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目的探讨尿微量清蛋白/尿肌酐(UACR)与糖尿病前期患者冠状动脉病变之间的关系。方法选取2011年7月—2012年12月因胸闷、胸痛入住我院的128例糖尿病前期患者,根据冠状动脉造影或冠状动脉CT血管造影(CTA)结果分为至少单支冠状动脉主干或其主要分支内径狭窄≥50%(冠心病组,68例)和冠状动脉管腔狭窄≤20%(对照组,60例)。采用速率散射比浊法测定两组患者的晨尿UACR;根据冠状动脉病变支数分为单支病变、双支病变和三支病变;采用Gensini积分评价冠状动脉病变程度;采用受试者工作特征(ROC)曲线分析UACR预测冠心病的最佳切点。结果 (1)冠心病组的收缩压(SBP)、低密度脂蛋白胆固醇(LDL-C)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)及UACR水平均高于对照组,差异有统计学意义(P<0.05)。(2)冠心病组单支(n=18)、双支(n=36)、三支(n=14)血管病变患者的UACR分别为(3.19±1.78)、(4.32±1.97)、(6.39±3.33)mg/mmol(F=7.961,P=0.001);多元线性回归分析显示,UACR与冠状动脉病变支数存在回归关系(t=3.283,P=0.002)。(3)UACR与Gensini积分亦存在相关性(rs=0.393,P<0.001)。UACR的ROC曲线下面积为0.825〔95%CI(0.754,0.896),P<0.001〕,UACR预测冠状动脉病变的最佳切点对应于2.75 mg/mmol(敏感度76.5%,特异度75.0%)。结论升高的UACR与糖尿病前期冠状动脉病变的发生、发展和严重程度相关。
Objective To investigate the relationship between urinary albumin / creatinine (UACR) and coronary artery disease in pre-diabetic patients. Methods A total of 128 pre-diabetic patients admitted to our hospital from July 2011 to December 2012 were divided into at least one coronary artery trunk Branch diameter narrow ≥ 50% (coronary heart disease group, 68 cases) and coronary artery stenosis ≤ 20% (control group, 60 cases). The morning urine UACR of two groups of patients was determined by rate nephelometry. According to the number of coronary lesions, the single-vessel lesion, double-vessel lesion and three-vessel lesion were divided. The degree of coronary artery lesion was evaluated by Gensini score. (ROC) curve analysis UACR prediction of coronary heart disease the best cut point. Results (1) SBP, LDL-C, 2 hPG, HbA1c and UACR in CHD patients were significantly higher than those in control group There was statistical significance (P <0.05). (2) The UACR in patients with coronary artery disease of coronary heart disease group were (3.19 ± 1.78), (4.32 ± 1.97), (6.39 ± 3.33) mg / mmol (F = 7.961, P = 0.001). Multivariate linear regression analysis showed that UACR was positively correlated with the number of coronary lesions (t = 3.283, P = 0.002). (3) There was also a correlation between UACR and Gensini scores (rs = 0.393, P <0.001). The area under the ROC curve of UACR was 0.825 [95% CI (0.754, 0.896), P <0.001). The optimal cutoff point for UACR predicting coronary artery disease was 2.75 mg / mmol (sensitivity 76.5% and specificity 75.0% . Conclusions The elevated UACR is associated with the occurrence, development and severity of pre-diabetic coronary artery disease.