腹型肥胖对正常体质指数的新诊断2型糖尿病患者尿白蛋白排泄率的影响

Effects of abdominal obesity on urinary protein excretion rate of newly diagnosed type 2 diabeticpatients with normal body mass index

目的观察腹型肥胖对正常体质指数（BMI）的新诊断2型糖尿病（T2DM）患者尿白蛋白排泄率（UAER）的影响。 方法选取2016年5至10月于解放军武汉总医院门诊及病房治疗的18.5 kg/m2≤BMI〈24 kg/m2的新诊断T2DM患者223例，根据内脏脂肪面积（VFA）分为腹型肥胖组[AO（＋）]113例（VFA〉100 cm2）和非腹型肥胖组[AO（-）]110例（VFA≤100 cm2）。测定两组BMI、血压、血糖、体脂率、VFA值、空腹胰岛素（FINS）、UAER等。以多元线性回归分析腹型肥胖与UAER的独立相关性。 结果与AO（-）组比较，AO（＋）组吸烟率、饮酒率、BMI、VFA、收缩压、血尿酸、C反应蛋白、甘油三酯、肌酐、空腹血糖、FINS水平更高（t值为-22.070^-2.153，均P〈0.05），预估肾小球滤过率和高密度脂蛋白胆固醇更低（t=5.319、5.028，P〈0.001）。AO（＋）组UAER明显高于AO（-）组[29.4（22.2，55.7）比18.4（15.4，24.7） mg/24 h，t=12.540，P〈0.001]。相关分析显示，VFA与UAER呈正相关（r=0.462，P〈0.001）。多元线性回归分析提示，腹型肥胖是体重正常的新诊断T2DM患者UAER的独立影响因子（β=0.256，P=0.001）。 结论VFA与T2DM患者UAER呈正相关，腹型肥胖是体重正常的新诊断T2DM患者UAER的独立影响因素。

ObjectiveTo investigate the effect of abdominal obesity （AO） on urinary protein excretion rate （UAER） of type 2 diabetes mellitus （T2DM） patients with normal body mass index （BMI）. MethodsFrom May 2016 to October 2016, 223 newly diagnosed T2DM patients （in-patient and out-patient） with normal BMI （18.5 kg/m2≤BMI〈24 kg/m2） were recruited from the Department of Endocrinology of Wuhan General Hospital of the Chinese People＇s Liberation Army. Based on visceral fat area （VFA）, the subjects were divided into AO （＋） group which had 113 cases （VFA〉100 cm2） and AO （-） group which had 110 cases （VFA≤100 cm2）. Data about BMI, systolic blood pressure （SBP）, diastolic blood pressure and other clinical characteristics were collected. Levels of body fat ratio, VFA, fasting insulin （FINS）, and UAER were examined. Independent correlation between AO and UAER of diabetes was analyzed by multivariate linear regression analysis. ResultsSubjects in AO （＋） group had higher smoking rate, alcohol use, BMI, VFA, SBP, uric acid, C reactive protein, triglyceride, creatinine, fasting glucose, FINS （t=-22.070--2.153, all P〈0.05） and lower estimated glomerular filtration rate and high density lipoprotein cholesterol （t=5.319, t=5.028, both P〈0.001） than those in AO （-） group. UAER levels were also significantly higher in AO （＋） group than in AO （-） group [29.4（22.2, 55.7） vs 18.4（15.4, 24.7） mg/24 h, t=12.540, P〈0.001]. The correlation analysis demonstrated that VFA was positively correlated with UAER （r=0.462, P〈0.001）. The multivariate linear analysis showed that AO was an independent determinant of UAER in newly diagnosed T2MD patients with normal BMI （β=0.256, P=0.01）. ConclusionsVFA is positively associated with UAER in type 2 diabetes; AO is an independent risk factor for UAER in newly diagnosed T2MD patients with normal BMI.