2型糖尿病合并糖尿病肾病脂联素水平变化及与血管内皮功能的关系

目的探讨糖尿病肾病患者血清脂联素水平的变化,及与血管内皮功能的关系。方法 50例无明显临床大血管并发症的2型糖尿病患者,按24 h尿白蛋白排出量分为正常白蛋白尿组、微量白蛋白尿组及大量白蛋白尿组。检测血清脂联素、可溶性血管细胞黏附分子1、生物化学指标、肱动脉内皮依赖性舒张功能(FMD)、含服硝酸甘油后肱动脉内皮依赖性舒张功能(NID)、心脏结构参数及颈动脉内膜-中膜厚度。结果大量白蛋白尿组脂联素水平是正常白蛋白尿组的4倍,是微量白蛋白尿组的2倍(P<0.01和P<0.05)。微量白蛋白尿组脂联素水平比正常白蛋白尿组升高(P<0.05)。脂联素/血肌酐在三组中有同样的变化(均P<0.05)。大量白蛋白尿组和微量白蛋白尿组可溶性血管细胞黏附分子1均高于正常白蛋白尿组(P<0.01和P<0.05)。大量白蛋白尿组FMD、NID随脂联素水平的增加而下降(P<0.05)。颈动脉内膜-中膜厚度在三组间无统计学差异。脂联素与可溶性血管细胞黏附分子1、24 h尿白蛋白排出量、血肌酐、左心室后壁厚度、内膜-中膜厚度呈正相关(r值分别为0.338、0.704、0.470、0.331、0.324,P<0.05),与FMD、NID呈显著负相关(r值为-0.397、-0.413,P<0.01)。结论糖尿病肾病伴随高脂联素血症,且与血管内皮功能损害密切相关。脂联素可作为糖尿病肾病患者早期血管内皮功能障碍的预测指标。     

糖尿病肾病患者血清电解质水平变化的研究

目的 探讨糖尿病肾病(DN)患者血清电解质变化,及与尿微量白蛋白的相关性.方法 选取2013年4月至2014年10月在天津中医药大学第二附属医院内科住院的2型糖尿病患者450例,按尿微量白蛋白排泄率(UAER)结果分为3组,＜20 μg/min为无DN组(176例),20～200 μg/min为微量白蛋白尿组(182例),≥200 μg/min为大量白蛋白尿组(92例).同时检测患者血清电解质钾、钠、氯、磷、镁、钙水平,并留取患者一般资料,分析各种电解质变化与DN的关系.结果 3组间的钾、磷、钙、镁水平有差异,大量白蛋白尿组的钾(F=11.139,P＜0.01)、磷(F=3.115,P＜0.05)水平最高,镁(F=7.251,P＜0.05)、钙(F=5.721,P＜0.01)水平最低.微量白蛋白尿组与大量白蛋白尿组患者的钾、磷水平均高于无DN组,镁水平低于无DN组(P＜0.05或P＜0.01).大量白蛋白尿组钙水平低于无DN组(P＜0.01).与微量白蛋白尿组相比,大量白蛋白尿组钾、磷水平升高,而钙、镁水平降低(P＜0.05或P＜0.01).直线相关分析显示,磷、钾水平与24 h尿微量白蛋白呈正相关(r=0.348,0.258,P＜ 0.001).钙、镁水平与24h尿微量白蛋白呈负相关(r=-0.360,-0.374,P＜0.001).结论 DN患者随着尿微量白蛋白的增多,钾、磷水平逐渐升高,镁、钙水平逐渐降低.     

2型糖尿病患者血清脂联素与肾功能相关性分析

59名T2DM患者,分为正常、微量和临床蛋白尿三组,采用酶联免疫法检测血清脂联素水平。结果：临床蛋白尿组脂联素明显高于正常蛋白尿组（P〈0．05）,微量蛋白尿（MAU）组与正常蛋白尿组血清脂联素水平无显著性差异;血清脂联素水平与血尿素氮（BBN）、血肌酐（Cr）、24小时尿白蛋白排泄量（CAE）呈正相关关系（P〈0．05）,与总胆固醇（TC）、甘油三脂（TG）、收缩压（SBP）、舒张压（DBP）无明显相关。结论：随DN病情进展血清脂联素水平升高,脂联素水平与血BON、血Cr、24小时UAE呈正相关。     

