Microalbuminuria and Associated Factors in Diabetics at the CNHU-HKM of Cotonou

Diabetes mellitus is a disease of great frequency and is a major public health problem. Several complications can occur during the course of diabetes such as diabetic nephropathy, which starts with microalbuminuria in diabetic patients. This was a cross-sectional and analytical study which took place from 23 September to 23 December 2021 in the Endocrinology-Metabolism-Nutrition Department of the CNHU-HKM of Cotonou, Benin. We carried out an exhaustive census of the patients. Type 2 diabetic patients were included in the study, and 24-hour microalbumunuria, fundus examination and assessment of complications were performed. We identified 145 type 2 diabetic patients of whom 44 had positive microalbuminuria, i.e. a prevalence of 30.3%. There were 61 men and 84 women with a sex ratio of 0.72. The mean age was 59 years with extremes of 26 and 85 years. The complications identified in diabetics with positive microalbuminuria were Neuropathy (43.2%), Nephropathy (22.7%) and Retinopathy (20.5%). Factors associated with microalbuminuria in diabetics were: age, occupation, hypertension, diabetes imbalance, erectile dysfunction. Conclusion: Microalbuminuria is common in type 2 diabetes. It should be managed early to slow the progression of kidney disease to the end stage.

Helicobacter pylori seropositivity in diabetic patients is associated with microalbuminuria

AIM:To investigate the relationship between Helicobacter pylori(H.pylori) seropositivity and the presence of microalbuminuria.METHODS:Between December 2003 and February 2010,asymptomatic individuals who visited the Seoul National University Healthcare System Gangnam Center for a routine check-up and underwent tests for H.pylori immunoglobulin G antibodies and urinary albumin to creatinine ratio(UACR) were included.All study subjects completed a structured questionnaire,anthropometric measurements and laboratory tests.Anti-H.pylori immunoglobulin G was identified using an enzyme-linked immunosorbent assay kit.A random single-void urine sample,collected using a clean-catch technique,was obtained to determine the UACR.The presence of microalbuminuria was defined as a UACR from 30 to 300 μg/mg.The presence of diabetes mellitus(DM) was defined as either a fasting serum glucose level greater than or equal to 126 mg/dL or taking anti-diabetic medication.Multiple logistic regression analysis was performed to identify the risk factors.The dependent variable was microalbuminuria,and the independent variables were the other study variables.RESULTS:A total of 2716 subjects(male,71.8%;mean age,54.9 years) were included.Among them,224 subjects(8.2%) had microalbuminuria and 324 subjects(11.9%) had been diagnosed with DM.Subjects with microalbuminuria had a significantly higher H.pylori seropositivity rate than subjects without microalbuminuria(60.7% vs 52.8%,P = 0.024).Multivariate analysis after adjustment for age,body mass index(BMI),waist circumference,and glucose and triglyceride levels showed that H.pylori seropositivity was significantly associated with microalbuminuria [odds ratio(OR),1.40,95% CI,1.05-1.89,P = 0.024].After the data were stratified into cohorts by glucose levels(≤ 100 mg/dL,100 mg/dL < glucose < 126 mg/dL,and ≥ 126 mg/dL or history of DM),H.pylori seropositivity was found to be significantly associated with microalbuminuria in diabetic subjects after adjusting for age,BMI and serum creatinine level(OR,2.21,95% CI,1.20-4.08,P = 0.011).In addition,the subjects were divided into five groups.Those without microalbuminuria(an UACR of < 30 μg/mg) were divided into four groups in accordance with their UACR values,and subjects with microalbuminuria comprised their own group.Notably,H.pylori seropositivity gradually increased with an increase in UACR(P = 0.001) and was highest in subjects with microalbuminuria(OR,2.41,95% CI,1.14-5.11).This suggests that H.pylori seropositivity is positively associated with microalbuminuria in diabetic subjects.CONCLUSION:H.pylori seropositivity was independently associated with microalbuminuria,and the prevalence of H.pylori seropositivity was associated with the severity of UACR in diabetic subjects.

