitus

目的观察2型糖尿病心自主神经病变的患病率及其与尿白蛋白排泄率的相关性。方法选取T2DM患者200例,根据尿蛋白排泄率分为正常蛋白尿组(80例)、微量蛋白尿组(66例)和大量蛋白尿组(54例);采集临床资料,测定收缩压、舒张压、空腹血糖、糖化血红蛋白及血脂等指标;行心血管反射试验检查,结合临床症状评价糖尿病患者心自主神经病变。结果三组患者在糖尿病病程、收缩压、甘油三酯、空腹血糖、糖化血红蛋白和心自主神经病变之间的差异有统计学意义。心自主神经病变者分别占1.3%、9.1%、22.2%(两两比较,P均<0.05)。尿蛋白排泄率与糖尿病病程、空腹血糖、糖化血红蛋白、收缩压、甘油三酯、低密度脂蛋白-胆固醇、心自主神经病变呈正相关(P均<0.05)。多元回归分析显示收缩压(X1)、甘油三酯(X2)、心自主神经病变(X3)、糖尿病病程(X4)是UACR的影响因素,回归方程为Y=-398.454+2.789X1+49.092X2+147.969X3+5.659X4。结论随着蛋白尿程度加重,合并心自主神经病变的患病率增加;收缩压、甘油三酯、心自主神经病变、糖尿病病程是尿蛋白排泄率的独立影响因素。

Objective To investigate the prevalence of cardiac autonomic neuropathy（ CAN） in type 2 diabetes mellitus（ T2DM） and the relationship between CAN and urinary albumin excretion rate（ UACR）. Methods The clinical data of 200 T2 DMpatients were co1 lected. They were assigned to no albuminuria group（ n =80）,micro-albuminuria group（ n = 66） and overt-albuminuria group（ n = 54） according to their UACR values. SBP,DBP,FBG,Hb A1 C and TG,TC,LDL-C were all evaluated and compared among groups.CAN was estimated with cardiovascular reflex test and clinical symptoms. Results There were significant differences in diabetic duration,SBP,TG,FBG,Hb Alc and CAN among the three groups. UACR in patients with CAN in albuminuria group,micro-albuminuria group and overt-albuminuria group were 1. 3%,9. 1%and 22. 2%,respectively. The Spearman correlation analysis showed that UACR was positively associated with diabetic duration,FBG,Hb Alc,SBP,TG,LDL-C and CAN（ all P〈0. 05）. In multiple stepwise regression analysis,SBP（ X1）,TG（ X2）,CAN（ X3） and diabetes duration（ X4） were independent risk factors of UACR. Regression equation： Y =-398. 454 ＋ 2. 789X1＋ 49. 092X2＋ 147. 969X3＋ 5. 659X4.Conclusion As albuminuria is increasingly elevated, the incidence of cardiac autonomic neuropathy progresses. SBP,TG,CAN and diabetic duration might be independent risk factors for UACR.