糖尿病肾病患者血清脂联素、血管内皮生长因子水平变化及意义

目的观察糖尿病肾病患者血清脂联素、血管内皮生长因子(VEGF)水平的变化,并探讨其临床意义。方法选择受检对象90例,其中单纯糖尿病组30例、早期糖尿病肾病组28例、临床糖尿病肾病组32例,测定3组血清脂联素及VEGF。结果单纯糖尿病组、早期糖尿病肾病组、临床糖尿病肾病组血清脂联素、VEGF水平依次升高(P<0.05),血清脂联素水平与体质量指数、空腹血糖、糖化血红蛋白、尿微量白蛋白、血肌酐、血脂水平有关(P均<0.05),VEGF与空腹血糖、糖化血红蛋白、尿微量白蛋白、血肌酐、CRP有关(P均<0.05)。结论糖尿病肾病患者血清脂联素、VEGF水平升高,并与尿蛋白及血肌酐水平的升高是同步的,检测血清脂联素、VEGF有助于糖尿病肾病的早期诊断。     

老年2型糖尿病患者肌肉量减少与白蛋白尿的相关性研究

目的 探讨老年2型糖尿病(T2DM)患者肌肉量减少与白蛋白尿的相关性。方法 选取2017年5月至10月在山西医科大学第一医院内分泌科住院的96例老年T2DM患者,根据尿微量白蛋白/肌酐比值(ACR)将研究对象分为两组:白蛋白尿组(ACR≥30 μg/mg,41例)与非白蛋白尿组(ACR<30 μg/mg,55例),比较两组四肢骨骼肌质量指数(SMI)、年龄、体重指数、空腹血糖、HbA1c等,以及肌肉量减少的检出率。并按SMI分为4组,比较白蛋白尿检出率,最后分析肌肉量减少与白蛋白尿的相关性。结果 与非白蛋白尿组相比,白蛋白尿组SMI降低(Z=4.700,P<0.05),而肌肉量减少检出率升高(χ2=5.525,P=0.019),随着SMI降低,白蛋白尿检出率升高(χ2=20.230,P<0.05)。SMI下降是白蛋白尿的独立危险因素(OR=0.438,95%CI: 0.292~0.658,P<0.001)。结论 老年T2DM患者出现白蛋白尿时肌肉量减少检出率升高,肌肉量减少是白蛋白尿的独立危险因素。     

eGFR>90ml/(min·1.73m~2)中老年2型糖尿病患者血清鸢尾素水平及其与尿酸、尿微量白蛋白/肌酐的关系

目的探讨eGFR>90 ml/(min·1.73 m~2)的中老年2型糖尿病患者血清鸢尾素水平及其与尿酸、尿微量白蛋白/肌酐(ACR)的关系。方法选取2016年11月至2017年11月于承德医学院附属医院住院的121例肾小球滤过率(eGFR)>90 ml/(min·1.73 m~2)的T2DM患者,按照ACR分为:正常蛋白尿组40例(ACR<30μg/mg,DM组)、微量蛋白尿组44例(ACR 30～299μg/mg,EDN组)、临床蛋白尿组38例(ACR>299μg/mg,CDN组)。同期40名健康体检人群作为对照组(NC组),比较各组体重指数(BMI)、腰围、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、血三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿素氮(BUN)、肌酐(Scr)、尿酸(UA)、糖化血红蛋白(HbA1c)、空腹C肽(F-CP)、HOMA-C肽、ACR、血清鸢尾素(Irisin)、eGFR的差异。采用Spearman相关分析及多重线性回归分析影响血清Irisin的相关因素。结果各组间Irisin水平随ACR升高依次降低(F=50.627,P<0.01);腰围随ACR升高依次升高(F=36.788,P<0.05);UA水平随ACR升高依次升高(F=14.156,P<0.05);HOMA-C肽水平随ACR升高依次升高(F=38.846,P<0.01)。相关性分析显示,eGFR>90 ml/min的2型糖尿病肾病患者Irisin水平与WC、FBG、HbA1c、TG、HOMA-C肽、ACR、UA均呈负相关(r=-0.722、-0.452、-0.265、-0.602、-0.557、-0.698、-0.373,P<0.01或P<0.05);多元线性回归分析显示:UA、ACR为影响Irisin的独立相关因素(β=-0.599,P<0.01;β=-0.379,P<0.05)。结论 eGFR>90 ml/(min·1.73 m~2)的糖尿病肾病患者血清Irisin水平降低,随ACR增加进一步降低,可能与早期糖尿病肾病的发生相关。     