Effects of Chinese herbal medicine Yiqi Huaju Qingli Formula in metabolic syndrome patients with microalbuminuria:a randomized placebo-controlled trial

BACKGROUND： Microalbuminuria （MAU） is a key component of metabolic syndrome （MetS） and is an early sign of diabetic nephropathy as well. Although routine Western medicine treatments are given to MetS patients to control high blood pressure, hyperglycemia and dyslipidemia, some patients still experience progressive renal lesions and it is necessary to modify and improve the treatment strategy for MetS patients. OBJECTIVE： To investigate the efficacy of Yiqi Huaju Qingli Herb Formula, a compound traditional Chinese herbal medicine, in MetS patients with MAU when it is combined with routine Western medicine treatment. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： Sixty patients with MetS were randomized into the Chinese herbal formula group （CHF, Yiqi Huaju Qingli formula treatment in combination with Western medicine） and control group （placebo in combination with Western medicine）. All treatments were administered for 12 weeks. MAIN OUTCOME MEASURES： Urinary microalbumin （MA）, urinary albumin-to-creatinine ratio （UACR）, 24-hour total urine protein （24-hTP）, body mass index （BMI）, waist circumference （WC）, waist-to-hip ratio （WHR）, fasting plasma glucose （FPG）, 2-hour postprandial plasma glucose （2-hPPG）, glycosylated hemoglobin （HbAlc）, homeostasis model assessment for insulin resistance （HOMA-IR）, blood lipid profile and blood pressure were observed. RESULTS： Compared with the control group, CHF treatment significantly decreased BMI （P〈0.05）, WC （P〈0.01） and WHR （P〈0.01）. Both groups had significant decreases in FPG, 2-hPPG, HbAlc, HOMA-IR, MA, and UACR, with CHF treatment showing better effects on these parameters compared with the control treatment （P〈0.05）. Both treatments significantly reduced the levels of total cholesterol, low-density lipoprotein cholesterol and triacylglycerol （TAG）, and a greater reduction in TAG was observed with CHF treatment （P〈0.05）. The level of high-density lipoprotein cholesterol did not change in the control group after treatment （P〉0.05）, whereas it significantly increased with CHF treatment （P〈0.01）. Compared with before the treatment, significant decreases in systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were observed in both groups （P〈0.01）. However, there was no significant difference between the two groups （P〉0.05）. CONCLUSION： Combined treatment ofYiqi Huaju Qingli Formula and Western medicine significantly alleviated MAU, which may correlate with the improvement of insulin sensitivity and glucose and lipid metabolism. TRIAL REGISTRATION IDENTIFIER： This trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR-TRC-11001633.

Tangled relationship between insulin resistance and microalbuminuria in children with obesity

Childhood obesity represents a complex disease with a well-known cardiometabolic burden including fatty liver,type 2 diabetes,metabolic syndrome,and cardiovascular disease.From a pathogenic point of view,insulin resistance(IR)represents the key factor underlying the spectrum of these obesity consequences.As observed in adults,recent data supported the occurrence of microalbuminuria(MA)as marker of early kidney dysfunction and its potential link with cardiometabolic factors also in children with obesity.In fact,a well-documented pathophysiological hypothesis both in adults and children supported an intimate correlation with the major feature of obesity such as IR through the influence of insulin on renal hemodynamics.Based on the clinical and prognostic relevance of this relationship in daily practice(including an increased risk of chronic kidney disease development overtime),more scientific attention needs to be paid to the evaluation of early kidney damage in children with obesity.In this paper,we attempt to address three debated questions regarding the intriguing liaison between IR and MA in children with obesity:(1)What is the prevalence of pediatric MA?(2)What is the state of art of MA in children with obesity?and(3)Is there a link between IR and MA in children with obesity?

RENAL ENDOGENOUS ET-1 AND URINARY SODIUM EXCRETION AND MICROALBUMINURIA IN HUMAN SALT-SENSITIVE HYPERTENSION

Objective To investigate the urinary endothelin-1 (ET-l ) excretion and urinary sodium excretion, microalbuminuria and ambulatory blood pressure(ABP) in salt-sensitive(SS) hypertension patients. Methods Twen- ty-one cases of normotensive subjects and 32 cases of uncomplicated hypertensive patients were recruited in this study. Salt sensitivity was determined by acute venous saline loading test. Before saline loading, 24-hour ABP mea- surements were performed. Urine samples were collected to assay ET-1,urinary sodium excretion and urinary albumin excretion(UAF). Results Compared to slat-resistant(SR) subgroup, SS showed low urinary ET-1 excretion in nor- motensive group (P<0.05) or hypertensive group (P<0.01),regardless or saline loading or not. The nighttime MAP of SS was higher than SR subgroup in normotensive or hypertensive group. Urinary sodium excretion during 4h of saline loading was significantly lower in SS than that in SR hypertensive patients (P<0.05). Twenty-four-hour UAE of SS patients was higher than SR group (P<0.01). Results of further correlation analysis indicated that the urinary ET-1 excretion was positively related to urinary sodium content and negatively to ABP and UAE. Conclusion Uri- nary ET-1 is low in SS normotensives or hypertension patients,which may play a role in renal sodium retention and renal impairment or SS hypertension patients.

