摘要
目的分析不同肥胖指标和2型糖尿病患者微量白蛋白尿的关系,探讨预测2型糖尿病患者微量白蛋白尿发生风险的适宜肥胖指标。方法选取2010年1月-2014年10月2型糖尿病住院患者1 887例,按尿白蛋白/肌酐(尿A/C)分为微量白蛋白尿组和正常蛋白尿组,比较与微量白蛋白尿发生相关的影响因素。结果和正常蛋白尿组比较,男性患者中微量白蛋白尿组年龄、病程、收缩压、体质指数(BMI)、腰围(WC)、腰臀比(WHR)、腰身比(WHtR)明显增加,血肌酐、甘油三酯(TG)、糖化血红蛋白(HbAlc)明显增高,低密度脂蛋白胆固醇(LDL-C)明显降低;女性患者中,微量蛋白尿组年龄、病程、收缩压、WC、WHR、WHtR明显增加,TG、HbA1c明显增高;以上差异均有统计学意义(P值均<0.05)。多因素logistic回归结果显示,校正了年龄、病程、收缩压、TG、HbA1c等影响因素后,男性患者BMI、WC、WHR、WHtR与微量白蛋白尿发生相关,OR值分别为1.097、1.043、1.348、2.212(P值均<0.01);女性患者WHR、WHtR与微量白蛋白尿相关,OR值分别为1.448、2.432(P值均<0.01)。男、女性WHtR ROC曲线下面积均最大,与WC、WHR及BMI ROC曲线下面积相比,男性组差异无统计学差异(P>0.05),女性组差异有统计学意义(P<0.05)。WHtR预测微量白蛋白尿发生的切点:男性0.54(敏感性59%,特异性61%),女性0.57(敏感性58%,特异性67%)。结论 WHtR是预测2型糖尿病微量白蛋白尿发生的适宜肥胖指标。合理减重,控制WHtR对2型糖尿病患者早期肾病的防治及减少相关死亡有重要意义。
Objective To investigate correlation of different obesity indices with microalbuminuria; to study appropriate obesity indices in predicting microalbuminuria in type 2 diabetes patients. Methods A total of 1 887 inpatients with T2DM from Jan 2010 to Oct 2014 were divided into microalbuminuria and normoalbuminuria group based on uring albumin and creatinine （urine A/C）. risk factors to induce microalbuminuria were analyzed. Results Compared with normoalbuminuric patients, male microalbuminuria patients were older, whose duration of disease , systolic blood pressure（SBP）, body mass index （BMI）, waist circumference （WC）, waist to hip ratio （WHR）, waist height ratio （WHtR）, serum creatinine, serum triglyceride （TG） and glycosylated hemoglobin （HbAlc） increased significantly, while low density lipoprotein cholesterol （LDL-C） decreased significantly; female microalbuminuria patients were older, whose trace protein in urine, duration , SBP, WC, WHR, WHtR, TG and HbAlc significantly increased, all with statistical difference（all P〈0.05）. Multivariate logistic regression with adjustment for age ,duration, SBP, HbAlc and TG showed BMI,WC,WHR,WHtR were independently associated with microalbuminuria for men, the odds ratio were 1. 097,1. 043,1. 348,2. 212, respectively（all P〈0. 01 ）; while WHR and WHtR were independently associated with microalbuminuria for woman, the odds ratio were 1. 448 and 2. 432, respectively （all P〈0.01）. The area under the receiver operating characteristic（ROC） curve of WHtR was the biggest, compared with areas under ROC curves of BMI,WC and WHR , no statistical difference was found for male patients （all P〈0.05） while statistical difference was observed for female patients （all P〈0.05）. The optimal cut-off values of WHtR for detecting microalbuminuria were 0.54 for men （ sensitivity 59 %, specificity 61 % ） and 0. 57 for woman （ sensitivity 58 %, specificity 67 % ）. Conclusion WHtR is the appropriate obesity index in predicting microalbuminuria. Reducing body weight and WHtR may be useful strategies to prevent development of early renal disease and reduce the related mortality in patients with type 2 diabetes.
出处
《江苏预防医学》
CAS
2015年第6期18-21,共4页
Jiangsu Journal of Preventive Medicine
基金
国家自然科学基金(71373132)
关键词
2型糖尿病
肥胖指标
微量白蛋白尿
回归分析
预测
Type 2 diabetes
Obesity indices
Microalbuminuria
Regression analysis
Predict