2型糖尿病患者脂联素与尿微量白蛋白的关系

目的 探讨2型糖尿病(T2DM)患者血清脂联素(APN)、尿微量白蛋白(MAU)含量及其之间的关系.方法 118例T2DM患者据MAU分为尿微量白蛋白增高组(50例)和尿微量白蛋白正常组(68例).另选同期健康人群70名为正常对照组.行静脉血APN水平、MAU等临床指标的测定,并进行相关性分析.结果 血清APN、MAU水平3组组间比较差异有统计学意义(P＜0.01).T2DM组血清APN水平与体重指数(BMI)、空腹血糖(FBG)、总胆固醇(TC)、低密度脂蛋白(LDL)、糖化血红蛋白(HbA1c)、MAU、餐后2h血糖(2 hPBG)呈负相关(P＜0.05).MAU水平与血清APN呈负相关(P＜0.05),与BMI、SBP、FBG、TC、TG、HbA1c、2 h PBG呈正相关(P＜0.05).结论 2型糖尿病患者APN与MAU有密切的关系.     

尿白蛋白排泄率与老年糖尿病视网膜病变的关系

目的分析尿白蛋白排泄率与老年糖尿病视网膜病变之间的关系。方法 80例老年糖尿病患者按照尿白蛋白排泄率分为甲组(正常白蛋白尿)、乙组(微量白蛋白尿)、丙组(大量白蛋白尿),观察患者病程、血压、糖化血红蛋白(HbA1c)、血脂等指标。结果甲组、乙组、丙组糖尿病视网膜病变发生率分别为36.84%、81.82%、100.00%,组间比较有统计学意义(P0.05)。三组年龄、体重指数(BMI)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等指标比较无统计学意义(P0.05),病程、HbA1c、三酰甘油(TG)、收缩压(SBP)、舒张压(DBP)比较有统计学意义(P0.05)。危险因素分析结果显示,病程、HbA1c、TG、SBP是尿白蛋白排泄的独立影响因素。结论尿白蛋白排泄率与老年糖尿病视网膜病变发生关系密切,患者尿白蛋白排泄率升高其糖尿病视网膜病变发生的风险也更高。     

尿L-FABP、KIM-1、NGAL和血清cystatin C在糖尿病肾病中的变化及意义

目的 探讨尿液肝型脂肪酸结合蛋白(L-FABP)、肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关载脂蛋白(NGAL)和血清半胱氨酸蛋白酶抑制剂(cystatin)C水平在糖尿病肾病患者中的改变以及临床意义.方法 纳入2011年10月至2012年10月泸州医学院附属医院内分泌科确诊为2型糖尿病(T2DM)的住院患者118例,根据尿微量白蛋白/肌酐比值(UACR)分为正常白蛋白尿组(n=45)、微量白蛋白尿组(n=42)以及大量白蛋白尿组(n=31).同时选择同期健康体检者41名作为正常对照组.采用ELISA法检测尿L-FABP、KIM-1和NGAL,免疫比浊法检测血清cystatin C.所有尿液检测指标经尿肌酐校正,比较各组间各标志物的变化情况及与UACR、估计的肾小球滤过率(eGFR)的相关性.结果 与正常对照组相比,糖尿病各组尿L-FABP和血清cystatin C水平明显升高,(x2=77.959,104.003,P均＜0.05);尿KIM-1水平亦明显升高(x2=29.711,P＜0.05).微量白蛋白尿组与大量白蛋白尿组尿NGAL水平较正常对照组和正常白蛋白尿组明显升高(x2=23.833,P＜0.05),但在正常白蛋白尿组与正常对照组间未见明显变化.尿L-FABP、KIM-1、NGAL及血清cystatin C与UACR呈正相关(r=0.719,0.427,0.327,0.726,P均＜0.01);仅L-FABP、血清cystatin C与eGFR呈负相关(r=-0.301、-0.791,P＜ 0.01).结论 尿L-FABP、KIM-1、NGAL和血清cystatin C在糖尿病肾病早期显著升高,其中尿L-FABP和血清cystatin C可能是反映糖尿病肾损伤较好的生物学指标.     

