2型糖尿病患者扫描式葡萄糖监测系统指标与尿白蛋白/肌酐比值的相关性研究

背景 随着血糖监测技术的发展，近些年来人们开始使用扫描式葡萄糖监测系统（FGMS）"全景式"地观察2型糖尿病（T2DM）患者的血糖水平，明确FGMS指标与T2DM并发症之间的关系有助于提高其临床应用价值，但目前相关研究较少。 目的 探究佩戴FGMS的T2DM患者葡萄糖在目标范围内时间（TIR）等指标与尿白蛋白/肌酐比值（UACR）的相关性。 方法 选取2019年1月至2021年10月于北京大学人民医院老年科就诊并佩戴FGMS的T2DM患者79例，以尿液检查中UACR是否<30 mg/g将患者分为无白蛋白尿组（n=50）和白蛋白尿组（n=29）。比较两组患者的临床特征、实验室检查指标及FGMS指标等。采用Pearson相关、Spearman秩相关分析探讨TIR、高血糖时间（TAR）与糖化血红蛋白（HbA1c）的相关性。分别采用Pearson相关、Spearman秩相关、偏相关分析探讨FGMS指标与lnUACR的相关性。使用多因素Logistic回归分析探究T2DM患者发生白蛋白尿的影响因素，采用受试者工作特征（ROC）曲线评估TIR对白蛋白尿的预测价值。 结果 白蛋白尿组T2DM病程长于无白蛋白尿组，三酰甘油（TG）、HbA1c、平均血糖（MBG）、TAR、平均血糖标准差（SDBG）、最大葡萄糖波动幅度（LAGE）、平均葡萄糖波动幅度（MAGE）、连续每隔2 h血糖净作用（CONGA2）高于无白蛋白尿组，TIR低于无白蛋白尿组（P<0.05）。Pearson相关、Spearman秩相关分析结果显示，TIR与HbA1c呈负相关（P<0.001），TAR与HbA1c呈正相关（P<0.001）。Pearson相关、Spearman秩相关、偏相关分析结果均表明，TIR与lnUACR呈负相关（P<0.001），MBG、TAR、SDBG、LAGE、MAGE、CONGA2与lnUACR呈正相关（P<0.001）。多因素Logistic回归分析结果显示，TIR>70%〔OR=0.038，95%CI（0.003，0.467）〕是T2DM患者出现白蛋白尿的保护因素（P<0.05），TAR升高〔OR=1.046，95%CI（1.000，1.094）〕是T2DM患者出现白蛋白尿的危险因素（P<0.05）。TIR预测T2DM患者出现白蛋白尿的ROC曲线下面积（AUC）为0.784〔95%CI（0.674，0.894）〕（P=0.003），灵敏度为78%，特异度为83%，最佳切点为69.71%。 结论 在FGMS指标中，TIR>70%是T2DM患者出现白蛋白尿的保护因素，TAR升高是T2DM患者出现白蛋白尿的危险因素。同时，SDBG、LAGE、MAGE、CONGA2等多种反映血糖波动的指标也与UACR密切相关。对TIR水平较低及TAR、SDBG、LAGE、MAGE、CONGA2水平较高的T2DM患者进行FGMS筛查有助于早期识别及预防白蛋白尿的发生、发展。     

