2型糖尿病患者尿白蛋白与葡萄糖负荷后2小时血糖增值的关系

doi:10.3969/j.issn.1004-583X.2021.01.010

摘要/Abstract

摘要：

目的探讨2型糖尿病患者尿白蛋白与口服75 g葡萄糖耐量试验(OGTT)葡萄糖负荷后2小时血糖增值(2 hPG-FBG)关系。方法利用电子病历系统,回顾性收集我院内分泌科住院的2型糖尿病患者120例。依据尿白蛋白/肌酐比值(UACR)分为尿白蛋白正常组(N组:UACR<30 mg/g)、微量白蛋白尿组(A组:30 mg/g≤ UACR<300 mg/g)和大量白蛋白尿组(B组:UACR≥300 mg/g), 比较三组间各指标是否存在差异。结果 2 hPG-FBG中位数在微量白蛋白尿组高于尿白蛋白正常组,大量白蛋白尿组高于微量白蛋白尿组(P<0.05),HbA₁c均值在微量白蛋白尿组和大量白蛋白尿组均高于尿白蛋白正常组(P<0.05)。Spearman相关分析显示,UACR与HbA₁c(r=0.294)和2 hPG-FBG(r=0.516)呈正相关关系(均P<0.05),多元线性逐步回归分析显示2 hPG-FBG是UACR独立危险因素(β=0.211)。结论以葡萄糖负荷后2 h血糖增值为代表的餐后血糖波动是造成2型糖尿病患者尿白蛋白增加的重要因素,其作用较持续血糖水平更为明显。

关键词: 糖尿病,2型, 尿白蛋白/肌酐比值,血糖, 糖尿病肾病

Abstract:

Objective To explore the relationship between urinary albumin in patients with type 2 diabetes and the increase in blood glucose (2hPG-FBG) 2 hours after oral 75 g glucose tolerance test (OGTT) glucose load. Methods The electronic medical record system, 120 patients with type 2 diabetes who were hospitalized in the Endocrinology Department of the Second Hospital of Hebei Medical University were retrospectively collected. According to the urine albumin/creatinine ratio (UACR), the patients were divided into normal urine albumin group (group N: UACR<30 mg/g), microalbuminuria group (group A: 30 mg/g≤UACR<300 mg/g) and massive albuminuria group (group B: UACR≥300 mg/g). The differences in the indicators among three groups were compared. Results 2 hPG-FBG in microalbuminuria group was higher than that of normal urine albumin group, and massive albuminuria group was higher than that of the microalbuminuria group (P<0.05). The HbA₁c in microalbuminuria group and massive albuminuria group were higher than that of normal urine albumin group (P<0.05). Spearman correlation analysis showed that UACR was positively correlated with HbA₁c (r=0.294) and 2 hPG-FBG (r=0.516) (all P<0.05). Multiple linear stepwise regression analysis showed that 2 hPG-FBG was an independent risk factor for UACR (β=3.239). Conclusion Postprandial blood glucose fluctuation, represented by 2 h blood glucose increase after glucose loading, is an important factor causing the increase of urinary albumin in patients with type 2 diabetes, and its effect is more obvious than that of sustained blood glucose level.

Key words: type 2 diabets mellitus, urine albumin/creatinine ratio,blood glucose, diabetic nephropathies

中图分类号:

R587.1

王亚丽, 王瑞英, 崔月. 2型糖尿病患者尿白蛋白与葡萄糖负荷后2小时血糖增值的关系[J]. 临床荟萃, 2021, 36(1): 49-53.

Wang Yali, Wang Ruiying, Cui Yue. Relationship between urinary albumin and glucose increase 2 hours after glucose load in patients with type 2 diabetes[J]. Clinical Focus, 2021, 36(1): 49-53.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.01.010

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I1/49

图/表 7

参考文献 26

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指标	N组	A组	B组	χ²值	P值
性别[例(%)]
男	23(57.5)	37(75.5)	18(58.1)	3.125	0.073
女	17(42.5)	12(24.5)	13(41.9)
年龄(岁)	46(37.5, 60.5)	36(31, 48.5)^*	53(48, 60)^#	14.817	0.010
BMI(kg/m²)	26.4(24.5, 29.0)	26.3(23.9, 28.7)	24.0(22.4, 25.6)^*#	11.786	0.030
SBP(mmol/L)	129.5(118.3, 142.5)	128(120.5, 141)	128(120.5, 141)	0.770	0.680
DBP(mmol/L)	83(75.3, 85)	84(78.5, 90.5)	83(77, 91)	2.033	0.362
病程(月)	36(6.5, 93)	6(1, 42)	60(6, 120)^*	9.379	0.009

指标	N组	A组	B组	χ²值	P值
性别[例(%)]
男	23(57.5)	37(75.5)	18(58.1)	3.125	0.073
女	17(42.5)	12(24.5)	13(41.9)
年龄(岁)	46(37.5, 60.5)	36(31, 48.5)^*	53(48, 60)^#	14.817	0.010
BMI(kg/m²)	26.4(24.5, 29.0)	26.3(23.9, 28.7)	24.0(22.4, 25.6)^*#	11.786	0.030
SBP(mmol/L)	129.5(118.3, 142.5)	128(120.5, 141)	128(120.5, 141)	0.770	0.680
DBP(mmol/L)	83(75.3, 85)	84(78.5, 90.5)	83(77, 91)	2.033	0.362
病程(月)	36(6.5, 93)	6(1, 42)	60(6, 120)^*	9.379	0.009

指标	N组	A组	B组	χ²/F值	P值
HbA₁c(%)	8.63±1.65	10.64±1.96^*	10.25±2.26^*	22.148		<0.001
FBG(mmol/L)	5.91±1.27	5.65±1.57	5.46±1.35	3.305		0.219
2 hPG(mmol/L)	14.25±3.33	16.09±4.16^*	18.94±3.86^*#	24.606		<0.001
2 hPG-FBG(mmol/L)	7.99(6.08, 10.34)	10.97(9.10, 12.54)^*	14.45(11.80, 15.91)^*#	31.880	<0.001
GFR ml/(min·1.73m²)	118.2(92.2, 138.6)	120.4(92.2, 153.4)	103.1(93.1, 128.4)	4.339	0.114

指标	N组	A组	B组	χ²/F值	P值
HbA₁c(%)	8.63±1.65	10.64±1.96^*	10.25±2.26^*	22.148		<0.001
FBG(mmol/L)	5.91±1.27	5.65±1.57	5.46±1.35	3.305		0.219
2 hPG(mmol/L)	14.25±3.33	16.09±4.16^*	18.94±3.86^*#	24.606		<0.001
2 hPG-FBG(mmol/L)	7.99(6.08, 10.34)	10.97(9.10, 12.54)^*	14.45(11.80, 15.91)^*#	31.880	<0.001
GFR ml/(min·1.73m²)	118.2(92.2, 138.6)	120.4(92.2, 153.4)	103.1(93.1, 128.4)	4.339	0.114

指标	r值	P值
年龄	0.042	0.646
BMI	-0.290	0.001
病程	0.003	0.973
HbA₁c	0.294	0.001
2 hPG-FBG	0.516	<0.001
空腹C肽	-0.246	0.007