血清胱抑素C在2型糖尿病早期肾损害中的意义

选择T2DM患者123例,根据尿中微量白蛋白（MA）与尿中肌酐（Cre）比值分为3组：正常白蛋白尿组（MA／Cre〈30μg／mg）40例;微量白蛋白尿组（MA／Cre30～300μg／mg）42例;临床蛋白尿组（MA／Cre〉300μg／mg）41例。健康体检人群40例为对照。测定血清CysC、MA／Cre、空腹血糖（FPG）、糖化血红蛋白（HbA1c）进行比较,并探讨CysC与MA／Cre、FPG、HbA1c的相关性。结果：T2DM各组CysC、MA／Cre、FPG、HbA1c均较正常对照组明显升高,有统计学意义（P〈0．01）。正常白蛋白尿组、微量白蛋白尿组和临床蛋白尿组CysC值、MA／Cre值各组问比较均有显著性差异（P〈0．01）。临床蛋白尿组HbA1c、FPG较微量白蛋白组、正常白蛋白尿组明显升高（P〈0．01）,微量白蛋白尿组HbA-c、FPG较正常白蛋白尿组明显升高（P〈0．05）,且CysC水平与MA／Cre、HbA,C有良好的正相关性。结论：血清胱抑素C随肾脏损害程度的增加而逐渐升高,可作为糖尿病早期肾损害检测指标。     

上海中心城区2型糖尿病患者高敏C反应蛋白与白蛋白尿相关性研究

目的 分析上海中心城区2型糖尿病患者高敏C反应蛋白（hs-CRP）与白蛋白尿的相关性.方法 2004年2月至8月,整群抽样上海市中心城区30岁以上已诊断2型糖尿病患者1039例,其中最后人组的574例患者采用免疫比浊法测定了hs-CRP,排除hs-CRP＞10 mg/L者54例,并根据资料完整性,最终有515例患者进行本次分析.采用单因素相关分析和Logistic回归分析评价hs-CRP与白蛋白尿的相关情况.结果 （1）log hs-CRP与年龄、体重指数、腰围、收缩压、舒张压、胆固醇、甘油三酯、白蛋白尿具有相关性（r值分别为0.142、0.305、0.243、0.225、0.264、0.126、0.105、0.168,均P＜0.05）;（2）随着hs-CRP的升高,正常白蛋白尿的比例下降,微量白蛋白尿和大量白蛋白尿的比例升高（x2=18.31,P＜0.01）;（3）组间比较显示,微量白蛋白尿组及大量白蛋白尿组hs-CRP水平与正常白蛋白尿组比较差异有统计学意义（x2值分别为12.36、9.61,均P＜0.01）,微量白蛋白尿组与大量白蛋白尿组相比较,差异无统计学意义（x2=1.24,P＞0.05）.（4）Logistic回归分析显示,收缩压（β值0.035）、hs-CRP（0.110）、HbA1c（0.246）为微量白蛋白尿的独立危险因素（均P＜0.05）.结论 hs-CRP与微量白蛋白尿独立相关,提示慢性亚临床炎症可能参与了社区糖尿病人群早期肾脏损伤.     