Importance of serum phosphate in elderly patients with diabetes mellitus

BACKGROUND Metabolic disturbances including changes in serum calcium,magnesium or phosphate(P) influence the prevalence of type 2 diabetes mellitus(DM).We assessed the importance of serum P in elderly patients with type 2 DM vs nondiabetes mellitus(non-DM) in relation to renal function.AIM To determine the association between serum P and serum glucose or insulin resistance in diabetic and non-diabetic patients.METHODS One hundred-ten subjects with a mean age of 69.02±14.3 years were enrolled.Twenty-nine of the participants had type 2 DM(26.4%).The incidence of hypertension,smoking and receiving vitamin D(vitD) derivates were recorded.The participants were classified by both estimated glomerular filtration rate(eGFR) and albuminuria categories according to the Kidney Disease Improving Global Outcomes 2012 criteria.RESULTS We divided the patients in two groups according to the P cut-off point related to DM value.A comparison between high and low P showed that body mass index30.2±6.3 vs 28.1±4.6(P=0.04),mean glucose 63.6 vs 50.2(P=0.03),uric acid 6.7±1.6 vs 6.09±1.7(P=0.05),mean intact-parathyroid hormone 68.06 vs 47.4(P=0.001),systolic blood pressure 147.4±16.7 vs 140..2±16.1(P=0.02),mean albuminuria 63.2 vs 50.6(P=0.04) and eGFR 45.6±22.1 vs 55.4±21.5(P=0.02)were significantly different.χ~2 tests showed a significant association between high P and DM,hypertension,receiving vitD,smoking and eGFR stage(χ~2=6.3,P=0.01,χ~2=3.9,P=0.03,χ~2=6.9,P=0.009,χ~2=7.04,P=0.01 and χ~2=7.36,P=0.04,respectively).The adjusted model showed that older age,female gender and increased body mass index were significant predictors of type 2 DM when entering the covariates.CONCLUSION High serum P contributes to vascular and metabolic disturbances in elderly patients with type 2 DM and renal impairment.     

阿托伐他汀联合丹参酮对慢性肾病患者白蛋白尿和血脂异常的影响

目的 评价阿托伐他汀和丹参酮联用对慢性肾病（CKD）患者肾功能和糖脂代谢参数的影响。方法 前瞻性纳入伴有白蛋白尿和血脂异常非透析性CKD患者90例,随机分为观察组（n=45）和对照组（n=45）。在CKD标准化治疗的基础上,对照组给予丹参酮ⅡA磺酸钠注射液;观察组加用阿托伐他汀钙片10 mg/d。两组疗程均为6个月。比较两组患者治疗前后的糖脂代谢功能及肝肾功能。结果 治疗半年后,两组患者的总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）均下降,高密度脂蛋白胆固醇（HDL-C）增加,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组患者的TC、TG、LDL-C显著低于对照组,HDL-C显著高于对照组,组间差异有统计学意义（P<0.05）。所有患者对阿托伐他汀均耐受,两组患者的天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）及肌酸激酶（CK）均无显著性差异。观察组和对照组患者的肾小球滤过率（eGFR）和高尿白蛋白肌酐比（UACR）无统计学差异。结论 他汀类药物联合丹参酮改善了CKD患者的血脂异常状态,表现出一定的肾脏保护作用。     

Ambulatory Blood Pressure and Endothelial Dysfunction in Hematopoietic Cell Transplantation Recipients

Hematopoietic cell transplantation (HCT) is a common treatment for many disorders. Albuminuria post-HCT, which may represent endothelial injury or inflammation from graft- versus-host disease, increases the risk of chronic kidney disease and nonrelapse mortality at 1 year. HCT recipients also have abnormal blood pressure (BP) and increased rates of cardiovascular complications. We sought to determine the relationships among albuminuria, endothelial dysfunction, and BP in HCT recipients. Patients age ?≥12 years who underwent their first allogeneic HCT between 2012 and 2015 and survived through day 80 post-HCT were eligible. Peripheral endothelial function was assessed using the EndoPAT2000 device at day 80 along with 24-hour ambulatory BP monitoring (ABPM). Clinical and laboratory data were collected along with a urine sample for calculation of the albumin-to-creatinine ratio. Both logistic and linear regression analyses were used to identify associations between EndoPAT score and clinical variables. Sixty patients (median age, 48 years; range, 14 to 69 years) completed the study. The median EndoPAT score was 2.05 (range, 1.02 to 4.45), and 17 patients (28%) had abnormal endothelial function. Forty-two patients (72%) had ambulatory hypertension (HTN), and 38 (63%) had blunted nocturnal dipping. HTN on ABPM (P?=?.045) and blunted nocturnal dipping (P?=?.04) were associated with a lower EndoPAT score. Albuminuria was not associated with EndoPAT score. There was a lack of agreement between our clinical definition of HTN (office BP and/or use of medications) and ABPM results (P?=?.04). We did not find an association between lower EndoPAT scores and albuminuria, but did find an association between an abnormal nocturnal dip and HTN diagnosed by ABPM. This suggests that albuminuria may reflect local endothelial injury and inflammation rather than a systemic process. Office BP readings do not accurately reflect true BP, suggesting that 24-hour ABPM studies are needed to diagnose and treat HTN appropriately.     