The development and validation of a risk score for predicting microalbuminuria in type 2 diabetic patients

Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who were treated at community hospitals was used to develop a prediction model (derivation set). The model evaluated at a tertiary hospital (validation set). A stepwise logistic regression model was used to identify the independent risk variables from the derivation set and a simple point scoring system was derived from the beta-coefficients. The risk scoring scheme was validated by the validation set. Results: The risk scoring scheme is based on six risk predictors: the duration of diabetes, age at the onset of diabetes, systolic blood pressure, low density lipoprotein levels, creatinine levels, and alcohol consumption. The total score ranged from 0 to 11.5. The likelihood of microalbuminuria in patients with low risk (scores ≤ 2) was 0.28, with moderate risk (scores 2.5 to 5.5) was 0.86, and high risk (scores ≥ 6) was 7.36. The area under the ROC curve of the derivation set and validation set were 0.768 (95% CI 0.73 - 0.81) and 0.758 (95% CI 0.70 - 0.80), respectively. Conclusion: Our scoring system is a simple and reasonably accurate method for predicting the future presence of microalbuminuria in type 2 diabetic patients.

Prevalence of microalbuminuria in type 2 diabetes patients in Tirana, a preliminary multicenter study

Background: Microalbuminuria is often the first sign of renal involvement predicting overt nephropathy. For this reason, monitoring microalbuminuria and other risk factors associated with this condition is important to take measures to prevent or postpone overt nephropathy. This study aimed to investigate the prevalence of microalbuminuria in type 2 diabetes patients attending three diabetes centers in Tirana city. Patients and Methods: Two hundred and twenty patients with type 2 diabetes attending diabetes centers in Tirana were recruited in this crosssectional study. Medical records were used to collect data on duration of diabetes, waist circumference, history of hypertension, smoking. Blood samples were drawn after 12 h overnight fasting to measure glycosylated hemoglobin (HbA1c), serum cholesterol, triglyceride and creatinine. Microalbuminuria was assessed using dipstick kits in early morning urine samples. Results: The prevalence of normoalbuminuria was 58.3%, microalbuminuria 38.6% and macroalbuminuria 3.1%. Systolic and diastolic blood pressure (p p < 0.01) and fasting plasma glucose (p moalbuminuric subjects. Multiple logistic regression analysis using microalbuminuria as the dependent variable in males shows that independent risk factors for diabetes patients with microalbuminuria were duration of diabetes, systolic blood pressure and waist circumference. We found that the OR for microalbuminuria became statistically significantly increased only at 16 years after the diagnosis of type 2 diabetes. At this time, 43.7% of patients had microalbuminuria. Conclusions: We found a high proportion of type 2 diabetes patients with microalbuminuria which raises implications for health policy inAlbania. This calls for early detection and good control of diabetes to reduce the burden of diabetic kidney disease in the future. Screening programs and optimized control of modifiable risk factors are needed to reduce the risk of diabetic nephropathy.

Microalbuminuria and Kidney Disease Risk in HIV Patients Taking Combined Antiretroviral Therapy

