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目的探讨病程大于5年的2型糖尿病(T2DM)患者尿白蛋白排泄率(UAER)与超敏C反应蛋白(hs-CRP)及胰岛素抵抗的关系,为糖尿病肾病(DN)的防治提供依据。方法将674例病程大于5年且肾功能正常的T2DM患者按UAER分为正常蛋白尿组(NAU组,UAER<20μg/min)296例,微量蛋白尿组(MAU组,UAER20～200μg/min)242例,临床蛋白尿组(CAU组,UAER>200μg/min)136例。进行口服葡萄糖耐量试验及胰岛素释放试验,计算胰岛素抵抗指数(HOMA-IR)、胰岛素曲线下面积和葡萄糖曲线下面积的比值(AUCI/AUCG)以评价胰岛素抵抗情况,并检测hs-CRP、糖化血红蛋白(HbA1c)等。结果与NAU组比较,MAU组和CAU组的胰岛素敏感指数(ISI)显著降低(3组的ISI分别为-3.67±0.53、-4.27±0.42、-4.39±0.47),HOMA-IR显著升高(3组的HOMA-IR分别为3.41±0.56、3.88±0.42、3.97±0.52),AUCI/AUCG显著升高(3组的AUCI/AUCG分别为2.89±0.62、2.93±0.84、2.97±0.53),差异均有统计学意义(P<0.05)。Spearman相关分析显示,UAER水平与hs-CRP水平呈正相关(r=0.319,P<0.05)。多元逐步回归分析结果显示,UAER与糖尿病病程、hs-CRP、AUCI/AUCG呈正相关(β值分别为0.643、0.148、0.219,P<0.05)。结论病程大于5年且肾功能正常的T2DM患者的UAER增加可能与胰岛素抵抗的发生发展和hs-CRP水平上升有关。
Objective To investigate the relationship between urinary albumin excretion rate (UAER) and high-sensitivity C-reactive protein (hs-CRP) and insulin resistance in type 2 diabetes mellitus (T2DM) patients with a disease course of more than 5 years and provide evidence for the prevention and treatment of diabetic nephropathy (DN). Methods A total of 674 T2DM patients with more than 5 years of history and normal renal function were divided into two groups according to UAER: 296 cases of normal proteinuria group (UAER <20μg / min), microalbuminuria group (MAU group, 20-200μg / min of UAER) 242 cases, clinical proteinuria group (CAU group, UAER> 200μg / min) in 136 cases. The oral glucose tolerance test and insulin release test were performed to evaluate the insulin resistance status by calculating the ratio of insulin-resistance index (HOMA-IR), area under the curve of insulin and area under the curve of glucose (AUCI / AUCG), and detecting hs-CRP, (HbA1c) and the like. Results Compared with the NAU group, the insulin sensitivity index (ISI) in the MAU group and the CAU group decreased significantly (ISI of the three groups was -3.67 ± 0.53, -4.27 ± 0.42 and -4.39 ± 0.47, respectively), and HOMA-IR was significantly increased The AUCI / AUCG of 3 groups were 3.41 ± 0.56, 3.88 ± 0.42 and 3.97 ± 0.52, respectively. The AUCI / AUCG of 3 groups were 2.89 ± 0.62, 2.93 ± 0.84 and 2.97 ± 0.53, respectively All were statistically significant (P <0.05). Spearman correlation analysis showed that there was a positive correlation between UAER level and hs-CRP level (r = 0.319, P <0.05). Multiple stepwise regression analysis showed that UAER was positively correlated with duration of diabetes, hs-CRP and AUCI / AUCG (β = 0.643, 0.148 and 0.229 respectively, P <0.05). Conclusion The increase of UAER in T2DM patients with more than 5 years of history and normal renal function may be related to the occurrence and development of insulin resistance and the increase of hs-CRP level.