校正后糖化白蛋白评估合并大量蛋白尿的糖尿病肾病患者血糖的价值

Role of adjusted glycated albumin in assessing glycemic levels in diabetic nephropathy patients with mass proteinuria

目的探讨校正后糖化白蛋白(adjGA)评估糖尿病肾病合并大量蛋白尿患者血糖的价值。方法共纳入166例24h尿微量白蛋白(24hUP)>1.0g/24h的糖尿病肾病患者,按其24hUP水平分为显性蛋白尿组(24hUP<3.5g,92例)和肾病综合征组(24hUP≥3.5g,74例)。测定两组空腹血糖(FBG)、餐后2h血糖(PBG)、糖化血红蛋白(HbA1c)、糖化白蛋白(GA)、体重、血清白蛋白(SA)水平。应用GA的校正公式计算adjGA,并比较两组间差异,分析GA和adjGA与其他因素的相关性。结果两组的FBG和PBG水平差异均无统计学意义(P值均>0.05)。肾病综合征组的GA和GA/HbA1c水平均显著低于显性蛋白尿组(P值均<0.01)。经过数据校正,两组间adjGA的差异仍有统计学意义(P<0.05),而adjGA/HbA1c的差异无统计学意义(P=0.445)。单因素相关性分析结果表明,在全体患者中GA与FBG、PBG、HbA1c、eGFR和SA均呈显著正相关(R^2值分别为0.101、0.067、0.474、0.095、0.072,P值均<0.01),与24hUP呈显著负相关(R^2=0.205,P<0.01);adjGA与FBG、PBG、HbA1c、eGFR均呈显著正相关(R^2值分别为0.156、0.039、0.469、0.089,P值均<0.01),与24hUP、SA均无明显相关性(r值分别为0.024,-0.013,P值均>0.05)。多元线性回归分析结果表明,在全体患者中adjGA仅与PBG相关(R^2=0.163,回归系数为0.497,P<0.05)。结论 adjGA对评估糖尿病肾病合并大量蛋白尿患者的血糖水平有临床价值,尤其适用于肾病综合征大量蛋白尿患者,但仍需进一步行动态血糖监测数据和大样本研究验证。

Objective To evaluate the role of adjusted glycated albumin （adjGA） in assessing glycemic levels in diabetic nephropathy （DN） patients with mass proteinuria. Methods A total of 166 DN patients with 24- hour microalbuminuria （24hUP） 〉 1.0 g were enrolled in this study. They were divided into 2 groups according to their 24hUP： group A （92 patients, 24hUP〈3.5 g） and group B （74 patients, 24hUP≥3.5 g）. Fasting blood glucose （FBG）, postprandial blood glucose （PBG）, glycosylated hemoglobin （HbA1c）, glycated albumin （GA）, body weight and serum albumin were measured. The adjGA was calculated by the formula. The relationship between adjGA and other factors were analyzed. Results There were no statistical difference in FBG or PBG between the two groups （both P〉 0. 05）. However, the levels of both GA and GA/HbA1c in group B were significantly lower than those in group A （both P 〈0.01）. After adjustment of data, there was still statistical difference in the adjGA between groups （P〈0.05）, but no difference was found in adjGA/HbA1c （ P = 0. 445）, Spearman correlation analysis showed that GA was positively correlated to FBG, PBG, HbA1c, eGFR and SA （R2 =0. 101, 0.067, 0.474, 0.095, 0.072, all P〈0. 01） ,and was neqatively correlated to 24hUP （R2 =0.205,P〈0.01 ） in all the patients. Furthermore, adjGA was also positively correlated to FBG, PBG, HbA1 c and eGFR （R2 =0. 156, 0. 039, 0. 469, 0. 089, all P〈0.01）, but it was not significantly correlated with 24hUP or SA （r= 0. 024,-0. 013, both P 〉 0.05）. Multivariate linear regression analysis found that the adjGA was significantly correlated with PBG （R2 = 0. 163, β = 0. 497, P〈0. 05）. Conclusion The adjGA is valueable in assessing blood glucose in DN patients with mass proteinuria, especially in those with nephrotic syndrome combined with mass proteinuria. But it is essential to perform continuous glucose monitoring and large-sample study. （Shanghai Med J, 2018, 41： 110-114）