CAJ | 학술논문

目的：探讨血糖达标且不伴高血压的2型糖尿病患者尿微量清蛋白（ MAU）与24 h动态血压之间的关系。方法选取2012年1月-2013年5月在安徽省黄山市中医院内分泌科及代谢科住院及门诊的糖化血红蛋白（ HbA1c ）＜7％且不伴高血压的2型糖尿病患者83例，按照尿MAU水平分为A组（ MAU＜30 mg/g，37例）和B组（MAU≥30 mg/g，46例），对两组患者的一般资料及动态血压指标进行分析比较。结果（1） B组患者血肌酐值高于A组〔（76.1±14.6）μmol/L 比（67.8±11.9）μmol/L 〕，但肾小球滤过率低于A组〔（73.0±13.6） ml/min比（79.0±11.4） ml/min〕，差异有统计学意义（P＜0.05）；（2） B组24 h平均收缩压〔（128.9±6.2） mm Hg比（122.2±7.2） mm Hg〕、夜间平均收缩压〔（128.9±12.9） mm Hg比（113.8±10.0） mm Hg 〕、夜间平均舒张压〔（78.0±8.6） mm Hg比（69.2±8.3） mm Hg〕、白昼收缩压负荷值〔（15.2±10.8）％比（9.8±7.5）％〕、夜间收缩压负荷值〔（54.5±34.3）％比（13.1±9.4）％〕、夜间舒张压负荷值〔（42.9±32.6）％比（9.6±8.7）％〕、夜间收缩压变异〔（11.2±4.4）比（10.9±4.3）〕及血压昼夜节律消失率（82.6％比37.8％）高于A组，差异有统计学意义（P＜0.05）；（3）多元逐步Logistic回归分析显示，年龄（β＝0.097）、病程（β＝0.127）、夜间收缩压负荷值（β＝0.068）、夜间舒张压负荷值（β＝0.077）及夜间收缩压变异（β＝-0.229）是MAU的独立预测因子。结论对血糖达标且不伴高血压的2型糖尿病患者，24 h动态血压监测尤其是夜间血压变化对早期肾损伤具有预测价值。
목적：탐토혈당체표차불반고혈압적2형당뇨병환자뇨미량청단백（ MAU）여24 h동태혈압지간적관계。방법선취2012년1월-2013년5월재안휘성황산시중의원내분비과급대사과주원급문진적당화혈홍단백（ HbA1c ）＜7％차불반고혈압적2형당뇨병환자83례，안조뇨MAU수평분위A조（ MAU＜30 mg/g，37례）화B조（MAU≥30 mg/g，46례），대량조환자적일반자료급동태혈압지표진행분석비교。결과（1） B조환자혈기항치고우A조〔（76.1±14.6）μmol/L 비（67.8±11.9）μmol/L 〕，단신소구려과솔저우A조〔（73.0±13.6） ml/min비（79.0±11.4） ml/min〕，차이유통계학의의（P＜0.05）；（2） B조24 h평균수축압〔（128.9±6.2） mm Hg비（122.2±7.2） mm Hg〕、야간평균수축압〔（128.9±12.9） mm Hg비（113.8±10.0） mm Hg 〕、야간평균서장압〔（78.0±8.6） mm Hg비（69.2±8.3） mm Hg〕、백주수축압부하치〔（15.2±10.8）％비（9.8±7.5）％〕、야간수축압부하치〔（54.5±34.3）％비（13.1±9.4）％〕、야간서장압부하치〔（42.9±32.6）％비（9.6±8.7）％〕、야간수축압변이〔（11.2±4.4）비（10.9±4.3）〕급혈압주야절률소실솔（82.6％비37.8％）고우A조，차이유통계학의의（P＜0.05）；（3）다원축보Logistic회귀분석현시，년령（β＝0.097）、병정（β＝0.127）、야간수축압부하치（β＝0.068）、야간서장압부하치（β＝0.077）급야간수축압변이（β＝-0.229）시MAU적독립예측인자。결론대혈당체표차불반고혈압적2형당뇨병환자，24 h동태혈압감측우기시야간혈압변화대조기신손상구유예측개치。
Objective To investigate the relationship between microalbuminurine ( MAU) and 24-hour ambulatory blood pressure ( 24 h -ABP ) in type 2 diabetes patients with targeted blood glucose levels but no high blood pressure.MethodsMedical records of 83 type 2 diabetes patients with glycated hemoglobin ( HbA1c ) <7% and no high blood pressure who were seeking treatment in Department of Endocrinology and Metabolism of Huangshan City ′s Hospital of Traditional Chinese Medicine were reviewed.Data on the demographic variables and 24h-ABP monitoring readings were stratified by the MAU concentration and accordingly analyzed.Results Plasma levels of creatine were significantly higher 〔 ( 76.1 ±14.6 )μmol/L vs.(67.8 ±11.9) μmol/L, P<0.01〕 but the estimated glomerular filtration rate was significantly lower 〔 (73.0 ± 13.6) ml/min vs.(79.0 ±11.4) ml/min, P<0.05〕 in patients with MAU≥30 mg/g than patients with MAU<30 mg/g.On average, the 24 h systolic blood pressure (BP) 〔 (128.9 ±6.2) mm Hg vs.(122.2 ±7.2) mm Hg, P<0.01〕, nocturnal systolic BP 〔(128.9 ±12.9) mm Hg vs.(113.8 ±10.0) mm Hg, P<0.01〕, nocturnal diastolic BP 〔(78.0 ±8.6) mm Hg vs.(69.2 ±8.3) mm Hg, P<0.01〕, daytime systolic BP load 〔(15.2 ±10.8)%vs.(9.8 ±7.5)%, P<0.05〕, noctur-nal systolic BP load 〔 (54.5 ±34.3)%vs.(13.1 ±9.4)%, P<0.01〕, nocturnal diastolic BP load 〔 (42.9 ±32.6)%vs.(9.6 ±8.7)%, P<0.01〕, standard deviation of nocturnal systolic BP 〔 (11.2 ±4.4) vs.(10.9 ±4.3), P<0.01〕, and disappearance rate of blood pressure circadian rhythm ( 82.6% vs.37.8%, P<0.01 ) were all significantly higher in patients with MAU≥30 mg/L than patients with MAU <30 mg/L.Multivariate logistic regression analyses indicated age (β=0.097 ) , the disease course (β=0.127 ) , nocturnal systolic BP load (β=0.068 ) , nocturnal diastolic BP load (β=0.077 ) , and stand-ard deviation of nocturnal systolic BP (β=-0.229 ) were independent predictors of MAU.Conclusion Ambulatory blood pres-sure monitoring variables , particularly the variation of blood pressure at night , may predict early MAU-related renal damage in type 2 diabetes patients whose blood pressure is not high and whose blood glucose is under an effective control .