Adiponectin concentrations are influenced by renal function and diabetes duration in Pima Indians with type 2 diabetes

Adiponectin is produced exclusively by adipocytes, and its serum concentration is inversely associated with adiposity. This study examines the relationship among diabetes, renal function, and serum adiponectin in Pima Indians. Serum adiponectin was measured in 1069 people in whom glycemia and renal function had been measured. Serum adiponectin, adjusted for age, sex, and body mass index, was lowest in those with impaired glucose regulation or diabetes of less than 10 yr duration and highest in those with normal glucose tolerance or diabetes of duration of at least 10 yr. Both urinary albumin to creatinine ratio (ACR) and serum creatinine were positively correlated with adiponectin (Spearman's r = 0.43; P < 0.0001, and r = 0.37; P < 0.0001, respectively) in diabetic subjects. After stratification by albuminuria (normoalbuminuria ACR < 30 mg/g, microalbuminuria ACR = 30-299 mg/g, and macroalbuminuria ACR >or= 300 mg/g), the highest adiponectin concentration was in the macroalbuminuria group (geometric mean = 9.6 microg/ml) and the lowest was in the normoalbuminuric group (geometric mean = 5.6 microg/ml). After adjustment for age, sex, body mass index, and diabetes duration, the serum adiponectin concentration in the macroalbuminuria group was significantly higher than in both other groups (P < 0.0001). Serum adiponectin is lowest in the presence of impaired glucose regulation and early diabetes. In the presence of diabetes, serum adiponectin is positively associated with abnormal renal function and diabetes duration.     

糖尿病肾病肾小球滤过膜结构与肾功能及代谢指标的关系

目的:观察2型糖尿病肾病(T2DN)患者肾小球滤过膜超微结构改变与肾功能及代谢指标的关系.方法:将明确诊断的T2DN 75例患者分为:微量白蛋白尿组(尿白蛋白/24h 30～300 mg);蛋白尿组(尿蛋白0.5～2.0g/24h)和大量蛋白尿组(尿蛋白＞3.5g/24h).收集三组患者临床指标,并分别使用Cockcroft-Gault公式、简化的肾脏疾病饮食控制(MDRD)公式等计算患者的肾小球滤过率(eGFR);采用形态学计量分析方法分别测算肾小球体积、肾小球足细胞和内皮细胞的相对密度、绝对数目和足细胞足突宽度及肾小球基膜(GBM)厚度.结果:(1)肾小球滤过膜结构与GFR的关系:微量白蛋白尿组Ccr与肾小球足细胞密度及数日均负相关(分别为r=-0.480,P＜=0.05;r=-0.478,P＜0.05);大量蛋白尿组以SCr估算的eGFR与肾小球足细胞密度正相关(r=0.462,P＜0.05);余均未见明显相关.(2)多元回归分析结果:微量白蛋白尿组中肾小球足细胞密度、糖化血红蛋白、三酰甘油、尿酸与Ccr相关(R~2=0.616,P＜0.01);大量蛋白尿组肾小球足细胞密度、尿酸与以SCr估算的eGFR相关(R~2=0.613,P＜0.01).(3)肾小球滤过膜结构及肾小球体积与糖、脂质代谢指标的关系:①肾小球体积与血糖的关系:微量白蛋白尿组中肾小球体积和糖化血红蛋白正相关(r=0.425,P＜0.05);而在蛋白尿组则为负相关(r=-0.427,P＜0.05).②GBM厚度与血糖、血脂代谢指标的关系:微量白蛋白尿组中,以GBM厚度为因变量,糖及脂质代谢水平为自变量,可见空腹血糖水平和总胆固醇与基膜厚度相关(R~2=0.247,P＜0.05).结论:肾小球滤过膜结构与GFR及糖、脂质代谢水平间存在着密切联系,且与DN发展的不同阶段相关.     

老年2型糖尿病患者尿白蛋白排泄率与胰岛素抵抗的相关性研究

目的探讨老年2型糖尿病患者不同尿白蛋白分期与胰岛素抵抗的关系,为糖尿病肾病的预防与控制提供有益的参考。方法将152例老年2型糖尿病患者根据24小时尿微量白蛋白,分为正常白蛋白尿、微量白蛋白尿和大量白蛋白尿3组,分别测定体质指数、血压、空腹血糖、空腹胰岛素、糖化血红蛋白、血脂、血尿酸、24小时尿白蛋白定量等,并计算胰岛素抵抗指数(HOMA-IR)及估算的肾小球滤过率(eGFR)。结果与正常白蛋白尿组比较,微量白蛋白尿组患者的年龄、高血压合并率、HOMA-IR均明显升高,而eGFR明显下降(P<0.05);大量白蛋白尿组患者的高血压合并率、血压、空腹血糖、空腹胰岛素、总胆固醇、HOMA-IR亦均明显升高,而eGFR明显下降(P<0.05)。与微量白蛋白尿组比较,大量白蛋白尿组患者舒张压、空腹血糖、空腹胰岛素、总胆固醇均明显增高(P<0.05)。多因素逐步回归分析显示HOMA-IR是影响老年2型糖尿病患者尿白蛋白排泄率的独立危险因素。结论老年2型糖尿病患者尿白蛋白增多与胰岛素抵抗有关。     