Objectives: This study proposes to evaluate risk factors for kidney disease in HIV patients treated chronically and correlate with microalbuminuria measurements. Methods: Review charts and analyses of microalbuminuria in subgroup of HIV patients treated at Ceara/Brazil. Results: 149 patients, 69.1% male, mean 38.5 years old, infection mean 86.8 months. Mean Creatinine Clearance 110.2%, Creatinine 0.97, Urea 27.76 mg/dl, CD4+ 600.37 cels/mm3 and detectable viral load 530.59 copies with 61.7% undetectable. Mean Dosages of microalbuminuria/24h 147, 46 ± 820, 45 (N = 48) and microalbuminuria (mg/dl) 32.05 ± 85.25 (N = 43). Kidney Diseases Classification analyses evidenced 6.4% patients in stages ≥3 and 6.2% presented altered Microalbuminuria/24h. Patients using Tenofovir (TDF) 27.27% had Stage 2 and protease inhibitors (PI) had 4.1% in Stage 3. Proteinuria was observed in 5% stage ≥3. Association PI/TDF had 4.1% in Stage 3. No statistical difference between CD4 > or 3 and microalbuminuria/24h > 300 mg (p = 0.69);detectable/undetectable viral load and microalbuminuria/24h (p = 0.63) or stage ≥3 (p = 0.17);relation to Diabetes or arterial hypertension and microalbuminuria 24 h (p = 0.5 and p = 0.21);relation stage ≥3 and microalbuminuria/24h (p = 0.33);relation HIV diagnoses >/< 60 months and stage ≥3 (p = 0.51);or microalbuminuria/24h and TDF (p = 0.4), PI (p = 1), TDF/PI (p = 0.69), Atazanavir (p = 0.4) or Lopinavir/r (p = 1) regimens. There was statistical significance comparing age > or or < 50 years and microalbuminuria/24h (p = 0.55) or microalbuminuria mg/d (p = 0.32). Relating comorbidities risk (Diabetes Mellitus plus Systemic Arterial Hypertension) to Kidney Diseases, it was found that 55.5% patients in Stage 3 or above with comorbidities compared with 15% with comorbidities in lower stages (P = 0.005). Nevertheless, comorbidities presence was not associated with microalbuminuria (p = 0.08). Conclusion: Kidney disease is a real risk for HIV patients and stages ≥3 have to be early detected. Microalbuminuria dosage did not demonstrate more sensibility than proteinuria to early diagnoses, even related to antiretroviral drugs. Major risk factor for kidney damage evidenced to be older than 50 years and there was no protective effect from CD4 or undetectable viral load.

Significance of intensive glycemic control on early diabetic nephropathy patients with microalbuminuria

Objective To investigate the therapeutic effect of intensive glycemic control on patients with early diabetic nephropathy. Methods A total of 41 type 2 diabetes patients who developed microalbuminuria were divided into two groups randomly. Patients in Group A received intensive glycemic control and the blood glucose in Group B was regularly controlled. Glycemic monitoring and control were followed for 12 weeks to observe the changes of microalbuminuria in both groups; meanwhile the levels of serum lipids and coagulation indices were also recorded. Results The urine albumin excretion rate (UAER) in Group A decreased significantly from (47.91±13.86)mg/24h to (35.31±14.56)mg/24h after 12 weeks (P<0.05),and this decrease was significantly greater than that in Group B. However,Group B had no significant difference in UAER decrease [(48.93±13.32)mg/24h to (40.48±19.62)mg/24h,P>0.05]. The decrease of triglyceride (TG) and low-density lipoprotein cholesterol (LDL cholesterol),and the increase of high-density lipoprotein cholesterol (HDL cholesterol) showed no significant differences (P>0.05). And the level of plasma fibrinogen (FIB) showed no significant decrease after 12 weeks,either (P>0.05). Conclusion Intensive glycemic control reduces the level of microalbuminuria and may ameliorate the progression of early diabetic nephropathy.

Microalbuminuria in pediatric patients with hypertension

Microalbuminuria in adults has been found to be an early indicator of both renal and systemic vascular disease, as well as significant cardiovascular risk predictor and therapeutic marker. Its role in essential hypertension in adults has also been well established. As diseases like hypertension and obesity have their roots in childhood and are already present in children, influencing the morbidity in adulthood, the role of microalbuminuria has been extensively investigated in children as well. Most investigations have been performed in diabetic children, confirming its clinical significance. There is also enough evidence to suggest that microalbuminuria in obese children should be taken as seriously as in children with diabetes. In children with hypertension rare studies also indicate that its presence identifies hypertensive children with higher risk, although the exact role has to be confirmed in prospective and larger studies. The mechanisms of microalbuminuria onset could be the result of renal damage secondary to hypertension or underlying renal and systemic endothelial dysfunction. Evidence from small intervention studies in children with microalbuminuria also suggests that early intervention with antihypertensive drugs is likely to be beneficial, pointing out the role of microalbuminuria as a therapeutic marker in children too. In addition, we have to stress the importance of follow-up of children with microalbuminuria, confirmation of its persistence and identification of progression. However, longitudinal prospective studies in children, investigating its future cardiovascular risk, are still lacking.

