糖尿病前期血压、血脂、血尿酸代谢异常与早期肾损伤的关系研究

Study on association among early renal damage and abnormal blood pressure,blood lipid and uric acid metabolism in pre-diabetic patients

目的综合探索血压、血脂、血尿酸水平对糖尿病前期肾脏损伤的影响。方法2018-2019年在盘锦市大洼区采用人口比例概率抽样,开展慢性病行为危险因素监测,通过比较不同糖代谢损伤组别人群尿微量白蛋白(U-mAlb)尿微量白蛋白/肌酐比值(UACR)的差异,利用Amos23.0建立血糖、血压、血脂、血尿酸和BMI等与U-mAlb的路径模型,分析不同糖代谢损伤(IGR)组别的早期肾损伤状况,分析血糖、血压、血脂、血尿酸代谢异常之间的关系以及对早期肾损伤的影响。结果调查的430名常住居民中糖耐量正常(NGT)、单纯空腹血糖受损(I-IFG)、单纯糖耐量低减(I-IGT)、糖耐量低减合并空腹血糖受损(IGT/IFG)、2型糖尿病标准(DM)组的微量白蛋白尿(MAU)患病率分别为3.88%(9/232)、6.85%(5/73)、11.76%(4/34)、12.20%(5/41)和12.00%(6/50),患病率差异有统计学意义(P<0.01)。路径模型结果显示,口服葡萄糖2 h血糖值(2 hBG)是尿微量白蛋白(U-mAlb)仅有的直接效应变量,标准总效应值为0.16,糖化血红蛋白(HbA1c)、空腹血糖(FBG)、甘油三酯(TG)、血尿酸、收缩压、舒张压和BMI对U-mAlb的标准间接效应分别为0.06、0.03、0.06、0.01、0.004、0.006和0.02,甘油三酯(TG)、血尿酸、收缩压、舒张压和BMI对血糖水平也有显著的直接和间接作用。结论糖尿病早期肾损伤即已发生,血糖水平是此人群早期肾损伤的最直接因素,通过控制血压、血脂、血尿酸和BMI水平间接预防和干预糖代谢损伤人群的肾损伤的发生发展。

Objective To comprehensively explore the influence of blood pressure,blood lipid and blood uric acid levels on renal injury in prediabetes.Methods In 2018-2019,population proportional probability sampling was used in Dawa district of Panjin city to carry out monitoring of chronic disease behavioral risk factors.By comparing the difference of urinary microalbumin(U-MALB)and urinary microalbumin/creatinine ratio(UACR)in different glucose metabolic injury groups,Amos 23.0 was used to establish u-MALB pathway models of blood glucose,blood pressure,blood lipid,blood uric acid and BMI,and analyze the status of early renal injury in different IGR groups.The relationship between abnormal blood glucose,blood pressure,blood lipid and blood uric acid metabolism and its influence on early renal injury were analyzed.Results Among 430 residents,the prevalence of microalbuminuria(MAU)in normal glucose tolerance(NGT),isolated impaired fasting glucose(I-IFG),isolated impaired glucose tolerance(I-IGT),impaired glucose tolerance with impaired fasting glucose(IGT/IFG)and standard type 2 diabetes mellitus(DM)group were 3.88%(9/232),6.85%(5/73),11.76%(4/34),12.20%(5/41)and 12.00%(6/50),and the differences were statistically significant(P<0.01).Pathway model results showed that oral glucose 2 h blood glucose(2 hBG)was the only direct effect variable of urinary microalbumin(U-MALB),and the standard total effect value was 0.16.The standard indirect effects of glycosylated hemoglobin(HbA1 c),fasting blood glucose(FBG),triglyceride(TG),blood uric acid,systolic blood pressure,diastolic blood pressure and BMI on U-MALB were 0.06,0.03,0.06,0.01,0.004,0.006 and 0.02.Triglyceride(TG),blood uric acid,systolic blood pressure,diastolic blood pressure and BMI also had significant direct and indirect effects on blood glucose level.Conclusion Early renal injury in diabetes has already occurred,and blood glucose level is the most direct factor for early renal injury in this population.The occurrence and development of renal injury in people with glucose metabolism injury can be prevented and intervened indirectly by controlling blood pressure,blood lipid,blood uric acid and BMI level.