2型糖尿病患者尿白蛋白与肌酐的比值和下肢动脉病变的相关性研究

Study of the relationship between urine albumin-to-creatinine ratio and peripheral artery disease in type 2 diabetes mellitus

目的探讨T2DM患者尿白蛋白/肌酐(UACR)与下肢动脉病变(PAD)患病率的关系。方法回顾性收集2013年1月至2016年5月于广东医科大学附属福田医院内分泌科住院的619例T2DM患者,依据UACR水平分为尿白蛋白正常(NAU)组、临界白蛋白尿(10≤UACR<30 mg/g)组、微量白蛋白尿(30≤UACR<300 mg/g)组和大量白蛋白尿(UACR≥300 mg/g)组。彩色多普勒超声检测下肢动脉,将双下肢动脉任一节段狭窄率≥50%或闭塞定义为PAD。结果(1)T2DM住院患者PAD的患病率为17.4%(108/619)。各组PAD患病率依次为8.5%(25/293)、18.2%(27/148)、24.2%(30/124)、48.1%(26/54);(2)各组年龄、糖尿病病程、SBP、DBP、TG、FPG、SUA、口服ACEI/ARB类降压药物百分比、高血压患病率和PAD患病率逐渐升高(P<0.01或P<0.05),eGFR逐渐降低(P<0.01);(3)Logistic二元回归分析,校正年龄、性别、血压、血糖、血脂、eGFR、口服ACEI/ARB类降压药物百分比和他汀类降脂药百分比等混杂因素,结果显示,UACR是PAD的危险因素;与NAU组比较,10≤UACR<30mg/g组、30≤UACR<300 mg/g组及UACR≥300 mg/g组PAD患病率逐渐升高,OR及95%CI分别为2.04(1.06~3.95)vs 2.33(1.17~4.66)vs 5.61(2.35~13.36)(P<0.01)。结论 PAD患病率随UACR的升高而升高。当T2DM患者UACR≥10 mg/g,PAD患病率已经升高。

Objective To investigate the relationship between urine albumin-to-creatinine ratio（UACR） and the risk of peripheral artery disease （PAD）in patients with type 2 diabetes mellitus （T2DM）.Methods A retrospective study was conducted in 619 patients with T2DM who were admitted to the Department of endocrinology of Futian Hospital Affiliated to Guangdong Medical University from January 2013 to May 2016.All the patients were divided into normal albuminuria group （NAU）,borderline albuminuria （10≤UACR＆lt;30 mg/g）group,microalbuminuria （30≤UACR＆lt;300 mg/g）and macroalbuminuria group （UACR≥300 mg/g） group according to UACR.Ultrasonic artery scan was used to check lower limb artery,and PAD was diagnosed when the stenosis was more than 50% or occluded in any arterial segment. Results （1） The prevalence of PAD in hospitalized patients with T2DM was 17.4%（108/619）.The percentage of PAD in each group was 8.5%（25/293）,18.2%（27/148）,24.2%（30/124） and 48.1%（26/54） respectively.（2） The age,diabetic duration,systolic blood pressure （SBP）,diastolic blood pressure （DBP）,triglyceride （TG）,fasting plasma glucose （FPG）,uric acid,the percentage of angiotensin-converting-enzyme in hibitor （ACEI） or angiotensin receptor blocker （ARB） drugs usage,the prevalence of hypertension and PAD in the four groups were all increased with the elevationof UACR （P〈0.01 or P〈0.05）.The estimated glomerular filtration rate （eGFR） in the four groups was decreased with the elevation of UACR （P〈0.01）.（3） Binary logistics regression analysis showed that UACR was an independent risk factor for PAD after adjusting sex,age,blood pressure,plasma glucose,lipids,eGFR,the percentage of ACRI/ARB and statins lipid-lowering drugs usage.Compared with NAU group,the prevalence of PAD increased in borderline albuminuria,microalbuminuria and macroalbuminuria group[OR（95%CI）：2.04（1.06~3.95）,2.33（1.17~4.66）and 5.61（2.35~13.36）,P〈0.01]. Conclusion The risk of PAD is increased with the elevation of UACR.The risk of PAD has already increased even when the UACR is only higher than 10 mg/g.