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目的探讨老年2型糖尿病(T2DM)患者尿微量白蛋白与尿肌酐比值(UACR)和肱动脉内皮功能、颈动脉内膜中层厚度(IMT)的关系,分析UACR与动脉粥样硬化程度的相关性,为临床防治糖尿病心脑血管并发症提供依据。方法选择2012年2月至2015年10月在徐州医学院附属医院老年科住院新诊断为T2DM的145例患者为研究对象,根据UACR将患者分为UACR正常组(54例)、微量蛋白尿组(48例)和临床蛋白尿组(43例),检测3组患者的身高、体重、血压、空腹血糖(FPG)、空腹胰岛素(FINS)、餐后2 h血糖(2 h PG)、餐后2 h胰岛素(2 h INS)、糖化血红蛋白(HbA1C)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血肌酐(SCr)、超敏C反应蛋白(hs-CRP)、肱动脉内皮依赖性舒张功能(EDD)和颈动脉IMT。用SPSS 19.0软件进行方差分析和多元逐步回归分析,分析UACR与肱动脉EDD和颈动脉IMT关系。结果与UACR正常组比较,微量蛋白尿组和临床蛋白尿组患者的EDD减低(分别为5.78%±0.76%、5.02%±0.83%和4.37%±0.92%),IMT升高[分别为(0.87±0.08)、(1.01±0.11)和(1.13±0.13)mm],差异有统计学意义(P<0.05,P<0.01);与微量蛋白尿组比较,临床蛋白尿组患者的EDD减低,IMT升高,差异有统计学意义(P<0.05)。多元线性逐步回归分析结果显示,EDD与FPG、2 h PG、2 h INS、HbA1C和UACR呈明显负相关(r值分别为-0.612、-0.665、-0.548、-0.622和-0.586);IMT与TC、TG、LDL-C、hs-CRP和UACR呈明显正相关(r值分别为0.646、0.569、0.710、0.665和0.604),差异均有统计学意义(P<0.05)。结论 UACR与糖尿病患者的动脉粥样硬化程度有相关性,应常规检测UACR,对及早评估动脉粥样硬化与筛查糖尿病心脑血管并发症有着重要意义。
Objective To investigate the relationship between urinary albumin and urinary creatinine (UACR), endothelial function of brachial artery and carotid intima-media thickness (IMT) in elderly patients with type 2 diabetes mellitus (T2DM) and to analyze the correlation between UACR and the degree of atherosclerosis , Provide the basis for clinical prevention and treatment of diabetic cardiovascular and cerebrovascular complications. Methods From February 2012 to October 2015, 145 patients newly diagnosed as T2DM in the Department of Geriatrics, Affiliated Hospital of Xuzhou Medical College were enrolled. According to UACR, the patients were divided into normal UACR group (n = 54), microalbuminuria group (48 cases) and clinical proteinuria group (43 cases). The body weight, blood pressure, fasting blood glucose (FPG), fasting insulin (FINS), 2 h postprandial blood glucose (2 h PG) 2 h INS, HbA1C, TC, TG, LDL-C, HDL-C, Serum creatinine (SCr), high-sensitivity C-reactive protein (hs-CRP), brachial artery endothelium-dependent vasodilation (EDD) and carotid IMT. ANOVA and multivariate stepwise regression analysis using SPSS 19.0 software were used to analyze the relationship between UACR and brachial artery EDD and carotid artery IMT. Results Compared with the normal UACR group, EDD decreased (5.78% ± 0.76%, 5.02% ± 0.83% and 4.37% ± 0.92%, respectively) and IMT increased in patients with microalbuminuria and clinical proteinuria [(0.87 (1.01 ± 0.11) and (1.13 ± 0.13) mm, respectively) (P <0.05, P <0.01). Compared with the microalbuminuria group, the EDD in patients with clinical albuminuria was decreased, while the IMT Increased, the difference was statistically significant (P <0.05). Multiple linear stepwise regression analysis showed that there was a significant negative correlation between EDD and FPG, 2 h PG, 2 h INS, HbA1C and UACR (r values were -0.612, -0.665, -0.548, -0.622 and -0.586, respectively); IMT and TC, TG, LDL-C, hs-CRP and UACR were positively correlated (r = 0.646,0.569,0.710,0.665 and 0.604 respectively), the difference was statistically significant (P <0.05). Conclusions UACR is associated with the degree of atherosclerosis in diabetic patients. UACR should be routinely measured. It is of great significance for the early assessment of atherosclerosis and screening for cardiovascular and cerebrovascular complications of diabetes mellitus.