糖尿病视网膜病变患者尿微量白蛋白/肌酐比值的变化及意义

doi:10.3969/j.issn.1673-8640.2016.010.009

摘要/Abstract

摘要：

目的探讨糖尿病视网膜病变（DR）患者尿微量白蛋白（mAlb）/肌酐（Cr）比值的变化及意义。方法将173例2型糖尿病（T2DM）患者分为无糖尿病视网膜病变（NDR）组76例、非增生性糖尿病视网膜病变（NPDR）组58例、增生性糖尿病视网膜病变（PDR）组39例,另选取健康体检者40名作为正常对照组。检测各组空腹血糖（FPG）、总胆固醇（TC）、餐后2 h血糖（2 hPG）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、C反应蛋白（CRP）、糖化血红蛋白（HbA_1c）及尿mAlb、Cr,计算尿mAlb/Cr比值,同时收集相关临床资料（包括身高、体重、腰围、臀围及糖尿病病程等）。采用Spearman秩相关分析及多元线性回归模型分析尿mAlb/Cr比值与其他临床参数的关系,采用Logistic回归分析评估DR的风险因素。结果 NDR组、NPDR组及PDR组尿mAlb/Cr比值依次增高,各组之间差异均有统计学意义（P<0.05）。T2DM患者尿mAlb/Cr比值与糖尿病病程、FPG、2 hPG、LDL-C、HbA_1c及CRP呈正相关（r值分别为0.372、0.227、0.276、0.231、0.294及0.308,P<0.05）;多元线性回归分析显示糖尿病病程、CRP及HbA_1c与尿mAlb/Cr比值呈独立正相关（β值分别为0.194、0.169、0.183,P值分别为0.007、0.018、0.013）。Logistic回归分析显示尿mAlb/Cr比值、糖尿病病程、HbA_1c及CRP是DR的独立风险因素{比值比（OR）[95%可信区间（CI）]分别为1.212（1.083~1.417）、1.036（1.012~1.063）、1.469（1.140~1.892）、1.330（1.011~1.273）}。结论尿mAlb/Cr比值与DR的发展密切相关,是DR的风险因素。CRP及HbA_1c可能通过损伤肾脏功能参与DR的发生与发展。

关键词: 尿微量白蛋白/肌酐比值, C反应蛋白, 糖化血红蛋白, 糖尿病视网膜病变

Abstract:

Objective To investigate the change of urinary microalbumin（mAlb）to creatinine（Cr）ratio in patients with diabetic retinopathy（DR） and its significance. Methods A total of 173 type 2 diabetes mellitus（T2DM）patients were enrolled,and 40 healthy subjects were enrolled as healthy controls. T2DM patients were classified into 3 groups,non-DR（NDR） group（76 cases）,non-proliferative DR（NPDR） group（58 cases） and proliferative DR（PDR） group（39 cases）. Fasting plasma glucose（FPG）,total cholesterol（TC）,2 h postprandial plasma glucose（2 hPG）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,C-reactive protein （CRP）,glycated hemoglobin A_1c（HbA_1c）,urinary mAlb and Cr were determined,and urinary mAlb/Cr ratio was calculated. Simultaneously,related clinical data were collected,including height,weight,waist circumference,hip circumference,the duration of diabetes mellitus and so on. The relationship between urinary mAlb/Cr ratio and other parameters was analyzed by Spearman's rank correlation analysis and multiple linear regression analysis. Logistic regression analysis was used to identify the risk factors of DR.Results Urinary mAlb/Cr ratio increased progressively from NDR,NPDR to PDR groups,and there was statistical significance among the groups（P<0.05）. Urinary mAlb/Cr ratio in T2DM patients was positively correlated with the duration of diabetes mellitus,FPG,2 hPG,LDL-C,HbA_1c and CRP（r=0.372,0.227,0.276,0.231,0.294 and 0.308,P<0.05）. Urinary mAlb/Cr ratio was correlated independently with the duration of diabetes mellitus,CRP and HbA_1c in multiple linear regression analysis（β=0.194,0.169 and 0.183,P=0.007,0.018 and 0.013）. Logistic regression analysis showed that urinary mAlb/Cr ratio,the duration of diabetes mellitus,HbA_1c and CRP were independent risk factors for DR {odds ratio（OR）[95% confidence interval（CI）] 1.212（1.083-1.417）,1.036（1.012-1.063）,1.469（1.140-1.892） and 1.330（1.011-1.273）}. Conclusions Urinary mAlb/Cr ratio is a risk factor for DR,and it is closely related with the development of DR. CRP and HbA_1c may be involved in the development and pathogenesis of DR through damaging renal function.

Key words: Urinary microalbumin to creatinine ratio, C-reactive protein, Glycated hemoglobin A1c, Diabetic retinopathy

中图分类号:

R446.1

金浩, 傅庆萍, 居会祥, 孙明忠, 朱蓉, 季禹乔, 朱晖, 季建伟, 周中卫. 糖尿病视网膜病变患者尿微量白蛋白/肌酐比值的变化及意义[J]. 检验医学, 2016, 31(10): 878-882.

JIN Hao, FU Qingping, JU Huixiang, SUN Mingzhong, ZHU Rong, JI Yuqiao, ZHU Hui, JI Jianwei, ZHOU Zhongwei. Change of urinary microalbumin to creatinine ratio in patients with diabetic retinopathy and its significance[J]. Laboratory Medicine, 2016, 31(10): 878-882.

