中老年糖尿病患者尿微量白蛋白/尿肌酐比值与脑微出血的关系分析  

Relationship between urinary microalbumin/urinary creatinine ratio and cerebral microbleed in middle-aged and elderly diabetic patients

作　　者：袁剑 赵佩 邓云 邵泽民 陈斐虹 杨帆[3] 朱德生[1,4] Jian Yuan;Pei Zhao;Yun Deng;Zemin Shao;Feihong Chen;Fan Yang;Desheng Zhu(Department of Neurology,Renji Hospital baoshan branch,Shanghai Jiao Tong University School of Medicine,Shanghai 200436,China;Department of Nephrology,Renji Hospital baoshan branch,Shanghai Jiao Tong University School of Medicine,Shanghai 200436,China;Department of Endocrinology,Renji Hospital baoshan branch,Shanghai Jiao Tong University School of Medicine,Shanghai 200436,China;Department of Neurology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院宝山分院神经内科,200436 [2]上海交通大学医学院附属仁济医院宝山分院肾内科,200436 [3]上海交通大学医学院附属仁济医院宝山分院内分泌科,200436 [4]上海交通大学医学院附属仁济医院神经内科,200127

出　　处：《中华脑血管病杂志(电子版)》2025年第1期25-31,共7页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：上海市宝山区科学技术委员会医学卫生项目(21-E-07);上海市宝山区科学技术委员会医学卫生项目(2023-E-09);上海交通大学医学院附属仁济医院宝山分院医学人才培养专项计划(rbxxrc-2023-010)。

摘　　要：目的探讨中老年糖尿病患者尿微量白蛋白/尿肌酐比值(UACR)与脑微出血(CMB)的关系及其临床意义。方法回顾性分析2019年7月至2023年7月上海交通大学医学院附属仁济医院宝山分院神经内科、肾内科和内分泌科确诊的957例中老年糖尿病患者的临床资料。根据影像评估将患者分为糖尿病伴与不伴CMB组,比较组间的临床、生化特征,按UACR临界值分组(UACR正常组和偏高组)并比较组间CMB发生率的差异;采用Spearman相关分析UACR水平与CMB发生的关系,采用多因素二元Logistic回归分析及曲线拟合分析方法探索UACR和CMB的关系。结果11.7%(112/957)的中老年糖尿病患者伴发CMB,糖尿病伴CMB组和不伴CMB组患者之间年龄、舒张压、收缩压、体质量指数、病程、血红蛋白、血小板数量、谷丙转氨酶、甘油三酯比较差异均具有统计学意义(P均<0.05)。UACR偏高组CMB发生率高于正常组(18.16%vs 6.57%),差异有统计学意义(χ^(2)=0.36,P<0.001);UACR水平与CMB发生呈正相关(r=0.183,P<0.001);多因素二元Logistic回归分析显示:调整混杂因素前后Log2 UACR水平对CMB发生的风险分别为OR=1.295(95%CI:1.182~1.418,P<0.001)、1.223(95%CI:1.034~1.445,P<0.001);曲线拟合分析显示Log2UACR水平与CMB发生概率呈现升高的曲线关系(χ^(2)=28.428,P<0.001)。结论中老年糖尿病患者UACR升高与CMB发生密切相关,临床提示UACR水平升高可能是CMB发生的一个危险因素,并在评估CMB发生方面具有一定价值。Objective To investigate the relationship between urine albumin-to-creatinine ratio(UACR)and cerebral microbleed(CMB)in middle-aged and elderly diabetic patients,and to explore its clinical significance.Methods A retrospective analysis was conducted on the clinical data of 957 patients with diabetes diagnosed in the Department of Neurology,Nephrology,and Endocrinology at Baoshan Branch of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,from July 2019 to July 2023.Patients were divided into two groups based on imaging assessments:those with and without CMB.The clinical and biochemical characteristics between the two groups were compared,and the differences in the incidence of CMB were compared according to UACR the threshold values.Spearman correlation analysis,multivariate binary Logistic regression analysis,and curve fitting analysis were used to explore the relationship between UACR and CMB.Results Among the middle-aged and elderly diabetic patients,11.7%(112/957)were found to have CMB.There were statistically significant differences in age,diastolic blood pressure,systolic blood pressure,body mass index(BMI),disease duration,hemoglobin,platelet count,alanine aminotransferase,and triglyceride between diabetic patients with CMB and those without CMB(all P<0.05).The incidence of CMB in patients with high or normal UACR were 18.16%and 6.57%respectively,with a statistically significant difference(χ^(2)=0.36,P<0.001).UACR levels were positively correlated with the occurrence of CMB(r=0.183,P<0.001).Multivariate binary Logistic regression analysis showed that Log2UACR was associated with the risk of CMB,with odds ratios(OR)of 1.295(95%CI:1.182-1.418,P<0.001)and before 1.223(95%CI:1.034-1.445,P<0.001)after adjusting for confounding factors.Curve fitting analysis revealed an increasing relationship between Log2UACR levels and the probability of CMB(χ^(2)=28.428,P<0.001).Conclusion Elevated UACR is closely related to the occurrence of CMB in middle-aged and elderly diabetic patients.Clini

关 键 词：糖尿病 尿微量白蛋白/尿肌酐比值 脑微出血 相关性 

分 类 号：R743.34[医药卫生—神经病学与精神病学]