氯沙坦对老年高血压患者微量蛋白尿的影响

目的观察氯沙坦对老年高血压患者微量蛋白尿(MCA)的改善作用。方法采用连续样本,自身前后及分组对照方法,对32例高血压伴MCA者(EH组),观察在治疗前和每天服用氯沙坦50 mg 12周后的血压、血尿素氮(BUN)、血肌酐(Cr)2、4 h内生肌酐清除率(Ccr)、尿蛋白/肌酐(Alb/Cr)的变化,同时设12例健康老人作对照(对照组)。结果用氯沙坦治疗后,除血压有明显下降外,尿Alb/Cr亦显著性降低(P<0.01),Ccr明显升高(P<0.05)。结论氯沙坦对老年高血压患者在降压治疗的同时可降低尿蛋白的排泄,改善肾功能。     

血清胱抑素C联合尿白蛋白与肌酐比值对老年2型糖尿病肾损害的早期诊断

目的探讨血清胱抑素C(Cys C)和尿中白蛋白(Alb)与肌酐(Cr)比值(UACR)对诊断老年2型糖尿病患者早期肾脏损害的临床价值。方法选择60岁以上尿蛋白阴性的2型糖尿病患者60例,其中血肌酐水平正常的30例(A组),血肌酐明显升高的30例(B组);同时纳入30例同期于我院门诊体检的60岁以上的健康人群作为对照组。采用免疫透射比浊法测定血清Cys C含量,免疫浊度法测定尿Alb含量,全自动生化分析仪同时测定血清Cr和尿Cr。结果老年糖尿病患者的血清Cys C和UACR均明显高于健康对照组,差异有统计学意义(P0.05);且联合检测的敏感性和特异性更高(相比较于单项检测,P0.05)。结论血清Cys C和UACR可以作为诊断老年2型糖尿病患者早期肾损害的敏感和特异性指标,两者联合检测对老年糖尿病患者早期肾损害的诊断有重要价值。     

培哚普利对伴微量白蛋白尿老年高血压者的肾脏作用

对１４例伴微量白蛋白尿老年高血压患者应用血管紧张素转换酶抑制剂（ＡＣＥＩ）—培哚普利，短期观察２个月，结果显示：２个月后，２４小时尿白蛋白排泄显著降低（Ｐ＜０．０５），平均动脉压亦显著降低（Ｐ＜０．０５），但两者的下降无显著相关；研究期间，血肌酐、尿素氮及血钾无明显变化。资料提示：培哚普利可降低老年高血压患者尿白蛋白排泄，可能对防治高血压肾脏病变有一定作用，该作用不完全依赖于血压的降低。     

Association between microalbuminuria and cardiovascular risk factors in general population

Objective To investigate the association between microalbuminuria and cardiovascular risk factors in a general Chinese population. Methods A multi-stage cluster randomized sampling method was used to select 2400 residents (18-69 years old) in four counties in Shandong and Jiangsu provinces in October 2013 to March 2014. 24-hour MAU were measured for each subject. The prevalence of MAU in different groups was analyzed. The relationship between the aggregation of risk factors and MAU was analyzed. Logistic regression analysis was used to evaluate the association between MAU and cardiovascular risk factors. Results A total of 2265 subjects were included in the analysis. The prevalence of MAU was 8.96%(203/2265, 95%CI: 7.82-10.21). The prevalence of MAU in obesity, hypertension, diabetes, hypertriglyceridemia, and low HDL-C group were 14.65%(63/430), 12.53%(104/830), 20.22%(36/178), 15.57%(64/411), 11.99%(53/442) respectively, which were significantly higher than the corresponding healthy population (all P＜0.01). Multivariate logistic regression analysis showed that obesity, hypertension, diabetes, and hypertriglyceridemia were risk factors for MAU. The OR(95%CI) values were 1.491(1.016-2.265), 1.660(1.190-2.314), 2.291(1.494-3.515) and 1.734(1.205-2.495) respectively. With the increase in the number of influencing factors, urinary albumin levels and the prevalence of MAU all showed an upward trend. Conclusion MAU was associated with cardiovascular risk factors such as obesity, hypertension, diabetes, and hypertriglyceridemia.