肥胖与2型糖尿病患者发生蛋白尿的关系研究  

Relationship between Obesity and Proteinuria in Type 2 Diabetic Patients

作　　者：马艺琳 柯蒋风 王俊薇 李连喜[1] MA Yilin;KE Jiangfeng;WANG Junwei;LI Lianxi(Department of Endocrinology and Metabolism,Shanghai Jiaotong University Affiliated Sixth People's Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院内分泌代谢科,上海市200233

出　　处：《中国全科医学》2022年第20期2457-2461,共5页Chinese General Practice

基　　金：国家重点研发计划项目(2018YFC1314900,2018YFC1314905);国家自然科学基金资助项目(81170759,81770813,82070866)。

摘　　要：背景肥胖是代谢综合征、2型糖尿病(T2DM)和动脉粥样硬化等诸多疾病发生、发展的危险因素,而糖尿病患者中肥胖和蛋白尿关系的研究较少。目的探讨T2DM患者肥胖和蛋白尿的关系。方法回顾性连续选取2007年1月至2009年6月在上海交通大学附属第六人民医院内分泌代谢科住院的T2DM患者。收集患者一般资料、体格检查资料、实验室检查结果。依据是否肥胖将患者分为T2DM肥胖组〔体质指数(BMI)≥25 kg/m^(2)〕和T2DM无肥胖组(BMI<25 kg/m^(2)),依据BMI将肥胖患者分为轻度肥胖亚组(25 kg/m^(2)≤BMI<30 kg/m^(2))、中度肥胖亚组(30 kg/m^(2)≤BMI<35 kg/m^(2))和重度肥胖亚组(BMI≥35 kg/m^(2))。蛋白尿诊断标准:24 h尿白蛋白定量≥30 mg/24 h。采用二元Logistic回归分析探究T2DM患者肥胖与蛋白尿的关系。结果3023例T2DM患者中,T2DM肥胖组1414例,T2DM无肥胖组1609例。1414例肥胖患者中,轻度肥胖亚组1196例、中度肥胖亚组206例和重度肥胖亚组12例。T2DM肥胖组患者中有饮酒史、高血压病史、降压药用药史者所占比例,收缩压、舒张压、腰臀比、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、血肌酐(Scr)、空腹C肽、餐后2 hC肽、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、丙氨酸氨基转移酶(ALT)、血尿酸高于T2DM无肥胖组,糖化血红蛋白(HbA;)、高密度脂蛋白(HDL)低于T2DM无肥胖组(P<0.05)。T2DM肥胖组患者24 h尿白蛋白定量为13.7(7.6,42.6)mg/24 h,高于T2DM无肥胖组患者的9.7(6.0,22.3)mg/24 h(P<0.05)。T2DM肥胖组患者蛋白尿发生率为30.0%(424/1414),高于T2DM无肥胖组患者的20.2%(325/1609)(P<0.05)。校正混杂因素后,二元Logistic回归分析结果显示,肥胖是T2DM患者发生蛋白尿的危险因素〔OR=1.266,95%CI(1.013,1.582),P<0.05〕。结论肥胖是T2DM患者发生蛋白尿的独立危险因素,控制肥胖对降低T2DM发生蛋白尿风险有重要的临床意义。Background Obesity is a risk factor for the development of metabolic syndrome,type 2 diabetes mellitus(T2DM),atherosclerosis and other diseases,but the correlation between obesity and albuminuria in diabetic patients has been insufficiently explored.Objective To investigate the correlation between obesity and albuminuria in patients with T2DM.Methods T2DM inpatients were consecutively recruited from Department of Endocrinology and Metabolism,Shanghai Jiaotong University Affiliated Sixth People’s Hospital from January 2007 to June 2009.The general clinical data,physical and laboratory examination results were collected.In accordance with prevalence of obesity(defined as BMI≥25 kg/m^(2)),the patients were divided into obese group and non-obese group(BMI<25 kg/m^(2)),then the obese cases were further divided into mild(25 kg/m^(2)≤BMI<30 kg/m^(2)),moderate(30 kg/m^(2)≤BMI<35 kg/m^(2)),and severe obesity subgroups(BMI≥35 kg/m^(2)).Albuminuria was diagnosed as 24-hour urinary albumin excretion≥30 mg/24 h.The relationship between obesity and albuminuria was analyzed by binary Logistic regression.Results In all,3023 T2DM cases were enrolled,including 1609 non-obese cases,and 1414 obese cases(1196 cases of mild obesity,206 cases of moderate obesity and 12 cases of severe obesity).Compared with non-obese cases,obese cases had higher prevalence of alcohol consumption,hypertension,and history of anti-hypertensive mediation use(P<0.05).Additionally,obese cases had higher average levels of systolic blood pressure,diastolic blood pressure,waist-to-hip ratio,fasting plasma glucose,2-h postprandial blood glucose,serum creatinine,fasting C-peptide,2-hour postprandial C-peptide,triglyceride,total cholesterol,low-density lipoprotein,alanine aminotransferase,and serum uric acid,and lower average levels of glycosylated hemoglobin and high-density lipoprotein(P<0.05).Obese cases also had higher average level of 24-h urinary albumin excretion〔13.7(7.6,42.6)mg/24 h〕than did non-obese cases〔9.7(6.0,22.3)mg/24 h〕(P<0.05

关 键 词：糖尿病 2型 肥胖 蛋白尿 体重 白蛋白尿 影响因素分析 

分 类 号：R587.1[医药卫生—内分泌]