2型糖尿病患者尿白蛋白/肌酐比值与大血管病变的关系
Relationship of urinary albumin/creatinine ratio with carotid atherosclerosis in type 2 diabetic patients

目的:探讨2型糖尿病(T2DM)患者尿白蛋白/肌酐比值(UACR)和大血管病变的关系,分析T2DM患者颈动脉粥样硬化相关危险因素。方法:回顾性分析403例糖尿病患者的临床资料,高分辨血管外超声检测颈动脉血管斑块厚度及内膜中层厚度(IMT),根据颈动脉内膜中层厚度(CIMT)分为颈动脉内膜正常组(A组,n=80)、内膜增厚组(B组,n=175)、斑块组(C组,n=148)。计算颈动脉斑块积分,同时测定UACR、空腹胰岛素(FINS)及其他常规生化指标。结果:C组的年龄、吸烟者比例、糖尿病病程及高血压病程、SBP、HbA1c水平、UACR和斑块积分高于B组(P＜0.05)。年龄、糖尿病病程、高血压病程、SBP、HbA1c、UACR均为颈动脉粥样硬化的独立危险因素,其OR(95%CI)分别是1.085(1.042～1.130)、1.137(1.066～1.212)、1.125(1.047～1.209)、1.045(1.013～1.079)、1.252(1.032～1.520)、1.012(1.002～1.022)(P均＜0.05)。UACR水平与年龄、糖尿病病程、高血压病程、HbA1c、尿酸、斑块积分呈正相关(r=0.109、0.248、0.119、0.132、0.116、0.432,P＜0.05)。结论:糖尿病患者大血管病变与多种因素有关,积极控制血压、血糖,有助于减缓动脉粥样硬化进展; UACR可作为预测T2DM患者大血管病变的指标。
Aim: To study the relationship of urinary albumin/creatinine ratio(UACR)with carotid atherosclerosis in patients with T2DM,and analyze the risk factors of carotid atherosclerosis in patients with T2DM.Methods: The clinical data of 403 patients with T2DM were retrospectively analyzed, the plaques in carotid arteries and intima media thickness(IMT)were measured with high resolution ultrasound, and scores of plaque was calculated. UACR, fasting insulin(FINS)and general biochemical indicators were collected at the same time. The patients were divided into three groups according to the carotid artery intima thickness(CIMT), including group with normal CIMT(group A, n=80), group with thickened carotid intima-media(group B, n=175)and group with carotid artery plaque(group C, n=148).Results: Compared with patients in group B, patients in group C were older and had higher smoking rate, longer diabetic duration and hypertension duration, higher level of UACR,SBP,HbA1c,and higher scores of plaque(P＜0.05). Multivariate logistic regression analysis showed age[OR(95%CI)=1.085(1.042-1.130)], diabetic duration[OR(95%CI)=1.137(1.066-1.212)], hypertension duration[OR(95%CI)=1.125(1.047-1.209)],SBP[OR(95%CI)=1.045(1.013-1.079)],HbA1c[OR(95%CI)= 1.252(1.032-1.520)], UACR[OR(95%CI)=1.012(1.002-1.022)] were the independent risk factors of carotid atherosclerosis in patients with T2DM(P＜0.05).UACR was positively correlated with age, diabetic duration, hypertension duration, HbA1c, uric acid, and scores of plaque(r=0.109,0.248,0.119,0.132,0.116,0.432,P＜0.05).Conclusion: A variety of clinic risk factors are associated with vascular disease of T2DM. Better control of blood pressure and blood glucose should be performed to delay the progress of atherosclerosis.UACR can be used as a prediction index of the T2DM patients with vascular disease