2型糖尿病患者心脏代谢指数与白蛋白尿的关系研究

Relationship between Cardiometabolic Index and Albuminuria in Patients with Type 2 Diabetes Mellitus

目的:探讨2型糖尿病(T2DM)患者心脏代谢指数(CMI)与白蛋白尿的关系。方法:选取2012年2月~2020年7月期间在江苏大学附属医院内分泌代谢科就诊且被诊断为T2DM的患者555例,收集患者的临床资料。根据CMI不同数值将患者分为低CMI(L-CMI)组(n=185)、中CMI(M-CMI)组(n=185)和高CMI(H-CMI)组(n=185),按照尿白蛋白/肌酐比值(UACR)将研究对象分为正常白蛋白尿组(n=294)、微量白蛋白尿组(n=209)和大量白蛋白尿组(n=52),然后对CMI与T2DM患者发生异常白蛋白尿的关系进行分析,通过受试者工作特征(ROC)曲线评估CMI对T2DM患者发生异常白蛋白尿的预测价值。结果:不同UACR组的收缩压(SBP)、舒张压(DBP)、体质量指数(BMI)、CMI、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、空腹胰岛素(FINS)、空腹C肽(FC-P)、稳态模型评估胰岛素抵抗指数(HOMA-IR)、尿素氮(BUN)、血尿酸(SUA)、血肌酐(Scr)及肾小球滤过率(eGFR)比较均有统计学差异(P<0.05)。L-CMI组、M-CMI组、H-CMI组异常白蛋白尿发生比例分别为21.08%、42.70%、77.30%,异常白蛋白尿发生比例呈显著递增趋势(P<0.05)。Spearman秩相关分析结果显示,T2DM患者UACR与FINS、BUN、CMI、Scr、SUA、SBP、DBP、BMI、TG、TC、HbA1c、FPG、FC-P、HOMA-IR呈正相关(P<0.05),与eGFR、HDL-C呈负相关(P<0.05)。多元线性回归分析显示,CMI对UACR的影响强度最大(P<0.05)。Logistic回归分析结果显示,年龄、SBP、CMI、TC、LDL-C及HbA1c是T2DM患者发生异常白蛋白尿的独立危险因素(P<0.05)。CMI预测异常白蛋白尿发生的曲线下面积为0.801,预测异常白蛋白尿的敏感性、特异性分别为68.60%、76.90%。结论:T2DM患者异常白蛋白尿发生风险与CMI密切相关,提示CMI有望成为临床上糖尿病肾病(DKD)的预测指标。

Objective:To investigate the relationship between cardiometabolic index and albuminuria in patients with type 2 diabetes mellitus(T2 DM).Methods:A total of 555 patients who were diagnosed as T2 DM in department of endocrinology and metabolism of Affiliated Hospital of Jiangsu University from February 2012 to July 2020 were selected,the clinical data were collected.Patients were divided into low CMI(L-CMI)group(n=185),medium CMI(M-CMI)group(n=185)and high CMI(H-CMI)group(n=185)according to the different CMI values,the subjects were divided into normal albuminuria group(n=294),microalbuminuria group(n=209)and macroalbuminuria group(n=52)according to the urinary albumin/creatinine ratio UACR,then the relationship between CMI and abnormal albuminuria in T2 DM patients was analyzed,the predictive value of CMI for abnormal albuminuria in T2 DM patients was evaluated by receiver operating characteristic(ROC)curve.Results:Systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),CMI,triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),glycosylated hemoglobin(Hb A1 c),fasting blood glucose(FPG),fasting insulin(FINS),fasting C-peptide(FC-P),homeostasis model assessment of insulin resistance index(HOMA-IR),urea nitrogen(BUN),serum uric acid(SUA),creatinine(SCR),glomerular filtration rate(EGFR)in different UACR groups were statistically significant differences(P<0.05).The incidence of abnormal albuminuria in L-CMI,M-CMI and H-CMI groups were 21.08%,42.70%and 77.30%respectively,and the incidence of abnormal albuminuria showed a significant increasing trend(P<0.05).The results of Spearman rank correlation analysis show that,UACR was positively correlated with FINS,BUN,CMI,Scr,SUA,SBP,DBP,BMI,TG,TC,HbA1 c,FPG,FC-P and HOMA-IR(P<0.05),and it was negatively correlated with eGFR and HDL-C(P<0.05).Multiple linear regression analysis showed that,CMI had the strongest effect on UACR(P<0.05).Logistic regression analysis showed that,age,SBP,CMITC,LDL-C and HbA1 c were independent risk factors for abnormal albuminuria in T2 DM patients(P<0.05).The area under the curve of CMI predicting the occurrence of abnormal albuminuria was 0.801,the sensitivity and specificity were68.60%and 76.90%respectively.Conclusion:The risk of abnormal albuminuria in patients with T2 DM is closely related to CMI,suggesting that CMI may be a clinical predictor of diabetic nephropathy(DKD).