老年2型糖尿病患者血尿酸、UACR、UmAlb与糖尿病肾病分期的相关性

Correlation between blood uric acid,urinary protein creatinine ratio,urinary microalbu⁃min level and diabetic nephropathy in elderly patients with type 2 diabetes mellitus

目的 探讨老年2型糖尿病患者血尿酸、尿蛋白肌酐比值(UACR)、尿微量白蛋白(UmAlb)水平与糖尿病肾病(DKD)的相关性。方法 选取2020年1月至2023年1月临泉县人民医院内分泌科收治的140例老年2型糖尿病患者为观察组,另选取同期常规体检的80名健康志愿者为对照组,根据患者肾小球滤过率(eGFR)将其分为非糖尿病肾病(NDKD)42例、DKD早期39例、DKD中期34例、DKD晚期25例。比较所有受试者血尿酸、UACR、UmAlb水平,分析各项指标与DKD分期的相关性及对DKD的诊断价值。结果 观察组血尿酸、UACR、UmAlb水平均高于对照组,差异有统计学意义(t=4.641、25.656、38.833,P<0.05);组内血尿酸、UACR、UmAlb水平表现为DKD晚期>DKD中期>DKD早期,差异有统计学意义(F=4.887、538.570、684.184,P<0.05);Spearman分析结果显示,血尿酸、UACR、UmAlb水平与DKD分期均呈正相关(P<0.001);DKD患者空腹血糖、平均动脉压(MAP)、甘油三酯(TG)、血尿酸、UACR、UmAlb均高于NDKD患者,病程较NDKD患者长,差异有统计学意义(t=3.866、14.824、7.718、5.022、33.588、53.438、9.364,P<0.05)。Logistic多因素回归分析显示,空腹血糖、MAP、TG、血尿酸、UACR、UmAlb是T2DM患者发生DKD的独立影响因素(P<0.05);血尿酸、UmAlb、UACR水平三项指标联合检测优于单一检测(P<0.05)。结论 血尿酸、UACR、UmAlb水平与DKD分期呈正相关,且三者联合检测对DKD具有较高诊断效能。

Objective To investigate the correlation between serum uric acid,urinary protein cre-atinine ratio(UACR)and urinary microalbumin(UmAlb)levels and diabetic nephropathy(DKD)in elderly patients with type 2 diabetes mellitus.Methods A total of 140 elderly patients with type 2 diabetes admitted to the Endocrinology Department of Linquan County People's Hospital from January 2020 to January 2023 were selected as the observation group.80 healthy volunteers who underwent routine physical examinations dur-ing the same period were chosen as the control group.The observation group was further divided into sub-groups based on the patientsglomerular filtration rate(eGFR):42 cases of non-diabetic nephropathy(NDKD),39 cases of early DKD,34 cases of middle DKD and 25 cases of late DKD.In addition,60 healthy volunteers were selected as an additional control group.The levels of uric acid,UACR and UmAlb in the blood of all subjects were compared,and the correlation between theselevels and the stage of DKD,as well as the diagnostic efficacy of DKD were analyzed.Results The levels of uric acid,UACR and UmAlb in the observation group were higher than those in the control group(t=4.641,25.656,38.833,P<0.05).The levels of uric acid,UACR and UmAlb in the blood were higher in late DKD,followed by middle DKD,and early DKD(F=4.887,538.570,684.184,P<0.05).Spearman analysis showed a positive correlation between blood uric acid,UACR,UmAlb levels,and DKD stage(P<0.001).Fasting blood glucose,mean arterial pressure(MAP),triglyceride(TG),blood uric acid,UACR and UmAlb were all higher in DKD patients compared to NDKD patients,the durstion of the disease was longer in DKD patients.The difference was statis-tically significant(t=3.866,14.824,7.718,5.022,33.588,53.438,9.364,P<0.05).Logistic multivariate re-gression analysis showed that fasting blood glucose,MAP,TG,blood uric acid,UACR and UmAlb were in-dependent influencing factors for DKD in T2DM patients(P<0.05).The AUC of serum uric acid and the com-bined detection was superior to the single detection(P<0.05).Conclusion Serum uric acid,UACR and Um-Alb levels are positively correlated with the stage of DKD.The combined detection of these three factors has high diagnostic efficacy for DKD.