尿微量清蛋白对不同糖代谢状态人群脑卒中发生风险的研究  

Role of Microalbuminuria in the Prediction of Stroke in Populations with Different Glycometabolic Conditions

作　　者：周洪仿 万沁 ZHOU Hong-fang;WAN Qin(Department of Endocrinology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,Chin)

机构地区：[1]西南医科大学附属医院内分泌科,四川省泸州市646000

出　　处：《中国全科医学》2018年第21期2571-2576,共6页Chinese General Practice

基　　金：国家科技部重点研发项目(2016YFC0901200;2016YFC0901205)

摘　　要：目的探讨在不同糖代谢人群中,尿微量清蛋白(MAU)对其脑卒中发生风险的影响,为不同糖代谢状态人群脑卒中的预防提供参考依据。方法选取2011年4—11月参加由中华医学会内分泌分会发起的"中国2型糖尿病患者肿瘤发生风险的流行病学研究(REACTION研究)"中四川泸州部分地区40岁以上基线人群为研究对象,共3 501例。收集研究对象的一般资料(性别、年龄、BMI、糖尿病家族史、吸烟史、心血管疾病史)、相关实验室检查结果[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(Hb A_(1c))、MAU]。并依据研究对象糖代谢状况分为糖代谢正常(NGT)人群、糖尿病前期(IGR)人群、糖尿病人群。根据研究对象是否合并MAU升高分为NGT+MAU正常组(A组)、IGR+MAU正常组(B组)、糖尿病+MAU正常组(C组)、NGT+MAU升高组(D组)、IGR+MAU升高组(E组)、糖尿病+MAU升高组(F组)。于2016年4—6月随访研究对象脑卒中发生情况。结果 3 501例研究对象中糖尿病735例(21.0%),IGR 1 212例(34.6%),NGT 1 554例(44.4%)。A组866例,B组837例,C组458例,D组688例,E组375例,F组277例。B组MAU低于C组,F组MAU高于C组,B组、D组、E组、F组MAU高于A组(P<0.05)。NGT、IGR和糖尿病人群随访期间脑卒中发病率分别为2.7%(42/1 554)、3.1%(37/1 212)、5.0%(37/735);糖尿病人群随访期间脑卒中发病率高于IGR、NGT人群(P<0.05);A组、B组、C组、D组、E组、F组随访期间脑卒中的发生率分别为1.4%(12/866)、1.8%(15/837)、3.7%(17/458)、4.4%(30/688)、5.9%(22/375)、7.2%(20/277)。NGT人群中,MAU升高者发生脑卒中的风险为MAU正常者的3.245倍[95%CI(1.649,6.386),P<0.05];IGR患者中,MAU升高者发生脑卒中的风险为MAU正常者的3.415倍[95%CI(1.751,6.661),P<0.05];糖尿病患者中,MAU升高者发生脑卒中的风险为MAU正常者的2.019倍[95%CI(1.039,3.924),P<0.05]。MAU升高者脑卒�Objective To investigate the role of microalbuminuria（MAU） in the prediction of stroke among populations with different glycometabolic conditions,providing a reference for the prevention of stroke.Methods The enrolled 3 501 participants over 40 years old were from part of Sichuan＇s Luzhou who participated in the Risk Evaluation of Cancer in Diabetic Chinese Individuals：a Longitudinal（REACTION） Study initiated by the Chinese Society of Endocrinology from April to November 2011.We collected their baseline characteristics,such as demographic data（sex,age,BMI,family history of diabetes,history of smoking and cardiovascular disease）,and laboratory findings[total cholesterol（TC）,triacylglycerol（TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,fasting plasma glucose（FPG）,glycated hemoglobin（HbA_（1c））,and MAU].We divided them into diabetes mellitus（DM） group,impaired glucose regulation（IGR） group,and normal glucose tolerance（NGT） group based on the status of glucose metabolism.Furthermore,in accordance with the level of MAU,we divided them into NGT with normal MAU subgroup（subgroup A）,IGR with normal MAU subgroup（subgroup B）,DM with normal MAU subgroup（subgroup C）,NGT with increased MAU subgroup（subgroup D）,IGR with increased MAU subgroup（subgroup E）,DM with increased MAU subgroup（subgroup F）.The occurrence of stroke was recorded during a follow-up visit from April to June 2016.Results There were 735 cases of DM（458 with normal MAU and 277 with increased MAU）,1 212 cases of IGR（837 with normal MAU and 375 with increased MAU）,and 1 554 cases of NGT（866 with normal MAU and 688 with increased MAU）,accounting for 21.0%,34.6%,and 44.4% of the total participants,respectively.The level of MAU in subgroup C was significantly lower than that of subgroup F but much higher when compared with that of subgroup B（P〈0.05）.Subgroup A demonstrated much lower level of MAU compared with subgroups of B,

关 键 词：糖尿病 糖尿病前期 尿微量白蛋白 卒中 

分 类 号：R589[医药卫生—内分泌]