High Prevalence and Diversity of Kidney Dysfunction in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease: The BARI 2D Baseline Data

BackgroundWe describe baseline renal function and albumin excretion rate in patients enrolled in Bypass Angioplasty Revascularization Investigation 2 Diabetes, a randomized clinical trial comparing the impact of revascularization and medical therapy with medical therapy alone and deferred or no revascularization and the impact of glycemic control with either insulin-providing or insulin-sensitizing drugs, on 5-year mortality.MethodsStudy participants had type 2 diabetes mellitus, documented coronary artery disease, and creatinine <2 mg/dL. Albuminuria status (albumin/creatinine ratio [ACR]) and estimated glomerular filtration rate (eGFR), using the abbreviated Modified Diet in Renal Disease equation, were determined at baseline. Univariate and multivariate relationships between baseline clinical characteristics and the presence of albuminuria and reduced eGFR rate were estimated.ResultsTwo thousand one hundred forty-six subjects were included in the analysis. Forty-three percent of the cohort had evidence of kidney dysfunction at baseline: 23% had an eGFR ≥60 mL/min/1.73 m² with either microalbuminuria (>30 ACR; 17%) or macroalbuminuria (>300 ACR; 6%). Twenty-one percent had a reduced eGFR <60 mL/min/1.73 m²; 52% with reduced eGFR had no albuminuria; 28% had microalbuminuria, and 20% had macroalbuminuria. Race, smoking status, duration of diabetes, hypertension, hemoglobin A1c, triglycerides, vascular disease, abnormal ejection fraction, and reduced eGFR were associated with greater albuminuria. Age, sex, duration of diabetes, ACR, hemoglobin A1c, high density lipoprotein, and number of hypertensive medications were associated with reduced eGFR.ConclusionKidney dysfunction is common in older patients with type 2 diabetes mellitus and coronary artery disease; Albuminuria was present in 33%. Reduced eGFR was present in 21%, and half the patients with reduced eGFR had no evidence of albuminuria.     

平均动脉压水平与血清脂联素浓度相关性研究

目的探讨不同平均动脉压水平与血清脂联素浓度的相关性。方法入选187例受试者,按不同血压水平以及治疗情况分为正常血压组、正常高值血压组、高血压未治疗组以及高血压正规药物治疗组。用放射免疫法检测血清脂联素浓度与尿微量白蛋白含量;计算胰岛素抵抗指数HOMA—IR和尿微量白蛋白与肌酐比（ACR）。结果（1）比较正常血压组和正常高值血压组发现,两组间平均动脉血压水平[（89±6）mmHg比（102±7）mmHg,1mmHg=0.133kPa]和脂联素浓度（中位数值：15．58μg／ml比9．06μg/ml）均有统计学意义（P〈0．01）;高血压治疗组的脂联素浓度明显高于未治疗组（11．89μg/ml比5．37μg/ml,P〈0．01）。（2）Pearson相关分析也发现脂联素浓度与平均动脉血压呈负相关（r=-0.479,P〈0．001）;按性别分层分析也得到类似的结果（r=-0．441,P〈0．001）。（3）多元线性逐步回归分析发现平均动脉血压和胰岛素抵抗指数是血清脂联素的独立影响因素,两者解释了57％的血清脂联素浓度的变异。结论平均动脉血压对脂联素浓度的影响独立于胰岛素抵抗状态和肾脏排泄功能;平均动脉血压水平高的患者,其血清脂联素浓度相对偏低。     

High prevalence of albuminuria in population-based patients diagnosed with type 2 diabetes in the Shanghai downtown

