CAJ | 학술논문

目的分析初诊2型糖尿病(T2DM)住院患者微量白蛋白尿的发生率及危险因素,为糖尿病及慢性微血管并发症的早期干预提供理论依据.方法 2006年3月至2009年9月在我院内分泌代谢科住院且资料完整的286例初诊T2DM患者,测定其血脂、24 h尿白蛋白、空腹及餐后胰岛索和血糖、糖化血红蛋白(HbA1c)以及C肽等.两次24h尿白蛋白定量为30 ～ 300 mg被定义为微量白蛋白尿.计算胰岛素抵抗指数(HOMA-IR).所有患者均由眼科医师进行扩瞳后眼底检查明确有无眼底病变.结果 (1)本研究人群中,微量白蛋白尿的发生率为19.58％ (56/286).(2)正常蛋白尿组与微量白蛋白尿组合并糖尿病视网膜病变者分别占19.57％ (45/230)与33.93％ (19/56),差异有统计学意义(x2=5.349,P=0.021)；微量白蛋白尿组的空腹血糖、HbA1c、HOMA-IR均显著高于正常蛋白尿组[空腹血糖:(11.08±1.76)、(9.24±1.65) mmol/L,HbA1c:(11.54±1.59)％、(9.39±1.64)％,HOMA-IR:(3.73±0.42)、(3.50±0.30),t值分别为-6.148、-7.533、-3.774,P均＜0.001].(3) Pearson相关分析显示,微量白蛋白尿与空腹血糖(r =0.460)、HbA1c(r =0.499)、HOMA-IR(r=0.308)、合并糖尿病视网膜病变(γ=0.405)呈正相关(P均＜0.01).(4)逐步回归分析显示,空腹血糖(β=-0.804,P＜0.01)、HbA1c(β=-0.455,P＜0.01)、合并糖尿病视网膜病变(β=1.527,P＜0.05)是影响糖尿病微量白蛋白尿的独立危险因素.结论初诊住院T2DM患者微量白蛋白尿的发生与空腹血糖、HbA1c、HOMA-IR相关,同时更容易合并糖尿病视网膜病变.
목적 분석초진2형당뇨병(T2DM)주원환자미량백단백뇨적발생솔급위험인소,위당뇨병급만성미혈관병발증적조기간예제공이론의거.방법 2006년3월지2009년9월재아원내분비대사과주원차자료완정적286례초진T2DM환자,측정기혈지、24 h뇨백단백、공복급찬후이도색화혈당、당화혈홍단백(HbA1c)이급C태등.량차24h뇨백단백정량위30 ～ 300 mg피정의위미량백단백뇨.계산이도소저항지수(HOMA-IR).소유환자균유안과의사진행확동후안저검사명학유무안저병변.결과 (1)본연구인군중,미량백단백뇨적발생솔위19.58％ (56/286).(2)정상단백뇨조여미량백단백뇨조합병당뇨병시망막병변자분별점19.57％ (45/230)여33.93％ (19/56),차이유통계학의의(x2=5.349,P=0.021)；미량백단백뇨조적공복혈당、HbA1c、HOMA-IR균현저고우정상단백뇨조[공복혈당:(11.08±1.76)、(9.24±1.65) mmol/L,HbA1c:(11.54±1.59)％、(9.39±1.64)％,HOMA-IR:(3.73±0.42)、(3.50±0.30),t치분별위-6.148、-7.533、-3.774,P균＜0.001].(3) Pearson상관분석현시,미량백단백뇨여공복혈당(r =0.460)、HbA1c(r =0.499)、HOMA-IR(r=0.308)、합병당뇨병시망막병변(γ=0.405)정정상관(P균＜0.01).(4)축보회귀분석현시,공복혈당(β=-0.804,P＜0.01)、HbA1c(β=-0.455,P＜0.01)、합병당뇨병시망막병변(β=1.527,P＜0.05)시영향당뇨병미량백단백뇨적독립위험인소.결론 초진주원T2DM환자미량백단백뇨적발생여공복혈당、HbA1c、HOMA-IR상관,동시경용역합병당뇨병시망막병변.
Objective To analyze the incidence and risk factors of microalbuminuria in newly diagnosed and hospitalized type 2 diabetes mellitus patients,and to provide the theoretical basis for therapy of diabetes and diabetic chronic complications.Methods The blood glucose,lipid profile,24h-urinaryalbumin,fasting and postprandial serum insulin and peptid C were measured in 286 newly diagnosed and hospitalized type 2 diabetic patients from Mar.2006 to Sep.2009.Microalbuminuria was defined as the 24h-urinary albumin between 30 to 300 mg twice.Insulin resistance index (HOMA-IR) was recorded and all the patients received fundus examination by ophthalmologists after expansion of the pupil to ensure whether there was retinopathy or not.Results (1)The incidence rate of microalbuminuria in this study was 19.58％ (56/286).(2)Normal albuminuria group and MA group combined DR were 19.57％ (45/230) and 33.93 ％ ( 19/56 ) respectively,and the difference was statistically significant( x2 =5.349,P =0.021 ).Compared with control,the FPG,HbA1c and HOMA-IR were significantly higher in microalbuminuria group ( FPG:[ 11.08 ± 1.76 ] mmol/L vs [9.24 ±1.65]mmol/L,t =-6.148,P ＜0.001;HbA1c:[11.54 ± 1.59]％ vs [9.39 ± 1.64]％,t =-7.533,P ＜0.001 ;HOMA-IR:[3.73 ±0.42] vs [3.50 ±0.30],t =-3.774,P ＜0.001 ).(3) Pearson correlation analysis revealed microalbuminuria was positively correlated with FPG( r =0.460),HbA1 c ( r =0.499),HOMA-IR( r =0.308)and combined DR(r =0.405)(P ＜0.01).(4)Stepwise multiple regression analysis revealed that FPG (ββ =- 0.804,P ＜ 0.01 ),HbA1 c (β =- 0.455,P ＜ 0.01 ) and combined DR (β =1.527,P ＜ 0.05 ) were independently risk factors of microalbuminuria.Conclusion The development of microalbuminuria in newly diagnosed and hospitalized type 2 diabetic patients is associated with FPG,HbA1c and HOMA-IR,and will be easier to merge diabetic retinopathy.