Microalbuminuria in White and Black Hypertensive Nondiabetic Brazilian Patients

Microalbuminuria (MAU) is a predictor of cardiovascular mortality in patients with diabetes mellitus (DM) and hypertension (HTN) and also in an unselected population. The American Diabetes Association (ADA) and the National Kidney Foundation (NKF) define MAU as an albumin/creatinine ratio (ACR) between 30 and 300 μg/mg in both men and women. Aim: To evaluate the possible relationship among MAU, HTN and gender and ethnicity in Brazilian nondiabetic primary hypertensive patients. Design: Population-based study. Participants: Ninety-eight men and women, seventy-two black and twenty-six white nondiabetic primary hypertensive patients aged 20 years or older were selected. Forty healthy individuals, paired according to age, gender, and ethnics were used as controls. Methods: Early-morning midstream urine was used. Urinary albumin was spectrophotometrically measured with Coomassie Brillant Blue G-250. Creatinine was determined by a method based on Jaffe’s reaction. ACR (μg albumin/mg creatinine) was calculated. Data are expressed as medians. Results: ACR level was significantly higher in 98 hypertensive patients (38.00) than in 40 control individuals (23.00) (P < 0.001). ACR level was significantly higher in 48 hypertensive male (46.00) than in 50 hypertensive female (34.00) (P = 0.008). No significant effect of ethnicity on ACR levels between 26 hypertensive Whites (35.50) and 72 hypertensive Blacks (38.00) was observed (P = 0.978). Conclusions: The ACR level, significantly higher in hypertensive patients than in control individuals, supports data from the literature. To our knowledge, this is the first study demonstrating that the ACR level is significantly higher in men than in women. The lack of an ethnicity effect supports what was already asserted, namely, that in Brazil, at an individual level, color, as determined by physical evaluation, is a poor predictor of genomic African ancestry, as estimated by molecular markers.

In vivo evaluation of renal function using diffusion weighted imaging and diffusion tensor imaging in type 2 diabetics with normoalbuminuria versus microalbuminuria

This work aims to estimate the value of diffusion weighted imaging （DWI） and diffusion tensor imaging （DTI） in detecting early-stage kidney injury in type 2 diabetic patients with normoalbuminuria （NAU） versus microalbuminuria （MAU） prospectively. A total of 30 T2DM patients with normal kidney function were recruited and assigned to the NAU group （n = 14） or MAU group （n = 16） according to 8 h overnight urinary albuminuria excretion rate （AER） results. A contemporary cohort of health check-up recipients were included as controls （n = 12）. DWI and DTI scans were performed on bilateral kidney using SE single-shot EPI, and apparent diffusion coefficient （ADC） and fractional anisotropy （FA） of the renal parenchyma was determined from ADC and FA maps of the three groups. ADC and FA values were compared among the three groups. According to DWI with a b value of 400 s/mm^2, the MAU and NAU groups showed significantly lowered mean ADC values compared with the healthy controls （P 〈 0.01）. The mean ADC in the MAU group [（2.22± 0.07） × 10^-3 mm^2/s] was slightly lower than that of the NAU group [（2.31 ± 0.22） × 10^- 3 mm^2/s], but this difference was not statistically significant （P 〉 0.05）. The FAvalue in the MAU group was higher than that in the control group （0.45 ± 0.07 vs. 0.3±0.03, P = 0.004） but did not differ from that in the NAU group （0.42 ± 0.03） （P 〉 0.05）. ADC and FA values may be more sensitive than urine AER in reflecting early-stage kidney injury and, hence, may facilitate earlier detection and quantitative evaluation of kidney injury in T2DM patients. Combined evaluation of ADC and FA values may provide a better quantitative approach for identifying diabetic nephropathy at early disease stages.

Microalbuminuria associated with systolic blood pressure and arterial compliance in Chinese metabolic syndrome patients