OBJECTIVE: The prevalence of albuminuria and the risk factors associated with albuminuria were evaluated among the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown. We also evaluated the variability of urinary albumin-to-creatinine ratio (ACR) among the three measurements and the relationship between diabetic retinopathy (DR) and albuminuria. METHODS: The 1039 Chinese patients diagnosed with type 2 diabetes aged over 30 were investigated by randomized cluster sampling in the Shanghai downtown and 1018 patients were analyzed in this study. Body mass measurements including height, weight, waist circumference and hip circumference, resting blood pressure, fasting blood measures, urinary ACR and the digitally stored fundus images were investigated. The prevalence of albuminuria was calculated and the risk factors associated with albuminuria were evaluated by stepwise logistic regression. The concordance of urinary ACR was evaluated by observed agreement. The relationship between albuminuria and DR was also evaluated. RESULTS: (1) The mean age of all patients was 66.10+/-11.54 years and the duration of diabetes was 7.89+/-7.16 years. (2) The prevalence of albuminuria was 49.6% among the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown, 41.4% with microalbuminuria and 8.2% with macroalbuminuria. (3) Microalbuminuria was significantly associated with systolic blood pressure, gender and waist circumference. Macroalbuminuria was significantly associated with systolic blood pressure and duration of diabetes. (4) Observed agreement among the three urinary ACR measurement for albuminuria staging was 73.3% (first versus second), 64.5% (first versus third) and 77.5% (second versus third). Observed agreement in the albuminuria staging between the single urinary ACR measurement and all three urinary ACR measurements was 85.8% (first versus all three), 87.6% (second versus all three) and 81.9% (third versus all three). (5) The percentage of DR in the macroalbuminuric group (59.2%) was significantly higher than that in the normalbuminuria group (16.1%) and microalbuminuria group (24.6%). (6) The macroalbuminuric patients with DR had significantly increased fasting blood glucose and HbA1c compared with the macroalbuminuric patients without DR. CONCLUSION: The prevalence of microalbuminuria observed in the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown reached up to 41.4% though the observations in our study might be representative of the diabetic patients of the Shanghai downtown. We agreed that at least two of the three urinary collections were done in a 3- to 6-month period because of the day-to-day variability in albumin excretion. The percentage of DR among the patients with macroalbuminuria was 59.2%, and the macroalbuminuric patients with the significantly high plasma glucose and DR were prone to diagnose DN.     

Relation of microalbuminuria to adiponectin and augmented C-reactive protein levels in men with essential hypertension

Microalbuminuria, and recently, hypoadiponectinemia, have been associated with progression of atherosclerotic disease and increased cardiovascular risk. We examined the possible associations of urinary albumin excretion, expressed as the ratio of albumin to creatinine (ACR), with plasma adiponectin and high-sensitivity C-reactive protein (hs-CRP) levels in men who had essential hypertension. The study population consisted of 108 men who did not have diabetes and were newly diagnosed with stage I to II essential hypertension (age 44.6 years, office blood pressure 148/95 mm Hg) and 110 men matched according to age and body mass index as controls. According to ACR values, which were determined as the average of 2 nonconsecutive overnight spot urine samples, subjects who had hypertension were categorized into 2 groups: those who had microalbuminuria (n = 28; mean ACR 30 to 300 mg/g) and those who had normal albuminuria (n = 80; mean ACR <30 mg/g). Subjects who had hypertension compared with controls exhibited higher ACR and log hs-CRP levels and a trend toward lower log adiponectin values (p = 0.062), whereas those who had normal albuminuria compared with controls had similar log adiponectin levels but significantly higher levels of ACR and log hs-CRP. Moreover, subjects who had hypertension and microalbuminuria compared with those who had hypertension and normal albuminuria had higher log hs-CRP and lower log adiponectin concentrations independently of confounding factors. Among those who had hypertension, ACR exhibited an independent positive correlation with log hs-CRP and a negative correlation with log adiponectin. Multiple linear regression analysis showed that age, body mass index, systolic blood pressure, log hs-CRP, and log adiponectin were significant independent predictors of the ACR. In conclusion, microalbuminuria is accompanied by decreased adiponectin and increased hs-CRP levels in the setting of essential hypertension, reflecting a rather diffuse atherosclerotic process.