早期糖尿病肾病患者尿白蛋白/肌酐比值与心血管事件风险关系的研究  

Association between longitudinal trajectories of urinary albumin-to-creatinine ratio and the risk of adverse cardiac events in elderly patients with early diabetic nephropathy

作　　者：王艳[1] 马素霞[1] 马海燕 王勇[1] WANG Yan;MA Suxia;MA Haiyan;WANG Yong(Department of Cardiology,The First People’s Hospital of Shangqiu City,Shangqiu 476100,China)

机构地区：[1]商丘市第一人民医院心血管内科,476100

出　　处：《心肺血管病杂志》2025年第2期142-147,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210987)。

摘　　要：目的:探讨尿白蛋白/肌肝比值(microalbuminuria,uACR)30~300 mg/g纵向变化轨迹与随访发生MACE风险的关系。方法:连续纳入了2015年1月至2019年12月,商丘市第一人民医院诊治的672例患有微量白蛋白尿的老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者。使用潜在混合模型来确定暴露期间(2016年至2020年)uACR的纵向变化轨迹。随访截止日期为2022年1月1日,主要结局为MACEs。结果:确定五组不同的uACR轨迹:低度稳定组(uACR 33.2~52.7mg/g,n=107)、中度稳定组(uACR 55.4~96.6 mg/g,n=202)、高度稳定组(uACR 99.1~173.2 mg/g,n=184)、中高度-降低组(uACR 37.1~111.6 mg/g,n=82)和中高度-增加组(uACR 64.3~298.1 mg/g,n=97)。中位随访31(16,47)个月,149例(22.2%)发生MACEs。Kaplan-Meier生存曲线显示,与低度稳定组相比,其余四组的MACEs发生风险均明显增加,发生风险最高的是中高度-增加组(HR=1.648,95%CI:1.139~2.387,P=0.009)。多变量COX比例风险模型显示,年龄、糖尿病病程、HbA1c、NT-proBNP、SGLT2i、uACR(2019)、uACR(2020)、uACR中高度-增加轨迹、高度稳定轨迹、中度稳定轨迹是MACEs风险的相关因素。结论:长期升高的uACR会显著增加患有微量白蛋白尿人群的MACEs风险,而uACR的降低提示预后改善。Objective:To explore the relationship between the longitudinal trajectory of microalbuminuria(uACR)30-300 mg/g and the risk of major adverse cardiovascular events(MACEs)during follow-up.Methods:This longitudinal cohort study included 672 elderly patients with type 2 diabetes mellitus(T2DM)and microalbuminuria,treated at Shangqiu First People’s Hospital from January 2015 to December 2019.A latent mixed model was used to determine the longitudinal trajectories of uACR during the exposure period(2016-2020).Follow-up continued until January 1,2022,and the primary outcome was the occurrence of MACEs.Results:Five distinct uACR trajectory groups were identified:low-stable group(uACR 33.2-52.7 mg/g,n=107),moderate-stable group(uACR 55.4-96.6 mg/g,n=202),high-stable group(uACR 99.1-173.2 mg/g,n=184),moderate-high decreasing group(uACR 37.1-111.6 mg/g,n=82),and moderate-high increasing group(uACR 64.3-298.1 mg/g,n=97).Over a median follow-up period of 31 months(16,47 months),149 patients(22.2%)experienced MACEs.Kaplan-Meier survival curves showed a significantly higher risk of MACEs in the other four groups compared to the low-stable group.The highest risk was observed in the moderate-high increasing group,with a risk increase of 64.8%(95%CI:13.9-138.7,P=0.009).Multivariate COX proportional hazards models identified age,duration of diabetes,HbA1c,NT-proBNP,SGLT2 inhibitors,uACR(2019),uACR(2020),moderate-high increasing trajectory,high stable trajectory,moderate stable trajectory as independent risk factors for MACEs.Conclusions:Long-term elevated uACR significantly increases the risk of MACEs in T2DM patients with microalbuminuria,while a decrease in uACR suggests improved prognosis.

关 键 词：尿白蛋白肌酐比值 变化轨迹 2型糖尿病 不良心脏事件 相关性 

分 类 号：R54[医药卫生—心血管疾病]