中国全科医学2018，Vol.21Issue(21)：2571-2576,6.DOI:10.3969/j.issn.1007-9572.2018.00.181
尿微量清蛋白对不同糖代谢状态人群脑卒中发生风险的研究
Role of Microalbuminuria in the Prediction of Stroke in Populations with Different Glycometabolic Conditions
摘要
Abstract
Objective To investigate the role of microalbuminuria (MAU) in the prediction of stroke among populations with different glycometabolic conditions,providing a reference for the prevention of stroke.Methods The enrolled 3 501 participants over 40 years old were from part of Sichuan's Luzhou who participated in the Risk Evaluation of Cancer in Diabetic Chinese Individuals:a Longitudinal (REACTION) Study initiated by the Chinese Society of Endocrinology from April to November 2011.We collected their baseline characteristics,such as demographic data (sex,age,BMI,family history of diabetes,history of smoking and cardiovascular disease),and laboratory findings〔total cholesterol (TC),triacylglycerol (TG), high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),fasting plasma glucose (FPG), glycated hemoglobin (HbA1c),and MAU〕.We divided them into diabetes mellitus (DM) group,impaired glucose regulation (IGR) group,and normal glucose tolerance (NGT) group based on the status of glucose metabolism.Furthermore,in accordance with the level of MAU,we divided them into NGT with normal MAU subgroup(subgroup A),IGR with normal MAU subgroup(subgroup B),DM with normal MAU subgroup(subgroup C),NGT with increased MAU subgroup(subgroup D),IGR with increased MAU subgroup(subgroup E),DM with increased MAU subgroup(subgroup F).The occurrence of stroke was recorded during a follow-up visit from April to June 2016.Results There were 735 cases of DM(458 with normal MAU and 277 with increased MAU),1 212 cases of IGR(837 with normal MAU and 375 with increased MAU),and 1 554 cases of NGT(866 with normal MAU and 688 with increased MAU),accounting for 21.0%,34.6%,and 44.4% of the total participants,respectively.The level of MAU in subgroup C was significantly lower than that of subgroup F but much higher when compared with that of subgroup B(P＜0.05).Subgroup A demonstrated much lower level of MAU compared with subgroups of B,D,E and F(P＜0.05).The follow-up showed that,the incidence of stroke in NGT,IGR,and DM groups was 2.7% (42/1 554),3.1% (37/1 212), and 5.0% (37/735),respectively,indicating that DM group had the highest incidence (P＜0.05);the incidence of stroke in subgroups of A,B,C,D,E,and F was 1.4% (12/866),1.8% (15/837),3.7% (17/458),4.4% (30/688),5.9% (22/375), and 7.2% (20/277),respectively.Among NGT cases,those with increased MAU having a risk of stroke 3.245 times that of those with normal MAU〔95%CI(1.649,6.386),P＜0.05〕.The risk of stroke in IGR cases with increased MAU was 3.415 times that of IGR cases with normal MAU〔95%CI(1.751,6.661),P＜ 0.05〕.For DM cases with increased MAU,the risk of stroke was 2.019 times that of DM cases with normal MAU〔95%CI(1.039,3.924),P＜0.05〕.The incidence of stroke was much higher in the participants with increased MAU compared with those with normal MAU〔5.4%(72/1 340) vs 2.0% (44/2 161)〕 (P＜0.05).Multivariate Logistic regression analysis showed that elevated MAU was an independent risk factor for stroke in people with different glycometabolic conditions〔OR=1.026,95%CI(1.018,1.033),P＜0.001〕.Conclusion Although people with different glycometabolic conditions have different prevalence of abnormal MAU,elevated MAU is an independent risk factor for stroke for all of them.Therefore,the risk of having stroke could be effectively reduced by early intervention addressing increased MAU in those with glycometabolism disorder.关键词
糖尿病/糖尿病前期/尿微量白蛋白/卒中Key words
Diabetes mellitus/Prediabetic state/Microalbuminuria/Stroke分类
医药卫生引用本文复制引用
周洪仿,万沁..尿微量清蛋白对不同糖代谢状态人群脑卒中发生风险的研究[J].中国全科医学,2018,21(21):2571-2576,6.基金项目
国家科技部重点研发项目(2016YFC0901200,2016YFC0901205) （2016YFC0901200,2016YFC0901205）
