微量白蛋白尿与胰岛素抵抗综合征的相关性研究

The relationship between microalbuminuria and insulin resistance syndrome

目的 探讨微量白蛋白尿 (MAU)与胰岛素抵抗综合征的关系。 方法 以葡萄糖耐量试验 (OGTT)将 2 4 0例入选者 (其中高血压者 130例 ,非高血压者 110例 )分为糖耐量正常 (NGT)组、糖耐量异常 (IGT)组及 2型糖尿病组 ,测定晨尿白蛋白浓度、血脂、血糖及血浆空腹真胰岛素(TI) ,计算体质指数 (BMI)、腰臀比 (WHR)。 结果 各组MAU(晨尿白蛋白浓度 :2 0～ 4 0mg L)的发生率分别为 8 8%、13 7%和 2 8 6 % (χ2 =9 313,P <0 0 1) ;MAU组有较高的BMI、WHR、收缩压 (SBP)、舒张压 (DBP)、空腹血糖 (FPG)、餐后 2h血糖 (2hPG)、TI及较低高密度脂蛋白 (HDL C)水平 (P <0 0 5～ 0 0 0 1)。多元线性回归显示 :FPG、DBP、BMI及TI是与MAU相关的独立因素 (P<0 0 5～ 0 0 0 1) ;Logistic回归亦显示 ,除了糖尿病与高血压外 ,高水平TI及WHR水平是发生MAU的独立危险因素 (P <0 0 5～ 0 0 1)。 结论 MAU与高胰岛素血症及向心性肥胖密切相关 ,MAU可能是独立于高血压和糖尿病的胰岛素抵抗综合征的特征之一。

Objective To investigate the relationship between microalbuminuria (MAU) and insulin resistance syndrome. Methods A total of 240 patients(130 of them with hypertension) were stratified by oral glucose tolerance status 〔normal glucose tolerance(NGT), impaired glucose tolerance(IGT), and type 2 diabetes mellitus(DM)〕. Morning urine albumin concentration and anthropometric indices, serum lipid, fasting plasma true insulin concentrations were also measured. Results The prevalence of MAU ( defined as morning urine albumin concentration between 20 and 40 mg/L) was increased as the glucose tolerance worsed (8.8%in NGT, 13.7% in IGT, 28.6% in DM, χ 2 =9.313, P <0.01). Patients with MAU had a higher body mass index(BMI), waist-to-hip circumference ratio(WHR), systolic and diastolic blood pressure (BP), fasting and 2 h plasma glocose(FPG, 2 h PG), fasting plasma true insulin (TI) level and lower high density lipoprotein cholesterol (HDL-C) level than those patients without MAU( P <0.05-0.001). In multiple regression analysis, DBP, 2 h PG, BMI and TI were found to be independent factors associated with MAU( P <0.05-0.001). Logistic regression analysis showed that not only diabetes mellitus and hypertension, but also fasting hyperinsulinemia and WHR were independent factors associated with the presence of MAU( P <0.05-0.01). Conclusions MAU is associated with hyperinsulinemia and central obesity independent of mellitus and hypertension, and it may be viewed as a feature of the insulin resistance syndrome.