尿白蛋白排泄率与2型糖尿病微血管病变的相关性分析

摘要

研究尿白蛋白排泄率(UAER)与糖尿病肾脏病变(DN)、视网膜病变(DR)之间的关系,并探讨与其有关的相关危险因素. 对465例2型糖尿病患者按UAER分成正常白蛋白尿组(NAU组,UAER＜20μg/min)、微量白蛋白尿组(MAU组,20μg/min ≤UAER＜200μg/min )和临床白蛋白尿组(CAU组,UAER≥200μg/min).比较三组间年龄、病程、体重指数、血压、血脂、血糖、肾功能、胰岛功能以及发生DR的比例等指标,并将UAER与各指标进行相关分析和多元逐步回归分析.用Logistic回归分析微血管病变的危险因素.结果表明, 本研究人群中DN的发生率为33.55%,其中MAU组的发生率为22.37%,CAU组的发生率为11.18%;DR的发生率为38.13%,其中背景型DR(BDR)的发生率为26.91%,增殖型DR(PDR)的发生率为11.22%.不同蛋白尿组之间收缩压、舒张压、空腹血糖、尿素氮、血肌酐、甘油三酯、高密度脂蛋白以及DR的患病率均有显著性差异(P值均<0.05).多元逐步回归分析显示:UAER与血肌酐和胆固醇呈独立正相关(P值均<0.05).以有无DR发生为因变量的logistic回归显示:UAER、糖尿病病程、胆固醇、2小时C肽及有无合并DN是DR发生的独立危险因素(P＜0.05).以有无DN发生为因变量的logistic回归显示:收缩压、胆固醇、血肌酐及有无合并DR是DN发生的独立危险因素(P＜0.05). UAER与血肌酐及胆固醇存在密切相关性,DN与DR互为独立危险因素,关系密切.%To investigate the relationship among urinary albumin excretion rate (UAER), type-2 diabetic nernphropathy ( DN), and diabetic retinopathy (DR) and to explore the prevalence and risk factors of UAER. 465 rntype-2 diabetic patients were divided into 3 groups. norrmal albuminuria group (NAU, UAER ＜ 20μg/min), rnmicroalbuminuria group ( MAU, 20μg/min ≤ UAER ＜ 200μg/min) , and clinical albuminuria group ( CAU, rnUAER ≥200μg/min). Comparisons between possible factors were made among the 3 groups, and correlation arnnalysis and stepwise regression analysis was applied to analyze UAER and these factors. The risk factors of mirncroangiopathy were determined by logistic analysis. The results showed that the prevalence of DN was 33.55％, rnincluding 22.37％ of MAU, and 11.18％ of CAU. The prevalence of DR was 38.13％, including 26.91％ of rnBDR, and 11.22％ of PDR. There were statistically significant differences in terms of SBP, DBP, FBG, BUN, rnTG, HDL-C, and prevalence of DR among the three groups(P ＜0.05 ). The TC and Cr were independent posirntively correlated with UAER (P ＜ 0.05 ). The logistic regression analysis showed that UAER, diabetic duration, rnTC, CP2 and DN were the independent risk factors of DR ( P ＜ 0.05 ). SBP、 TC、 Cr and DR were the indernpendent risk factors of DN ( P ＜ 0. 05 ). UAER was closely associated with TC and Cr. DN and DR were the inrndependent risk factor of each other, and demonstrated a close relationship.