2型糖尿病患者尿白蛋白与心血管自主神经病变的相关性分析  

Correlation between urinary albumin and cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus

作　　者：宋雯婧 蒋伏松[1] 肖元元[1] 高清歌[1] 祝超瑜[1] 魏丽[1] Song Wenjing;Jiang Fusong;Xiao Yuanyuan;Gao Qingge;Zhu Chaoyu;Wei Li(Department of Endocrinology,Shanghai Jiaotong University Sixth People′s East-hospital,Shanghai 201306,China)

机构地区：[1]上海交通大学附属第六人民医院东院内分泌代谢科,201306

出　　处：《中华糖尿病杂志》2020年第10期797-801,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：浦东新区卫生计生科技项目(PW2018D-14)。

摘　　要：目的探讨2型糖尿病(T2DM)患者尿白蛋白与尿肌酐比值(UACR)与心血管自主神经病变(CAN)的关系。方法采取随机抽样法纳入了2019年7月至12月在上海市第六人民医院东院内分泌科住院的T2DM患者共385例作为研究对象,所有患者均进行标准心血管反射试验(CART),并记录临床及生化指标等。通过糖尿病肾病(DKD)诊断标准将UACR分为正常白蛋白尿组、微量白蛋白尿组及大量白蛋白尿组,分别观察尿白蛋白与CAN间的相关性。组间计量资料的比较采用单因素方差分析或非参数Kruskal-Wallis检验,计数资料采用χ2检验比较,双变量相关分析采用Spearman相关分析法,多因素分析采用二元logistic回归分析。结果 385例T2DM患者中,CAN组209例,非CAN组176例,CAN的发病率为54.3%(209/385)。正常白蛋白尿组合并CAN占46.1%(119/258),微量白蛋白尿组合并CAN占63.6%(56/88),大量白蛋白尿组合并CAN占87.2%(34/39),三组间差异有统计学意义(χ2=27.03,P<0.01)。与正常白蛋白尿组相比,微量白蛋白尿组及大量白蛋白尿组的Valsalva R-R比值、深呼吸心率差值更小,差异有统计学意义(P均<0.05),而立卧位收缩压差值及立卧位舒张压差值则更大(P均<0.05),大量白蛋白尿组中立卧位心率差值与其他两组相比差异均有统计学意义(P<0.05)。UACR与Valsalva R-R比值、深呼吸心率差值、立卧位心率差值呈负相关(r值分别为-0.236、-0.180和-0.202,P均<0.01),与立卧位收缩压差值、立卧位舒张压差值呈正相关(r值分别为0.116和0.182,P均<0.05)。以是否合并CAN为因变量进行逐步回归分析,年龄、UACR、稳态模型评估胰岛素抵抗指数(HOMA-IR)均是CAN的独立影响因素。结论 UACR与T2DM患者发生CAN存在一定的相关性,同时HOMA-IR可能是促进CAN发生的危险因素。Objective To investigate the relationship between urinary albumin and urinary creatinine ratio(UACR)and cardiovascular autonomic neuropathy(CAN)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 385 hospitalized T2DM patients in Shanghai Jiaotong University Sixth People′s East-hospital from July 2019 to December 2019 were selected by random sampling method.All patients underwent standard cardiovascular reflex tests(CART)and recorded clinical and biochemical parameters.According to the diagnostic criteria of diabetic kidney disease(DKD),UACR was divided into normal albuminuria,microalbuminuria and a large amount of albuminuria group,and the correlation between urine albumin and CAN was observed.Kruskal-Wallis test were used for comparison between groups.Count date usingχ2 test.Spearman correlation analysis and binary logistic regression analysis were performed.Results The prevalence of CAN was 54.3%(209/385).Normal albuminuria combined with CAN accounted for 46.1%(119/258),microalbuminuria group accounted for 63.6%(56/88),and large albuminuria group accounted for 87.2%(34/39),the difference among three groups was statistically significant(P<0.01).Compared with normal albuminuria group,the Valsalva RR value,the deep respiratory heart rate were smaller in the microalbuminuria group and the large albuminuria group(P<0.05),while the vertical position blood pressure difference was larger(P<0.05).Spearman correlation analysis showed that UACR was negatively correlated with Valsalva R-R value,deep respiratory heart rate difference,and deep respiratory heart rate(r=-0.236,-0.180 and-0.202,P<0.01),but positively correlated with the vertical position blood pressure difference(r=0.116 and 0.182,P<0.03).Stepwise regression analysis was carried out while CAN as the dependent variable.Age,BMI,UACR and HOMA-IR were independent factors of CAN.Conclusion UACR was associated with the occurrence of CAN in patients with T2DM,and HOMA-IR maybe a risk factor for the occurrence of CAN.

关 键 词：糖尿病 2型 尿微量白蛋白 心血管自主神经病变 

分 类 号：R747.9[医药卫生—神经病学与精神病学] R587.2[医药卫生—临床医学]