初诊2型糖尿病患者微量白蛋白尿的影响因素分析

目的分析初诊2型糖尿病（T2DM）住院患者微量白蛋白尿的发生率及危险因素，为糖尿病及慢性微血管并发症的早期干预提供理论依据。方法2006年3月至2009年9月在我院内分泌代谢科住院且资料完整的286例初诊T2DM患者，测定其血脂、24h尿白蛋白、空腹及餐后胰岛素和血糖、糖化血红蛋白（HbA1c）以及C肽等。两次24h尿白蛋白定量为30—300mg被定义为微量白蛋白尿。计算胰岛素抵抗指数（HOMA-IR）。所有患者均由眼科医师进行扩瞳后眼底检查明确有无眼底病变。结果（1）本研究人群中，微量白蛋白尿的发生率为19．58％（56／286）。（2）正常蛋白尿组与微量白蛋白尿组合并糖尿病视网膜病变者分别占19．57％（45／230）与33．93％（19／56），差异有统计学意义（x2=5．349，P=0．021）；微量白蛋白尿组的空腹血糖、HbA1c、HOMA-IR均显著高于正常蛋白尿组空腹血糖：（11．08±1．76）、（9．24±1．65）mmol／L，HbA1c：（11．54±1．59）％、（9．39±1．64）％，HOMA—IR：（3．73±0．42）、（3．50±0．30），t值分别为-6．148、-7．533、-3．774，P均〈0．001]。（3）Pearson相关分析显示，微量白蛋白尿与空腹血糖（r=0．460）、HbA1c（r=0．499）、HOMA—IR（r=0．308）、合并糖尿病视网膜病变（r=0．405）呈正相关（P均〈0．01）。（4）逐步回归分析显示，空腹血糖（β=-0．804，P〈0．01）、HbAle（β=-0．455，P〈0．01）、合并糖尿病视网膜病变（β=1．527，P〈0．05）是影响糖尿病微量白蛋白尿的独立危险因素。结论初诊住院T2DM患者微量白蛋白尿的发生与空腹血糖、HbA1c、HOMA—IR相关，同时更容易合并糖尿病视网膜病变。

Risk factors analysis of microalbuminuria in patients newly diagnosed with type 2 diabetes mellitus

Objective To analyze the incidence and risk factors of microalbuminuria in newly diagnosed and hospitalized type 2 diabetes mellitus patients, and to provide the theoretical basis for therapy of diabetes and diabetic chronic complications. Methods The blood glucose, lipid profile, 24h-urinaryalbumin, fasting and postprandial serum insulin and peptid C were measured in 286 newly diagnosed and hospitalized type 2 diabetic patients from Mar. 2006 to Sep. 2009. Microalbuminuria was defined as the 24h-urinary albumin between 30 to 300 mg twice. Insulin resistance index （HOMA-IR） was recorded and all the patients received fundus examination by ophthalmologists after expansion of the pupil to ensure whether there was retinopathy or not. Results （ 1 ） The incidence rate of microalbuminuria in this study was 19. 58% （56/286）. （2） Normal albuminuria group and MA group combined DR were 19. 57% （45/230） and 33.93% （19/56） respectively, and the difference was statistically significant（ Х^2 = 5. 349, P = 0. 021 ）. Compared with control, the FPG, HbAlc and HOMA-IR were significantly higher in microalbuminuria group （ FPG： 11.08 ± 1.76 ] mmol/L vs 9. 24 ± 1.65]mmol/L,t= -6.148,P〈0.001;HbAlc：11.54±1.591% vs 9.39±1.641%,t= -7.533,P〈 0. 001 ; HOMA-IR ： 3.73 ± 0.42 ] vs 3.50 ± 0. 30 ], t = - 3. 774, P 〈 0. 001 ）. （ 3 ） Pearson correlation analysis revealed mieroalbuminuria was positively correlated with FPG （ r.= 0. 460 ） , HbAle （ r = 0. 499 ）, HOMA-IR （ r = 0. 308 ） and combined DR （ r = 0. 405 ） （ P 〈 0.01 ）. （4） Stepwise multiple regression analysis revealed that FPG （β = - 0. 804, P 〈 0. 01 ）, HbAle （/3 = - 0. 455, P 〈 0. 01 ） and combined DR （β = 1. 527, P 〈 0. 05 ） were independently risk factors of microalbuminuria. Conclusion The development of microalbuminuria in newly diagnosed and hospitalized type 2 diabetic patients is associated with FPG, HbAlc and HOMA-IR, and will be easier to merge diabetic retinopathy.