血糖达标且不伴高血压的2型糖尿病患者微量尿清蛋白与动态血压关系探讨

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目的:探讨血糖达标且不伴高血压的2型糖尿病患者尿微量清蛋白( MAU)与24 h动态血压之间的关系。方法选取2012年1月-2013年5月在安徽省黄山市中医院内分泌科及代谢科住院及门诊的糖化血红蛋白( HbA1c )<7%且不伴高血压的2型糖尿病患者83例,按照尿MAU水平分为A组( MAU<30 mg/g,37例)和B组(MAU≥30 mg/g,46例),对两组患者的一般资料及动态血压指标进行分析比较。结果(1) B组患者血肌酐值高于A组〔(76.1±14.6)μmol/L 比(67.8±11.9)μmol/L 〕,但肾小球滤过率低于A组〔(73.0±13.6) ml/min比(79.0±11.4) ml/min〕,差异有统计学意义(P<0.05);(2) B组24 h平均收缩压〔(128.9±6.2) mm Hg比(122.2±7.2) mm Hg〕、夜间平均收缩压〔(128.9±12.9) mm Hg比(113.8±10.0) mm Hg 〕、夜间平均舒张压〔(78.0±8.6) mm Hg比(69.2±8.3) mm Hg〕、白昼收缩压负荷值〔(15.2±10.8)%比(9.8±7.5)%〕、夜间收缩压负荷值〔(54.5±34.3)%比(13.1±9.4)%〕、夜间舒张压负荷值〔(42.9±32.6)%比(9.6±8.7)%〕、夜间收缩压变异〔(11.2±4.4)比(10.9±4.3)〕及血压昼夜节律消失率(82.6%比37.8%)高于A组,差异有统计学意义(P<0.05);(3)多元逐步Logistic回归分析显示,年龄(β=0.097)、病程(β=0.127)、夜间收缩压负荷值(β=0.068)、夜间舒张压负荷值(β=0.077)及夜间收缩压变异(β=-0.229)是MAU的独立预测因子。结论对血糖达标且不伴高血压的2型糖尿病患者,24 h动态血压监测尤其是夜间血压变化对早期肾损伤具有预测价值。
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