2型糖尿病患者尿白蛋白/肌酐比值与左心室内径参数的关联性研究

Correlation between urinary albumin/creatinine ratio and left ventricular diameter in patients with type 2 diabetes mellitus

目的探讨2型糖尿病患者尿白蛋白/肌酐比值与左心室内径参数的关联,分析2型糖尿病(T2DM)患者左心室内径参数的相关危险因素。方法回顾性地分析325例糖尿病患者的临床资料,根据2型糖尿病患者尿白蛋白/肌酐比值(UACR)的水平,分为三组。其中A组为尿白蛋白/肌酐比值<30 mg/g(尿白蛋白/肌酐比值<3.4 mg/mmol),B组为尿白蛋白/肌酐比值30~300 mg/g(尿白蛋白/肌酐比值3.4~33.9 mg/mmol),C组为尿白蛋白/肌酐比值>300 mg/g(尿白蛋白/肌酐比值>33.9 mg/mmol)。另一方面,通过超声心动图检测左室舒张末内径(LVEDd)和左室收缩末内径(LVSDd),并计算二者差值(LVEDd-LVSDd)。此外,测量左心室射血分数(LVEF),收集年龄、糖尿病病程、体重指数、空腹血糖、空腹C肽、血脂、糖化血红蛋白、肾小球滤过率、尿转铁蛋白(UTRF)、尿N-乙酰-β-D-葡萄糖苷酶(NAG)等生化指标。比较不同尿白蛋白/肌酐分级三组患者的生化指标水平,LVEDd、LVSDd、LVEF及二者差值(LVEDd-LVSDd)的差异。结果与A组患者相比,C组患者UTRF、NAG、糖尿病病程、FBG、HbA1c水平呈逐渐上升趋势(P<0.05),而TC、TG、HDL-C、LDL-C、GFR、CP、年龄水平差异无统计学意义(P>0.05)。与A组患者比较,尿白蛋白/肌酐比值分级越高的患者,内径差值、LVEDd和LVEF水平越低,而LVSDd水平越高(P<0.05)。C组患者内径差值和LVEF均低于B组患者(P<0.05)。不同UACR分级的患者中,年龄、糖尿病病程、UTRF、NAG、LVESd与尿白蛋白/肌酐比值分级呈正相关(P<0.05)。而内径差值、LVEDd、LVEF与尿蛋白/肌酐的比值分级呈负相关(P<0.05)。结论2型糖尿病患者的LVEDd、LVSDd、LVEDd-LVSDd可作为临床评估心功能参考指标。

[Objective]To investigate the relationship between urinary albumin/creatinine ratio and left ventricular diameter parameters in patients with type 2 diabetes and to analyze the risk factors of left ventricular diameter parameters in patients with type 2 diabetes.[Methods]Clinical characteristics of 325 patients with type 2 diabetes were retrospectively analyzed in this study.And the patients were divided into three groups according to the level of urinary albumin/creatinine ratio(UACR)in patients with type 2 diabetes.They were divided into group A with urinary albumin/creatinine ratio<30 mg/g,group B with urinary albumin/creatinine ratio of 30-300 mg/g and group C with urinary albumin/creatinine ratio>300 mg/g.Additionally,the left ventricular end-diastolic diameter(LVEDd)and left ventricular end-systolic diameter(LVSDd)were detected using echocardiography and the difference between them(LVEDD-LVSDD)was calculated.Furthermore,left ventricular ejection fraction(LVEF)was measured,biochemical indicators such as age,duration of diabetes,BMI,fasting glucose,fasting C peptide,blood lipid,glycosylated hemoglobin,glomerular filtration rate,urinary transferrin and urinary N-acetyl-beta-D-glycosidase enzymes(NAG)were collected.The differences of biochemical indicators,LVEDd,LVSDd,LVEF and the difference(LVEDD-LVSDD)among the three groups were compared.[Results]Compared with group A,UTRF,NAG,duration of diabetes,FBG and HbA1c levels in group C had a trend for gradual increase,which was statistically significant(P<0.05).However,no statistically significant differences were observed regarding TC,TG,HDL-C,LDL-C,GFR,CP and age levels(P>0.05).Compared with group A,patients with higher urinary albumin/creatinine ratio grade had lower LVEDd-LVSDd,LVEDd and LVEF levels,but higher LVSDd levels(P<0.05).LVEDd-LVSDd,LVEF in group C were lower than those in group B(P<0.05).Age,duration of diabetes,UTRF,NAG,LVESd were positively correlated with urinary protein/creatinine ratio(P<0.05).LVEDd-LVSDd,LVEDd and LVEF were negatively correlated with urinary protein/creatinine ratio(P<0.05).[Conclusion]LVEDd,LVSDd and LVEDd-LVSDd in patients with type 2 diabetes can be used as reference indicators for clinical evaluation of cardiac function.