Background There is significant evidence showing that microalbuminuria and arterial compliance are sensitive markers for early cardiovascular diseases. However, whether microalbuminuria is associated with reduced arterial compliance in Chinese metabolic syndrome （MS） patients remains unknown. Methods According to the definition of MS proposed by ATPⅢ in 2001, USA, subjects （n=362） were divided into three groups according to the number of risk factors： group 1 （control）, group 2 （medium, 〈 3 risk factors） and group 3 （MS, ≥ 3 risk factors）. Both large artery compliance （C1） and small artery compliance （C2） were measured with the CVProfilor DO-2020 Cardiovascular Profiling System, and microalbuminuria was evaluated with the ratio of albumin to urine creatinine. Results （1） As C1 and C2 levels elasticity decreased, albumin creatinine ratio （ACR） and the prevalence of microalbuminuria increased within those groups with MS risk factors. C1 and C2 were negatively correlated with the ranking of MS risk factors, ACR was positively correlated with the ranking of MS risk factors （all P〈0.05）. （2） Subjects were also categorized into a microalbuminuria group and a normal group, C1 and C2 in the microalbuminuria group were lower than in the normal group. （3） Multivariate regression analysis showed that increased systolic blood pressure （SBP） and reduced arterial compliance were the main risk factors for microalbuminuria in the MS group. Conclusions The risk of developing microalbuminuria was higher in the subjects with multiple metabolic abnormalities. Increased systolic blood pressure and reduced arterial compliance may be the main predictors for microalbuminuria in MS.

中老年体检人群系统免疫炎症指数和系统炎症反应指数与微量白蛋白尿的相关性研究

背景微量白蛋白尿是反应肾脏早期微血管损害的敏感指标,也是心血管疾病的独立危险因素,既往研究表明长期慢性炎症在微量白蛋白尿的发生、发展中起着重要作用,但血液炎症标志物与微量白蛋白尿相关性的报道较少。目的探讨中老年体检人群中系统免疫炎症指数(SII)和系统炎症反应指数(SIRI)与微量白蛋白尿的相关性。方法本研究为横断面研究,选取2023年4—7月于东部战区总医院健康医学科进行健康体检的2105例40岁以上体检者为研究对象。根据尿微量白蛋白/尿肌酐比值(UACR)将研究对象分为两组:非微量白蛋白尿组(1857例,UACR<30 mg/g)和微量白蛋白尿组(248例,UACR=30~300 mg/g)。根据三分位数将SII分为T1(0.09~0.27)、T2(0.28~0.40)和T3(0.41~1.38),将SIRI分为t1(0.11~0.41)、t2(0.42~0.66)和t3(0.67~3.52)。收集两组研究对象的一般资料及实验室检查结果并进行比较,采用线性回归分析探讨SII、SIRI水平与UACR对数转化值(log UACR)的相关性,采用二元Logistic回归分析探讨SII、SIRI与微量白蛋白尿发生风险的相关性。结果两组性别、腰臀比、总胆固醇、低密度脂蛋白胆固醇、尿酸水平比较,差异无统计学意义(P>0.05);微量白蛋白尿组年龄、BMI、收缩压、舒张压、空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油、同型半胱氨酸、肾小球滤过率、红细胞沉降率、SII、SIRI水平高于非微量白蛋白尿组,高密度脂蛋白胆固醇水平低于非微量白蛋白尿组(P<0.05)。线性回归分析结果显示,SII、SIRI水平与log UACR均呈正相关(P<0.05)。二元Logistic回归分析结果显示,校正各控制变量后,SII水平升高是微量白蛋白尿发生风险的危险因素(OR=1.17,95%CI=1.01~1.35,P=0.031);与T1水平患者相比,T3水平患者微量白蛋白尿发生风险升高(OR=1.43,95%CI=1.01~2.03,P=0.046),且微量白蛋白尿发生风险随着SII增加呈升高趋势(P趋势=0.038)。校正各控制变量后,SIRI水平升高是微量白蛋白尿发生风险的危险因素(OR=1.18,95%CI=1.03~1.35,P=0.019);与t1水平患者相比,t3水平患者微量白蛋白尿发生风险升高(OR=1.45,95%CI=1.01~2.09,P=0.046),且微量白蛋白尿发生风险随着SIRI增加呈升高趋势(P趋势=0.032)。结论中老年体检人群SII、SIRI水平与log UACR及微量白蛋白尿发生风险均呈正相关。

