2型糖尿病患者扫描式葡萄糖监测系统指标与尿白蛋白/肌酐比值的相关性研究  

Association of Metrics Derived from a Flash Glucose Monitoring System with Urine Albumin-to-creatinine Ratio in T2DM Patients

作　　者：潘梓末 褚琳[1] 陈陵霞[1] 王晶桐[1] PAN Zimo;CHU Lin;CHEN Lingxia;WANG Jingtong(Department of Geriatrics,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院老年科,北京市100044

出　　处：《中国全科医学》2022年第23期2856-2863,共8页Chinese General Practice

基　　金：北京市科委基金项目(Z161100000116095)。

摘　　要：背景 随着血糖监测技术的发展,近些年来人们开始使用扫描式葡萄糖监测系统(FGMS)“全景式”地观察2型糖尿病(T2DM)患者的血糖水平,明确FGMS指标与T2DM并发症之间的关系有助于提高其临床应用价值,但目前相关研究较少。目的 探究佩戴FGMS的T2DM患者葡萄糖在目标范围内时间(TIR)等指标与尿白蛋白/肌酐比值(UACR)的相关性。方法 选取2019年1月至2021年10月于北京大学人民医院老年科就诊并佩戴FGMS的T2DM患者79例,以尿液检查中UACR是否<30 mg/g将患者分为无白蛋白尿组(n=50)和白蛋白尿组(n=29)。比较两组患者的临床特征、实验室检查指标及FGMS指标等。采用Pearson相关、Spearman秩相关分析探讨TIR、高血糖时间(TAR)与糖化血红蛋白(HbA;)的相关性。分别采用Pearson相关、Spearman秩相关、偏相关分析探讨FGMS指标与lnUACR的相关性。使用多因素Logistic回归分析探究T2DM患者发生白蛋白尿的影响因素,采用受试者工作特征(ROC)曲线评估TIR对白蛋白尿的预测价值。结果 白蛋白尿组T2DM病程长于无白蛋白尿组,三酰甘油(TG)、HbA;、平均血糖(MBG)、TAR、平均血糖标准差(SDBG)、最大葡萄糖波动幅度(LAGE)、平均葡萄糖波动幅度(MAGE)、连续每隔2 h血糖净作用(CONGA;)高于无白蛋白尿组,TIR低于无白蛋白尿组(P<0.05)。Pearson相关、Spearman秩相关分析结果显示,TIR与HbA;呈负相关(P<0.001),TAR与HbA;呈正相关(P<0.001)。Pearson相关、Spearman秩相关、偏相关分析结果均表明,TIR与lnUACR呈负相关(P<0.001),MBG、TAR、SDBG、LAGE、MAGE、CONGA;与lnUACR呈正相关(P<0.001)。多因素Logistic回归分析结果显示,TIR>70%〔OR=0.038,95%CI(0.003,0.467)〕是T2DM患者出现白蛋白尿的保护因素(P<0.05),TAR升高〔OR=1.046,95%CI(1.000,1.094)〕是T2DM患者出现白蛋白尿的危险因素(P<0.05)。TIR预测T2DM患者出现白蛋白尿的ROC曲线下面积(AUC)为0.784〔95%CI(0.674,0.894)〕(P=0.003),灵敏�Background With the advances in blood glucose monitoring technologies,a flash glucose monitoring system(FGMS) has recently been used to panoramically observe the blood glucose level in patients with type 2 diabetes mellitus(T2DM).Evaluating the relationship of blood glucose metrics monitored by the FGMS with T2DM complications will facilitate the clinical application of FGMS but relevant studies are rare.Objective To assess the correlation of time in range(TIR) and other markers with urine albumin-to-creatinine ratio(UACR) in patients with T2DM using a FGMS.Methods T2DM patients(n=79) using a FGMS were selected from Department of Geriatrics,Peking University People’s Hospital from January 2019 to October 2021,including 29 with UACR greater than 30 mg/g(albuminuria group) and 50 with UACR less than 30 mg/g(non-albuminuria group).The clinical characteristics,laboratory test markers,and blood glucose metrics monitored by the FGMS of the two groups were compared.Pearson correlation and Spearman correlation analyses were used to explore the correlation of TIR and time above range(TAR) with glycated hemoglobin(HbA;).Pearson correlation,Spearman correlation and partial correlation analyses were used to explore the correlations of FGMS markers with natural logarithm-transformed UACR,respectively.Multivariate Logistic regression analysis was used to explore the factors influencing the development of albuminuria in T2DM.The predictive value of TIR for albuminuria was assessed using the receiver operating characteristic(ROC) curve.Results Compared with the non-albuminuria group,albuminuria group had longer duration of T2DM(P<0.05).Moreover,albuminuria group had higher triacylglycerol,HbA;,mean blood glucose(MBG),TAR,the standard deviation of mean blood glucose(SDBG),the largest amplitude of glycemic excursions(LAGE),mean amplitude of glycemic excursions(MAGE),and 2 h continuous overlapping net glycemic action(CONGA;),as well as lower TIR(P<0.05).Pearson correlation and Spearman correlation analyses showed that HbA;was neg

关 键 词：糖尿病 2型 糖尿病肾病 白蛋白尿 尿白蛋白/肌酐比 血糖自我监测 扫描式葡萄糖监测系统 目标范围内时间 血糖波动 

分 类 号：R587.1[医药卫生—内分泌] R587.24[医药卫生—内科学]