老年2型糖尿病患者纤维蛋白原与尿微量白蛋白的相关性研究

Relationship between fibrinogen and microalbuminuria in elderly patients with type 2 diabetes mellitus

目的探讨老年2型糖尿病患者正常范围内血浆纤维蛋白原(FIB)与尿微量白蛋白(UMA)的相关性。方法收集2012年10月至2014年10月上海市第五人民医院收治的869例老年2型糖尿病患者的临床资料。将患者按FIB四分位数分为Q1组(<2.42 g/L)、Q2组(2.42~2.89 g/L)、Q3组(2.90~3.61 g/L)、Q4组(≥3.62 g/L),分析FIB与尿白蛋白与肌酐比值(UACR)的相关性。结果随着FIB水平升高,UACR水平显著升高(P<0.05)。Pearson相关分析显示,在男性和女性患者中FIB与年龄、糖尿病病程、肌酐和UACR均呈显著正相关(P<0.01)。多元逐步回归分析显示FIB是UACR的独立影响因素(P<0.01)。Logistic多元回归分析显示,在校正性别、年龄、糖尿病病程、体重指数(BMI)、收缩压、舒张压、空腹血糖(FPG)、HbAlC、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、肌酐、丙氨酸氨基转移酶(ALT)、吸烟史和饮酒史因素后,Q4组发生微量白蛋白尿和大量白蛋白尿的危险性分别是Q1组的4.536倍(95%CI 2.516~8.175,P<0.01)和13.314倍(95%CI 2.925~60.612,P<0.01),Q3组发生微量白蛋白尿和大量白蛋白尿的危险性分别是Q1组的2.177倍(95%CI 1.273~3.724,P<0.01)和4.098倍(95%CI 1.101~19.226,P<0.05)。以UACR 30 mg/g和300 mg/g为分界值,分别行FIB与UACR的ROC曲线所得FIB的最佳切点值分别为3.18 g/L和3.22 g/L。结论老年2型糖尿病患者血浆FIB与UMA密切相关,可能是糖尿病肾病的预测指标之一。

Objective To analyze the relationship between plasma fibrinogen(FIB)within normal range and microalbuminuria in elderly patients with type 2 diabetes mellitus.Methods A total of 869 elderly subjects with type 2 diabetes mellitus admitted to the Department of Endocrinology of Shanghai Fifth People′s Hospital from October 2012 to October 2014 were included in the study.The patients were divided into four groups based on the quartile level of FIB:Q1 group(<2.42 g/L),Q2 group(2.42-2.89 g/L),Q3 group(2.90-3.61 g/L),and Q4 group(≥3.62 g/L).The relationship between FIB and urinary albumin/creatinine ratio(UACR)was analyzed.Results With the increasing of FIB,the level of UACR was significantly elevated(P<0.05).Pearson correlation analysis showed that FIB was positively associated with age,duration of diabetes,creatinine(Cr)and UACR in men and women(P<0.01).Multiple regression analysis showed that FIB was an independent factor of UACR(P<0.01).Logistic regression analysis showed that the risks of microalbuminuria and macroalbuminuria were respectively 4.536 folds(95%CI 2.516-8.175,P<0.01)and 13.314 folds(95%CI 2.925-60.612,P<0.01)in Q4 group,and 2.177 folds(95%CI 1.273-3.724,P<0.01)and 4.098 folds(95%CI 1.101-19.226,P<0.05)in Q3 group as compared with Q1 group after adjused by following factors:gender,age,duration of diabetes,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),HbA1C,total cholesterol(TC),triglyceride(TG),low density lipoprotein-cholesterol(LDL-C),Cr,alanine aminotransferase(ALT),as well as smoking and drinking behavior.Based on the cut off values to UACR 30 mg/g and 300 mg/g,the receiver operating characteristic curve(ROC)was used to evaluate the value of FIB for UACR.The optimal cut-off value of FIB was 3.18 g/L and 3.22 g/L respectively.Conclusions Plasma FIB was closely associated with microalbuminuria in elderly patients with type 2 diabetes mellitus,which may be considered as one of the predictors for diabetic nephropathy.