达格列净治疗糖尿病伴微量白蛋白尿的效果观察

目的:分析达格列净治疗糖尿病伴微量白蛋白尿的效果。方法:选取2021年1—12月北京市海淀区北太平庄社区卫生服务中心收治的糖尿病伴微量白蛋白尿患者60例作为研究对象,随机分为两组,各30例。对照组在常规治疗基础上加用磷酸西格列汀,试验组在常规治疗基础上加用达格列净治疗。比较两组血糖水平、肾小球滤过率(e GFR)和尿白蛋白与肌酐比值(UACR)、血压水平、体质量指数(BMI)、不良反应发生情况。结果:治疗前后,两组空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(Hb A_(1c))水平比较,差异无统计学意义(P>0.05);治疗后,两组FBG、2 h PBG、Hb A_(1c)水平低于治疗前,差异有统计学意义(P<0.05)。治疗前后,两组e GFR水平比较,差异无统计学意义(P>0.05)。治疗前,两组UACR水平比较,差异无统计学意义(P>0.05);治疗后,试验组UACR水平低于治疗前及同期对照组,差异有统计学意义(P<0.05)。治疗前后,两组舒张压、BMI比较,差异无统计学意义(P>0.05)。治疗前,两组收缩压(SBP)水平比较,差异无统计学意义(P>0.05);治疗后,试验组SBP水平低于治疗前与同期对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:达格列净治疗糖尿病伴微量白蛋白尿的效果显著,可降低患者血糖、尿白蛋白、SBP水平,且安全性较高。

高血压合并肥胖患者左心室肥厚与RDW、微量白蛋白尿的关系

目的 探究高血压合并肥胖患者左心室肥厚与红细胞分布宽度(red blood cell distribution width, RDW)、微量白蛋白尿(micro albuminuria, MAU)的关系。方法 将138例高血压合并肥胖患者按照左心室质量指数(LVMI)分为80例左心室肥厚组与58例无左心室肥厚组,另选择同时期80例健康体检者作为对照组。对各组RDW、MAU进行检测,并分析其与患者左心室肥厚的关系。结果 左心室肥厚组RDW、MAU较无左心室肥厚组及对照组高,差异有统计学意义(P<0.05)。RDW、MAU与高血压合并肥胖患者左心室肥厚呈正相关(P<0.05)。左心室肥厚组体质量指数、高血压病程、收缩压较无左心室肥厚组高,HDL-C较无左心室肥厚组低,差异有统计学意义(P<0.05)。RDW、MAU、体质量指数、高血压病程均为患者左心室肥厚的高危因素(P<0.05)。结论 高血压合并肥胖患者左心室肥厚与RDW、MAU密切相关,检测RDW、MAU可为患者左心室肥厚防治提供一定参考依据。

Association of microalbuminuria with ambulatory arterial stiffness index in patients with type 2 diabets mellitus

Background Microalbuminuria （MAU） and ambulatory arterial stiffness index （AASI） may predict cardiovascular events and death. However, there is little information about the correlation between the two parameters in patients with type 2 diabetes mellitus （T2DM）. Therefore, we examined the association of MAU with 24-hour AASI in patients with T2DM. Methods A total of 189 patients with 24-hour ambulatory blood pressure monitoring （24h-ABPM） who were hospitalized from January 2011 to January 2017 were selected. 136 patients without hypertension were screened. The subjects were divided into two groups according to urinary albumin-to-creatinine ratio （uACR）. MAU group was defined as uACR of 30-299 mg/g （n=69）, NMAU group was defined as uACR 〈30 mg/g （n=67）. AASI was calculated as 1 minus the regression slope of diastolic blood pressure （DBP） value vs. systolic blood pressure （SBP） value according to ABPM. The differences of clinical and bio- chemical indicators between the two groups were determined. The correlation between AASI and MAU was analyzed by unconditional forward stepwise logistic regression. Results Patients with MAU had significantly higher level of diabetic duration, TC, LDL-C, Scr, AASI and lower eGFR than NMAU group （P〈0.05）. Using MAU as the dependent variable （ 1 with MAU and 0 without MAU）, LDL-C, decreased eGFR, AASI were independent risk factors of MAU in patients with T2DM. The ROC curve of AASI in predicting the risk of MAU showed when AASI was 0.48, the area under the curve was the largest 0.659（95 % CI 0.568-0.750, P=0.001）. The sensitivity was 71.0% and the specificity was 56.7%. Conclusions Patients with MAU have higher AASI than patients without MAU. As a new index of arterial stiffness, AASI is associated with MAU, and could inde- pendently predict MAU in patients with T2DM.

