糖尿病视网膜病变患者尿微量白蛋白/肌酐比值的变化及意义

摘要

目的：探讨糖尿病视网膜病变（DR）患者尿微量白蛋白（mAlb）/肌酐（Cr）比值的变化及意义。方法将173例2型糖尿病（T2DM）患者分为无糖尿病视网膜病变（NDR）组76例、非增生性糖尿病视网膜病变（NPDR）组58例、增生性糖尿病视网膜病变（PDR）组39例，另选取健康体检者40名作为正常对照组。检测各组空腹血糖（FPG）、总胆固醇（TC）、餐后2 h血糖（2 hPG）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、C反应蛋白（CRP）、糖化血红蛋白（HbA1c）及尿mAlb、Cr，计算尿mAlb/Cr比值，同时收集相关临床资料（包括身高、体重、腰围、臀围及糖尿病病程等）。采用Spearman秩相关分析及多元线性回归模型分析尿mAlb/Cr比值与其他临床参数的关系，采用Logistic回归分析评估DR的风险因素。结果 NDR组、NPDR组及PDR组尿mAlb/Cr比值依次增高，各组之间差异均有统计学意义（P<0.05）。T2DM患者尿mAlb/Cr比值与糖尿病病程、FPG、2 hPG、LDL-C、HbA1c及CRP呈正相关（r值分别为0.372、0.227、0.276、0.231、0.294及0.308，P<0.05）；多元线性回归分析显示糖尿病病程、CRP及HbA1c与尿mAlb/Cr比值呈独立正相关（β值分别为0.194、0.169、0.183，P值分别为0.007、0.018、0.013）。Logistic回归分析显示尿mAlb/Cr比值、糖尿病病程、HbA1c及CRP是DR的独立风险因素｛比值比（OR）[95%可信区间（CI）]分别为1.212（1.083~1.417）、1.036（1.012~1.063）、1.469（1.140~1.892）、1.330（1.011~1.273）}。结论尿mAlb/Cr比值与DR的发展密切相关，是DR的风险因素。CRP及HbA1c可能通过损伤肾脏功能参与DR的发生与发展。%ObjectiveTo investigate the change of urinary microalbumin(mAlb)to creatinine(Cr)ratio in patients with diabetic retinopathy(DR) and its significance.MethodsA total of 173 type 2 diabetes mellitus (T2DM)patients were enrolled,and 40 healthy subjects were enrolled as healthy controls. T2DM patients were classified into 3 groups,non-DR(NDR) group(76 cases),non-proliferative DR(NPDR) group(58 cases) and proliferative DR(PDR) group(39 cases). Fasting plasma glucose(FPG),total cholesterol(TC),2 h postprandial plasma glucose(2 hPG),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C),C-reactive protein(CRP),glycated hemoglobin A1c(HbA1c), urinary mAlb and Cr were determined,and urinary mAlb/Cr ratio was calculated. Simultaneously,related clinical data were collected,including height,weight,waist circumference,hip circumference,the duration of diabetes mellitus and so on. The relationship between urinary mAlb/Cr ratio and other parameters was analyzed by Spearman's rank correlation analysis and multiple linear regression analysis. Logistic regression analysis was used to identify the risk factors of DR.ResultsUrinary mAlb/Cr ratio increased progressively from NDR,NPDR to PDR groups, and there was statistical significance among the groups(P<0.05). Urinary mAlb/Cr ratio in T2DM patients was positively correlated with the duration of diabetes mellitus,FPG,2 hPG,LDL-C,HbA1c and CRP(r=0.372, 0.227,0.276,0.231,0.294 and 0.308,P<0.05). Urinary mAlb/Cr ratio was correlated independently with the duration of diabetes mellitus,CRP and HbA1c in multiple linear regression analysis(β=0.194,0.169 and 0.183, P=0.007,0.018 and 0.013). Logistic regression analysis showed that urinary mAlb/Cr ratio,the duration of diabetes mellitus,HbA1c and CRP were independent risk factors for DR {odds ratio(OR)[95% confidence interval(CI)] 1.212(1.083-1.417),1.036(1.012-1.063),1.469(1.140-1.892) and 1.330(1.011-1.273)}.Conclusions Urinary mAlb/Cr ratio is a risk factor for DR,and it is closely related with the development of DR. CRP and HbA1c may be involved in the development and pathogenesis of DR through damaging renal function.