成人1型糖尿病患者尿白蛋白比肌酐比值的相关因素分析

Study on factors associated with urinary albumin-to-creatinine ratio among adults with type 1 diabetes mellitus

目的糖尿病肾病(DKD)与1型糖尿病(T1DM)患者终末期肾功能衰竭、心血管疾病风险增加密切相关.本研究拟探讨成人T1DM患者尿白蛋白比肌酐比值(UACR)的相关因素,构建UACR升高预判模型.方法纳入2016年1月至2017年12月广东省1型糖尿病转化医学研究数据库中符合标准的成年T1DM患者,收集患者基本特征和临床指标.根据UACR水平将患者分为UACR正常组(UACR<30 mg/g)和UACR升高组(UACR≥30 mg/g),比较组间人群基本特征,筛选UACR升高相关因素.并利用多因素Logistic回归模型分析UACR的主要相关因素,构建Nomogram模型预判UACR升高概率.结果共纳入495例患者,平均年龄(34.44±11.65)岁,平均病程(7.83±6.22)年,女性296例(59.8%).分组后UACR正常组纳入385例(77.8%),UACR升高组110例(22.2%).组间比较发现UACR相关因素包括病程、收缩压(SBP)、舒张压(DBP)、静息心率、糖化血红蛋白(HbA1c)、估算的葡萄糖处置率对数值(lneGDR)、是否合并高血压.多因素Logistic回归模型分析提示lneGDR是UACR升高的保护因素[OR=0.33(95%CI,0.17~0.60),P<0.05],静息心率[OR=1.03(95%CI,1.00~1.05),P<0.05]和是否合并高血压[OR=2.17(95%CI,1.29~3.63),P<0.05]是危险因素.校正糖尿病病程后,构建Nomogram模型,结果提示,随着lneGDR降低(IR越严重)、静息心率增快、病程增加、高血压出现,患者UACR升高概率增大.结论我国成人T1DM患者UACR水平与多个因素相关,或可通过改善胰岛素抵抗、控制静息心率、控制血压以降低UACR升高发生概率,为成人T1DM患者预防和控制DKD提供思路.

Objective Diabetic kidney disease(DKD)is closely related to end-stage renal failure and increased risk of cardiovascular disease in type 1 diabetes mellitus(T1DM).To investigate factors associated with urinary albumin-to-creatinine ratio(UACR)and establish the prediction model for elevation of UACR among adults with T1DM.Methods Eligible adults with T1DM from Guangdong Type 1 Diabetes Translational Study who were enrolled between January,2016 and December,2017.Basic characteristics and clinical information were collected.All patients were divided into two groups:normal UACR group(UACR<30 mg/g)and elevated UACR group(UACR≥30 mg/g)according to their UACR level.To screen factors that were potentially associated with UACR,comparison of clinical variables between the two groups were performed.Logistic regression analysis and Nomogram model were used to explore major factors associated with UACR and to predict the probability of UACR elevation.Results A total of 495 patients were enrolled,with a mean age of(34.44±11.65)years and diabetes duration of(7.83±6.22)years.Among them,296 patients(59.8%)were women.385 patients(77.8%)were assigned to the normal UACR group and 110 patients(22.2%)to the elevated UACR group.Findings from the comparisons between the two groups demonstrated that diabetes duration,systolic blood pressure(SBP),diastolic blood pressure(DBP),resting heart rate,glycosylated hemoglobin A1c(HbA1c),estimated glucose disposal rate(lneGDR),hypertension were associated with UACR.The results of logistic regression showed that lneGDR[OR=0.33(95%CI,0.17~0.60),P<0.05]was a protective factor from UACR elevation,while resting heart rate[OR=1.03(95%CI,1.00~1.05),P<0.05]and presence of hypertension[OR=2.17(95%CI,1.29~3.63),P<0.05]were risk factors.The Nomogram model suggested that a higher probability of UACR elevation was associated with lower lneGDR(i.e.,greater insulin resistance),higher resting heart rate,longer diabetes duration and the presence of hypertension.Conclusion Many factors were associated with UACR among adult T1DM patients in China.It is possible to reduce the incidence of UACR by improving insulin resistance,controlling resting heart rate and blood pressure,so as to provide ideas for the prevention and control of DKD among adults with type 1 diabetes mellitus.