老年2型糖尿病患者发生低血糖事件的相关因素分析

目的 探讨老年2型糖尿病患者发生低血糖事件的相关危险因素。方法 选择2019年7月至2021年6月在清华大学附属垂杨柳医院内分泌科就诊的94例老年(年龄≥65岁)2型糖尿病患者,根据动态血糖监测结果进行分组:血糖<3.9mmol/L且持续时间在15min以上的34例患者为低血糖组,余60例患者为无低血糖组。比较两组患者的临床资料,采用多因素logistic回归分析老年2型糖尿病患者发生低血糖事件的危险因素。结果 低血糖组的34例患者中,发生夜间低血糖者占61.8%。低血糖组患者的体重指数、血糖平均值均低于无低血糖组,高密度脂蛋白胆固醇、尿微量白蛋白、尿微量白蛋白/尿肌酐比值、血糖变异系数和平均血糖波动幅度均高于无低血糖组,差异有显著性(P<0.05)。多因素logistic回归分析显示,尿微量白蛋白/尿肌酐比值、血糖变异系数与低血糖事件的发生呈正相关(OR=1.043、1.305);体重指数和血糖平均值与低血糖事件的发生呈负相关(OR=0.815、0.704)。结论 血糖变异系数、尿微量白蛋白/尿肌酐比值、体重指数及血糖平均值是老年2型糖尿病患者发生低血糖事件的独立危险因素。

Early diabetic kidney disease:Focus on the glycocalyx

The incidence of diabetic kidney disease(DKD)is sharply increasing worldwide.Microalbuminuria is the primary clinical marker used to identify DKD,and its initiating step in diabetes is glomerular endothelial cell dysfunction,particularly glycocalyx impairment.The glycocalyx found on the surface of glomerular endothelial cells,is a dynamic hydrated layer structure composed of proteoglycans,glycoproteins,and some adsorbed soluble components.It reinforces the negative charge barrier,transduces the shear stress,and mediates the interaction of blood corpuscles and podocytes with endothelial cells.In the highglucose environment of diabetes,excessive reactive oxygen species and proinflammatory cytokines can damage the endothelial glycocalyx(EG)both directly and indirectly,which induces the production of microalbuminuria.Further research is required to elucidate the role of the podocyte glycocalyx,which may,together with endothelial cells,form a line of defense against albumin filtration.Interestingly,recent research has confirmed that the negative charge barrier function of the glycocalyx found in the glomerular basement membrane and its repulsion effect on albumin is limited.Therefore,to improve the early diagnosis and treatment of DKD,the potential mechanisms of EG degradation must be analyzed and more responsive and controllable targets must be explored.The content of this review will provide insights for future research.

Postprandial glucagon-like peptide 1 secretion is associated with urinary albumin excretion in newly diagnosed type 2 diabetes patients

BACKGROUND Microalbuminuria is an early and informative marker of diabetic nephropathy.Our study found that microalbuminuria developed in patients with newly diagnosed type 2 diabetes mellitus(T2DM).AIM To investigate the association between glucagon-like peptide 1(GLP-1)and microalbuminuria in newly diagnosed T2DM patients.METHODS In total,760 patients were recruited for this cross-sectional study.The GLP-1 levels during a standard meal test and urinary albumin-creatinine ratio(UACR)were determined.RESULTS Patients with microalbuminuria exhibited lower GLP-1 levels at 30 min and 120 min during a standard meal test than patients with normal albuminuria(30 min GLP-1,16.7±13.3 pmol vs 19.9±15.6 pmol,P=0.007;120 min GLP-1,16.0±14.1 pmol vs 18.4±13.8 pmol,P=0.037).The corresponding area under the curve for active GLP-1(AUCGLP-1)was also lower in microalbuminuria patients(2257,1585 to 3506 vs 2896,1763 to 4726,pmol×min,P=0.003).Postprandial GLP-1 levels at 30 min and 120 min and AUCGLP-1 were negatively correlated with the UACR(r=0.159,r=0.132,r=0.206,respectively,P<0.001).The prevalence of microalbuminuria in patients with newly diagnosed T2DM was 21.7%,which decreased with increasing quartiles of AUCGLP-1 levels(27.4%,25.3%,18.9%and 15.8%).After logistic regression analysis adjusted for sex,age,hemoglobin A1c,body mass index,systolic blood pressure,estimated glomerular filtration rate,homeostasis model assessment of insulin resistance,AUC_(glucose)and AUC_(glucagon)patients in quartile 4 of the AUCGLP-1 presented a lower risk of microalbuminuria compared with the patients in quartile 1(odds ratio=0.547,95%confidence interval:0.325-0.920,P=0.01).A consistent association was also found between 30 min GLP-1 or 120 min GLP-1 and microalbuminuria.CONCLUSION Postprandial GLP-1 levels were independently associated with microalbuminuria in newly diagnosed Chinese T2DM patients.