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  

Change of urinary microalbumin to creatinine ratio in patients with diabetic retinopathy and its significance

作　　者：金浩[1] 傅庆萍[1] 居会祥[1] 孙明忠[1] 朱蓉[1] 季禹乔[1] 朱晖[1] 季建伟[1] 周中卫[1] 

机构地区：[1]东南大学医学院附属盐城医院检验科,江苏盐城224001

出　　处：《检验医学》2016年第10期878-882,共5页Laboratory Medicine

摘　　要：目的探讨糖尿病视网膜病变（DR）患者尿微量白蛋白（m Alb）/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 h PG）、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（Hb A1c）及尿m Alb、Cr,计算尿m Alb/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m Alb/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m Alb/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m Alb/Cr比值与糖尿病病程、FPG、2 h PG、LDL-C、Hb A1c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Hb A1c与尿m Alb/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m Alb/Cr比值、糖尿病病程、Hb A1c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m Alb/Cr比值与DR的发展密切相关,是DR的风险因素。CRP及Hb A1c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 〈br〉 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

关 键 词：尿微量白蛋白/肌酐比值 C反应蛋白 糖化血红蛋白 糖尿病视网膜病变 

分 类 号：R446.1[医药卫生—诊断学]