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。

Study on the Correlation Between Different Urinary Albumin Excretion Rate and Insulin Resistance in Elderly Type 2 Diabetes Mellitus

Objective To investigate the correlation between different urinary albumin excretion rate and insulin resistance in elderly type 2 diabetes patients.Methods 152 elderly type 2 diabetic patients were recruited in the study,and were divided into three groups:normoalbuminuria group,microalbuminuria group and macroalbuminuria group.Body mass index,blood pressure,fasting plasma glucose,fasting insulin,glycated hemoglobin,lipids,uric acid,24-hour urinary albumin quantification,insulin resistance index HOMA-IR and estimated glomerular filtration rate were measured.Results The age,hypertension rate,HOMA-IR of the patients with microalbuminuria were significantly higher and eGFR was significantly lower compared with the normal albuminuria patients(P<0.05).The hypertension rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting glucose(FPG),fasting insulin(FINS),total cholesterol(TC),HOMA-IR of the patients with macroalbuminuria were all increased significantly and eGFR decreased significantly compared with the normalalbuminuria patients(P<0.05).The DBP,FPG,FINS,TC of patients with macroalbuminuria were significantly higher compared with the patients with microalbuminuria.Multivariate analysis showed that HOMA-IR was an independent risk factor that affect urinary albumin excretion rate in the elderly type 2 diabetic patients.Conclusions Urinary albumin increase is associated with insulin resistance in elderly type 2 diabetic patients.