CAJ | 학술논문

目的探讨糖耐量减低(IGT)患者早期糖尿病肾病的预测指标、患病率及影响因素.方法 262例受试者中正常糖耐量(NGT)103人、IGT98人、糖尿病(DM)61人,全部进行即刻尿转铁蛋白/肌酐(UTRF/Cr)和尿白蛋白/肌酐(UAlb/Cr)的检测及临床观察指标的测定.结果 (1)UTRF/Cr与UAlb/Cr呈显著正相关,r＝0.618,P＜0.001.(2)IGT组的UAlb/Cr(中位数,极差)、UTRF/Cr(中位数,极差)高于NGT组(0.015,0.44mg/mg比0.012,0.58mg/mg,t=-1.981,P=0.049;0.064,4.96mg/mg比0.034,7.30mg/mg,t=-2.249,P=0.026).(3)各组UTRF/Cr比值的阳性率明显高于白蛋白尿的阳性率(41.6%比29.7%,P＜0.01).(4)Logistic回归分析显示白蛋白尿的主要危险因素是DBP,OR=1.064,2hPG OR=1.109,P＜0.01;非糖尿病组的主要危险因素是DBP,OR=1.064,P＜0.01.结论在IGT阶段已存在早期糖尿病肾脏损害,高血压是其重要的危险因素.尿转铁蛋白/肌酐比值的检测较白蛋白尿/肌酐比值更灵敏,但仍需进一步综合比较二者的敏感性和特异性.
목적 탐토당내량감저(IGT)환자조기당뇨병신병적예측지표、환병솔급영향인소.방법 262례수시자중정상당내량(NGT)103인、IGT98인、당뇨병(DM)61인,전부진행즉각뇨전철단백/기항(UTRF/Cr)화뇨백단백/기항(UAlb/Cr)적검측급림상관찰지표적측정.결과 (1)UTRF/Cr여UAlb/Cr정현저정상관,r＝0.618,P＜0.001.(2)IGT조적UAlb/Cr(중위수,겁차)、UTRF/Cr(중위수,겁차)고우NGT조(0.015,0.44mg/mg비0.012,0.58mg/mg,t=-1.981,P=0.049;0.064,4.96mg/mg비0.034,7.30mg/mg,t=-2.249,P=0.026).(3)각조UTRF/Cr비치적양성솔명현고우백단백뇨적양성솔(41.6%비29.7%,P＜0.01).(4)Logistic회귀분석현시백단백뇨적주요위험인소시DBP,OR=1.064,2hPG OR=1.109,P＜0.01;비당뇨병조적주요위험인소시DBP,OR=1.064,P＜0.01.결론 재IGT계단이존재조기당뇨병신장손해,고혈압시기중요적위험인소.뇨전철단백/기항비치적검측교백단백뇨/기항비치경령민,단잉수진일보종합비교이자적민감성화특이성.
Objective To investigate the prevalence,predictable markers and risk factors for early diabetic nephropathy(DM). Methods Urinary transferrin-to-creatinine ratio (UTRF/Cr) and urinary albumin-to-creatinine ratio (UALB/Cr) and other clinical parameters such as waist circumference,blood pressure,body mass index(BMI) and lipids were measured in 262 subjects (103 subjects with NGT,98 with IGT,61 with DM). Results 1. UTRF/Cr was positively related with UALB/Cr (r=0.618,P<0.001). 2.Both UALB/Cr(Median,range) and UTRF/Cr(Median,range) were significantly higher in IGT group than in the NGT group(0.015,0.44 mg/mg vs 0.012,0.58 mg/mg,t=-1.981,P=0.049;0.064,4.96mg/mg vs 0.034,7.30mg/mg,t=-2.249,P=0.026). 3.The positive rate of UTRF/Cr was significantly higher than that of microalbuminuria (41.6% vs 29.7%,P<0.01). 4. Logistic regression analysis showed that diastolic blood pressure (OR 1.064,95%CI 1.003-1.097,P<0.001) and 2h plasma glucose (OR 1.109,95%CI 1.032-1.191,P<0.001) were risk factors for the development of microalbuminuria in all groups,while diastolic pressure (OR 1.064,95%CI 1.028-1.101,P<0.01) was the only risk factor in nondiabetic subjects. Conclusions The prevalence of early diabetic nephropathy is high even in the stage of IGT. Hypertension is a main risk factor for the development of DN. UTRF/Cr is more sensitive than UALB/Cr for detecting diabetic nephropathy