内脏脂肪面积对早期糖尿病肾病影响的临床观察

Clinical observation of the effect of visceral fat area on early diabetic nephropathy

目的观察内脏脂肪面积对早期糖尿病肾病的影响。方法回顾性选取2021年8月至2022年8月海南医学院第二附属医院收治的早期糖尿病肾病患者50例作为研究组,单纯糖尿病患者50例作为对照组。统计分析两组患者体格检查、实验室资料、脂肪相关指标;Spearman分析内脏脂肪面积(VFA)、内脏脂肪指数(CVAI)与肾功能的相关性;多因素Logistic逐步回归模型分析早期糖尿病肾病的影响因素,统计分析各影响因素和多因素Logistic逐步回归模型对早期糖尿病肾病的诊断效能。结果两组患者的舒张压、收缩压、身高、糖化血红蛋白、血脂水平比较,差异均无统计学意义(P>0.05),研究组患者的颈围、臀围、腰围、腰臀比、腰高比、体重、体重指数、空腹血糖、尿白蛋白与肌酐比值(UACR)、尿白蛋白排泄率(UAER)、皮下脂肪面积(SFA)、内脏脂肪面积(VFA)、内脏脂肪指数(CVAI)、脂质蓄积指数(LAP)均高于对照组,eGFR低于对照组,差异均有统计学意义(P<0.05)。Spearman相关性分析显示,VFA、CVAI和UACR、UAER均呈显著正相关(P<0.05),但和eGFR均无相关性(P>0.05)。多因素Logistic逐步回归模型分析显示,早期糖尿病肾病影响因素包括糖尿病病程、空腹血糖、VFA、CVAI(P<0.05)。多因素Logistic逐步回归模型诊断早期糖尿病肾病的曲线下面积高于糖尿病病程、空腹血糖、VFA、CVAI(P<0.05),敏感度高于糖尿病病程、CVAI(P<0.05),特异度高于糖尿病病程、空腹血糖、VFA(P<0.05)。结论内脏脂肪面积是早期糖尿病肾病的一个重要影响因素,可以作为一项预警指标,检测内脏脂肪面积可为临床管理内脏型肥胖糖尿病患者提供重要依据。

Objective To observe the effect of visceral fat area on early diabetic nephropathy.Methods Fifty patients with early diabetic nephropathy in the Second Affiliated Hospital of Hainan Medical College from August 2021 to August 2022 were selected as the study group and 50 patients with simple diabetes as the control group.Physical examination,laboratory data,and adipose-related indexes of the two groups were analyzed statistically.Spearman analysis showed the correlation between visceral fat area(VFA),visceral fat index(CVAI)and renal function.Multivariate Logistic stepwise regression model was used to analyze the influencing factors of early diabetic nephropathy.The diagnostic efficacy of various influencing factors and multi-factor Logistic stepwise regression model for early diabetic nephropathy was analyzed.Results There were no statistically significant differences in diastolic blood pressure,systolic blood pressure,height,glycosylated hemoglobin and lipid levels between 2 groups(P>0.05).The parameters of neck circumference,hip circumference,waist circumference,waist-to-hip ratio,waist-to-height ratio,body weight,body mass index,fasting blood glucose,urinary albumin to creatinine ratio(UACR),urinary albumin excretion rate(UAER),subcutaneous fat area(SFA),visceral fat area(VFA),visceral fat index(CVAI),and lipid accumulation index(LAP)were higher than those of control group,and the eGFR was lower than that of control group,the differences were statistically significant(P<0.05).Spearman correlation analysis showed that VFA,CVAI,UACR,UAER were significantly positively correlated with eGFR(P<0.05),but had no correlation with EGFR(P>0.05).Multivariate Logistic regression model analysis showed that the influencing factors of early diabetic nephropathy included diabetes course,FPG,VFA and CVAI(P<0.05).The area under the curve of multi-factor Logistic stepwise regression model in the diagnosis of early diabetic nephropathy was higher than that of course of diabetes,glucose test,fasting blood sugar,VFA,CVAI(P<0.05),the sensitivity was higher than that of diabetes course,CVAI(P<0.05),and the specificity was higher than that of diabetes course,FPG,VFA(P<0.05).Conclusion Visceral fat area is an important influencing factor of early diabetic nephropathy,and can be used as an early warning indicator.Detection of visceral fat area can provide an important basis for clinical management of visceral obesity diabetes patients.