成纤维细胞生长因子21和尿微量白蛋白与2型糖尿病患者下肢大血管病变的关系研究

Relationship between Fibroblast Growth Factor-21,Urinary Microalbumin and Lower Extremity Macroangiopathy in Patients with Type 2 Diabetes Mellitus

目的探讨成纤维细胞生长因子21(FGF-21)和尿微量白蛋白(mAlb)与2型糖尿病(T2DM)患者下肢大血管病变的关系。方法选取2015年5月—2016年5月榆林市第一医院收治的T2DM患者127例,根据是否合并下肢大血管病变分为无病变组68例和病变组59例;另选取同期榆林市第一医院收治的非糖尿病下肢大血管病变患者30例作为对照组。比较3组患者临床资料和实验室检查指标并进行Pearson相关性分析,T2DM患者下肢大血管病变的影响因素分析采用多因素Logistic回归分析。结果 3组患者性别、年龄、体质指数(BMI)、舒张压(DBP)和三酰甘油(TG)比较,差异无统计学意义(P>0.05);病变组患者糖尿病病程长于无病变组,高密度脂蛋白胆固醇(HDL-C)低于无病变组,空腹血糖(FBG)高于对照组(P<0.05);病变组患者收缩压(SBP)、糖化血红蛋白(HbA_(1c))、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、尿素氮(BUN)、血肌酐(Scr)、胱抑素C(Cys-C)、FGF-21及mAlb高于对照组和无病变组,肾小球滤过率估计值(eGFR)低于对照组和无病变组(P<0.05);无病变组患者FBG及HbA_(1c)高于对照组,TC低于对照组(P<0.05)。Pearson相关性分析结果显示,FGF-21与病变组患者糖尿病病程、HbA_(1c)、TC、BUN、Scr、Cys-C及mAlb呈正相关(r值分别为0.317、0.269、0.356、0.407、0.392、0.337、0.504,P<0.05),与eGFR呈负相关(r=-0.473,P<0.05);mAlb与病变组患者糖尿病病程、HbA_(1c)、TC、BUN、Scr及Cys-C呈正相关(r值分别为0.295、0.316、0.412、0.513、0.447、0.508,P<0.05),与eGFR呈负相关(r=-0.531,P<0.05)。多因素Logistic回归分析结果显示,Cys-C[OR=2.039,95%CI(1.185,3.496)]、FGF-21[OR=2.207,95%CI(1.126,4.331)]、mAlb[OR=2.308,95%CI(1.549,3.461)]是T2DM患者下肢大血管病变的影响因素(P<0.05)。结论 FGF-21和mAlb是T2DM患者下肢大血管病变的影响因素。

Objective To explore the relationship between fibroblast growth factor- 21 （FGF-21）, urinary, microalbumin （mAlb） and lower extremity macroangiopathy in patients with type 2 diabetes me]litus （T2DM）. Methods From May 2015 to May 2016 in the First Hospital of Yu]in, a total of 127 patients with T2DM were selected and divided into A group （with lower extremity maeroangiopathy, n = 59 ） and B group （without lower extremity macroangiopathy, n = 68 ） according to the incidence of lower extremity macroangiopathy, meanwhile a total of 30 lower extremity maeroangiopathy patients without diabetes were selected as control group. Clinical data and laboratory examination results were compared among the three groups and the correlations were analyzed by Pearson correlation analysis, and influencing factors of lower extremity macroangiopathy in patients with T2DM were analyzed by multivariate Logistic regression analysis. Results No statistically significant differences of gender, age, BMI, DBP or TG was found among the three groups （ P 〉 O. 05 ） ; diabetes course of A group was statistically significantly longer than that of B group, HDL-C of A group was statistically significantly lower than that of B group, while FBG of A group was statistically significantly higher than that of control group （P 〈0. 05） ; SBP, HbAtc, TC, LDL-C, BUN, Scr, Cys-C, FGF-21 and mAlb of A group were statistically significantly higher than those of B group and control group, while eGFR of A group was statistically significantly lower than that of B group and control group, respectively （P 〈 0.05 ） ; FBG and HbAic of B group were statistically significantly higher than those of control group, while TC of B group was statistically significantly lower than that of control group （P 〈0. 05）. Pearson correlation analysis results showed that, FGF-21 was positively cmTelated with diabetes course （r = 0. 317）, HbA1c （ r = 0. 269） , TC （ r = 0. 356） , BUN （ r = 0. 407） , Ser （ r = 0. 392）, Cys-C （ r = 0. 337） and mAlb （ r = 0. 504） of T2DM patients complicated with lower extremity macroangiopathy, respectively （P 〈0. 05 ） , was negatively correlated with eGFR （r = -0. 473, P 〈0. 05） ; mAlb was positively correlated with diabetes course （r=0.295）, HbA^o （r=0.316）, TC （r=0.412）, BUN （r=0.513）, Ser （r=0.447） and Cys-C （r= 0. 508） of T2DM patients complicated with lower extremity macroangiopathy, respectively （ P 〈 0. 05 ）, was negatively correlated with eGFR （r = -0. 531, P 〈0. 05）. Multivariate Logistic regression analysis results showed that, Cys-C [ OR = 2.039, 95%CI （1.185, 3,496）3, FGF-21 [OR=2.207, 95%CI （1.126, 4.331）3 and mAlb [OR=2.308, 95%CI （ 1. 549, 3.461 ） 3 were influencing factors of lower extremity macroangiopathy in patients with T2DM （P 〈0. 05）. Conclusion FGF-2I and mAlb are influencing factors of lower extremity macroangiopathy in patients with T2DM.