目的:探讨早期2型糖尿病肾病(diabetic kidney disease,DKD)患者尿微量白蛋白肌酐比值(urinary albumin to creatinine ratio,UACR)与肺结核(pulmonary tuberculosis,PTB)的相关性,为临床糖尿病肾病与肺结核共病(DKD-PTB)患者的管理和...目的:探讨早期2型糖尿病肾病(diabetic kidney disease,DKD)患者尿微量白蛋白肌酐比值(urinary albumin to creatinine ratio,UACR)与肺结核(pulmonary tuberculosis,PTB)的相关性,为临床糖尿病肾病与肺结核共病(DKD-PTB)患者的管理和治疗提供理论支持。方法:选取2020年1月—2023年5月南华大学附属长沙中心医院收治的102例2型DKD-PTB患者(设为DKD-PTB组)和同期未合并PTB的105例DKD患者(设为DKD组)作为研究对象,再根据患者的UACR水平不同将其分为UACR正常组、微量白蛋白尿组、大量白蛋白尿组,分析DKD与DKD-PTB患者的差异,以及UACR水平与DKD-PTB的关联性及其影响因素。结果:DKD-PTB组患者的身体质量指数(body mass index,BMI)、空腹C肽(fasting C-peptide,F-CP)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、白蛋白(albumin,ALB)指标水平均低于DKD组(P<0.05),而其空腹血糖(fasting plasma glucose,FPG)、餐后2 h血糖(two-hour postprandial plasma glucose,2hPG)、球蛋白(globulin,GLB)、中性粒细胞百分比(NEUT%)、糖化血红蛋白(hemoglobin A1c,HbA1c)、餐后2 h C肽(two-hour postprandial C-peptide,2h-CP)、UACR等指标的水平则均明显高于DKD组(P<0.05);与UACR正常组患者相比,微量白蛋白尿组、大量白蛋白尿组患者的DKD-PTB发生率明显升高(P<0.05);将UACR水平与相关指标进行Spearman相关性分析,结果显示,UACR水平与BMI、ALB、肾小球滤过率(estimated glomerular filtration rate,eGFR)、F-CP、2h-CP、25(OH)D等指标水平呈负相关,而与NEUT%、血尿素氮(blood urea nitrogen,BUN)、FPG、HbA1c等指标水平呈正相关,与DKD-PTB亦呈正相关(r=0.329,P<0.001);有序Logistic回归分析结果显示,SBP、HbA1c、血清25羟维生素D(25-hydroxyvitamin D,25(OH)D)、eGFR可影响DKD患者UACR水平,并且合并PTB是影响DKD患者UACR水平可能的独立危险因素(OR=2.732,95%CI=1.381~5.407,P=0.004)。结论:UACR水平与DKD-PTB的发生具有相关性,并且受SBP、HbA1c、25(OH)D、eGFR等指标的影响,对此临床应加强DKD患者的管理和监测,避免或减少DKD-PTB的发生。展开更多
天门冬氨酸氨基转移酶(AST)与丙氨酸氨基转移酶(ALT)比值(AAR),传统上用于肝脏功能评估,近年来研究发现它与肝外疾病,如心血管疾病、代谢综合征和肾脏功能等存在关联。尿白蛋白肌酐比(ACR)作为肾脏敏感指标,在预测心血管风险、脑卒中、...天门冬氨酸氨基转移酶(AST)与丙氨酸氨基转移酶(ALT)比值(AAR),传统上用于肝脏功能评估,近年来研究发现它与肝外疾病,如心血管疾病、代谢综合征和肾脏功能等存在关联。尿白蛋白肌酐比(ACR)作为肾脏敏感指标,在预测心血管风险、脑卒中、糖尿病和全因死亡率方面具有重要意义。本文旨在探讨AST/ALT比值与ACR相关潜在机制的关联性,以利用这两个指标全面评估人体健康,并通过它们的关系,利用肝损伤指标预测肾脏状况,从而对肾病患者实施早期临床管理。The ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT), traditionally known as the AST/ALT ratio (AAR), has been used for the assessment of liver function. Recent studies have identified its association with extrahepatic diseases, such as cardiovascular diseases, metabolic syndrome, and renal function. The urinary albumin-to-creatinine ratio (ACR) serves as a sensitive marker for kidney health and holds significant prognostic value in predicting cardiovascular risks, stroke, diabetes, and all-cause mortality. This article aims to explore the correlation between the AST/ALT ratio and ACR in chronic kidney disease, to utilize these two indicators for a comprehensive assessment of human health. Furthermore, by understanding their relationship, liver injury markers can be used to predict kidney conditions, thereby facilitating early clinical management for patients with kidney disease.展开更多
文摘天门冬氨酸氨基转移酶(AST)与丙氨酸氨基转移酶(ALT)比值(AAR),传统上用于肝脏功能评估,近年来研究发现它与肝外疾病,如心血管疾病、代谢综合征和肾脏功能等存在关联。尿白蛋白肌酐比(ACR)作为肾脏敏感指标,在预测心血管风险、脑卒中、糖尿病和全因死亡率方面具有重要意义。本文旨在探讨AST/ALT比值与ACR相关潜在机制的关联性,以利用这两个指标全面评估人体健康,并通过它们的关系,利用肝损伤指标预测肾脏状况,从而对肾病患者实施早期临床管理。The ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT), traditionally known as the AST/ALT ratio (AAR), has been used for the assessment of liver function. Recent studies have identified its association with extrahepatic diseases, such as cardiovascular diseases, metabolic syndrome, and renal function. The urinary albumin-to-creatinine ratio (ACR) serves as a sensitive marker for kidney health and holds significant prognostic value in predicting cardiovascular risks, stroke, diabetes, and all-cause mortality. This article aims to explore the correlation between the AST/ALT ratio and ACR in chronic kidney disease, to utilize these two indicators for a comprehensive assessment of human health. Furthermore, by understanding their relationship, liver injury markers can be used to predict kidney conditions, thereby facilitating early clinical management for patients with kidney disease.