图/表 4

参考文献 11

[1]	OLMOS P,ARAYA-DEL-PINO A,GONZÁLEZ C,et al. Pathophysiology of diabetic retinopathy and nephropathy[J]. Rev Med Chil,2009,137(10):1375-1384.
[2]	TARR JM,KAUL K,CHOPRA M,et al.Pathophysiology of diabetic retinopathy[J]. ISRN Ophthalmol,2013,2013:343560.
[3]	CHEN WZ,HUNG CC,WEN YW,et al.Effect of glycemic control on microalbuminuria development among type 2 diabetes with high-normal albuminuria[J]. Ren Fail,2014,36(2):171-175.
[4]	VICENTINI J,VALENTINI J,GROTTO D,et al.Association among microalbuminuria and oxidative stress biomarkers in patients with type 2 diabetes[J]. J Investig Med,2011,59(4):649-654.
[5]	CHOUDHARY N,AHLAWAT RS.Interleukin-6 and C-reactive protein in pathogenesis of diabetic nephropathy:new evidence linking inflammation,glycemic control,and microalbuminuria[J]. Iran J Kidney Dis,2008,2(2):72-79.
[6]	MORIYA T,TANAKA S,KAWASAKI R,et al.Diabetic retinopathy and microalbuminuria can predict macroalbuminuria and renal function decline in Japanese type 2 diabetic patients:Japan Diabetes Complications Study[J]. Diabetes Care,2013,36(9):2803-2809.
[7]	LI XY,XU M,WANG JG,et al.Serum C-reactive protein(CRP) and microalbuminuria in relation to fasting and 2-h postload plasma glucose in a Chinese population[J]. Clin Endocrinol(Oxf),2009,70(5): 691-697.
[8]	TOMIC(/) M,LJUBIC(/) S,KASTELAN S. The role of inflammation and endothelial dysfunction in the pathogenesis of diabetic retinopathy[J]. Coll Antropol,2013,37(Suppl 1):51-57.
[9]	SABANAYAGAM C,LEE J,SHANKAR A,et al.C-reactive protein and microalbuminuria in a multi-ethnic Asian population[J]. Nephrol Dial Transplant,2010,25(4):1167-1172.
[10]	SHEU SJ,LIU NC,GER LP,et al.High HbA1c level was the most important factor associated with prevalence of diabetic retinopathy in Taiwanese type Ⅱ diabetic patients with a fixed duration[J]. Graefes Arch Clin Exp Ophthalmol,2013,251(9): 2087-2092.
[11]	田俊华,莫百军,王宇军. 老年2型糖尿病患者BNP、HbA1c的变化与视网膜病变的关系[J]. 检验医学,2010,25(1):42-43.

组别	例数	年龄（岁）	性别		BMI（kg/m²）	WHR
组别	例数	年龄（岁）	男（例）	女（例）	BMI（kg/m²）	WHR
PDR组	39	59.89±9.06	19	20	25.24±3.05^*	0.88±0.06^*
NPDR组	58	59.21±9.73	31	27	25.13±2.87^*	0.87±0.05
NDR组	76	58.74±9.37	41	35	24.82±2.95^*	0.87±0.06
正常对照组	40	57.43±8.86	22	18	23.10±2.24	0.84±0.05

组别	糖尿病病程（年）	FPG（mmol/L）	2 hPG（mmol/L）	TC（mmol/L）	TG（mmol/L）
PDR组	11.62（5.31~16.82）^#△	8.17±3.15^*	15.27±5.48	5.31±1.22^*	1.95±1.38^*
NPDR组	8.43（3.84~9.13）^#	8.39±2.92^*	15.13±5.61	4.84±1.19	1.92±1.33^*
NDR组	7.15（2.05~7.59）	8.25±2.86^*	14.79±5.28	4.71±1.14	1.81±1.28^*
正常对照组		4.85±0.71		4.53±1.02	1.19±0.59

组别	HDL-C（mmol/L）	LDL-C（mmol/L）	HbA_1c（%）	CRP（mg/L）	尿mAlb/Cr比值（mg/mmoL）
PDR组	1.04±0.51^*	3.03±0.85^*	8.43±1.96^*	6.71±5.21^*#△	420.17（219.69~670.42）^#△
NPDR组	1.10±0.51^*	2.96±0.84^*	8.45±1.92^*	5.68±4.76^*#	76.20（45.30~235.45） ^#
NDR组	1.12±0.49^*	2.98±0.80^*	8.24±1.86^*	4.62±4.33^*	15.90（4.80~17.90）
正常对照组	1.36±0.37	2.18±0.60	5.52±0.45	2.42±2.18

组别	例数	年龄（岁）	性别		BMI（kg/m²）	WHR
组别	例数	年龄（岁）	男（例）	女（例）	BMI（kg/m²）	WHR
PDR组	39	59.89±9.06	19	20	25.24±3.05^*	0.88±0.06^*
NPDR组	58	59.21±9.73	31	27	25.13±2.87^*	0.87±0.05
NDR组	76	58.74±9.37	41	35	24.82±2.95^*	0.87±0.06
正常对照组	40	57.43±8.86	22	18	23.10±2.24	0.84±0.05

组别	糖尿病病程（年）	FPG（mmol/L）	2 hPG（mmol/L）	TC（mmol/L）	TG（mmol/L）
PDR组	11.62（5.31~16.82）^#△	8.17±3.15^*	15.27±5.48	5.31±1.22^*	1.95±1.38^*
NPDR组	8.43（3.84~9.13）^#	8.39±2.92^*	15.13±5.61	4.84±1.19	1.92±1.33^*
NDR组	7.15（2.05~7.59）	8.25±2.86^*	14.79±5.28	4.71±1.14	1.81±1.28^*
正常对照组		4.85±0.71		4.53±1.02	1.19±0.59