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中国2型糖尿病患者中C反应蛋白和高尿酸血症与糖尿病肾病的关联

Association of C-reactive protein and hyperuricemia with diabetic nephropathy in Chinese type 2 diabetic patients.

作者信息

Fu Chen-Chung, Wu Du-An, Wang Ji-Hung, Yang Wen-Chin, Tseng Chin-Hsiao

机构信息

Department of Metabolism and Endocrinology, Buddhist Tzu Chi General Hospital, Tzu Chi University, 707, Sect. 3, Chung Yang Road, Hualien, Taiwan.

出版信息

Acta Diabetol. 2009 Jun;46(2):127-34. doi: 10.1007/s00592-008-0069-0. Epub 2008 Oct 14.

Abstract

To investigate the relationship of micro-albuminuria with C-reactive protein (CRP) and hyperuricemia in Chinese patients with type 2 diabetes. All patients with type 2 diabetes, 40 years old and over were recruited consecutively from diabetic clinics at a medical center. Serum lipid, creatinine, uric acid, CRP, HbA(1C) and urinary albumin concentration were measured. A total of 515 patients, aged 60.3 +/- 10.7 years were recruited and the number (rate) of micro- and macro-albuminuria were 109 (21.2%) and 55 (10.7%). The prevalence of micro-albuminuria for the quartiles of CRP levels demonstrated a meaningful trend of increases between groups from 17.4, 21.1, 30.3, and 31.2% (P trend = 0.002). Besides, the median CRP concentrations was significantly higher in the patients with micro- and macro-albuminuria than those with non-albuminuria. Stepwise logistic regression analysis revealed that CRP was significantly associated with abnormal albuminuria (OR = 1.36, 95% CI = 1.12-1.64, P = 0.002). After excluding those subjects with angiotensin-converting enzyme inhibitors/angiotension II receptor blockers or/and statin usage, the observed relationship between serum CRP levels and albuminuria was still persistent (OR = 1.61, 95% CI = 1.24-2.08, P < 0.001). In addition, hyperuricemia were significantly associated with abnormal albuminuria in the patients without diuretics, uricosuric agents or alcohol usage. Both serum CRP levels and hyperuricemia were significantly related to the presence of albuminuria in patients with diabetes. In addition, Chinese type 2 diabetic patients with serum CRP levels in the lower range as other ethnic groups can lead to the development of micro-albuminuria.

摘要

探讨中国2型糖尿病患者微量白蛋白尿与C反应蛋白(CRP)及高尿酸血症之间的关系。从某医疗中心的糖尿病门诊连续招募所有年龄在40岁及以上的2型糖尿病患者。检测血清脂质、肌酐、尿酸、CRP、糖化血红蛋白(HbA₁C)及尿白蛋白浓度。共招募了515例年龄为60.3±10.7岁的患者,微量白蛋白尿和大量白蛋白尿的例数(比例)分别为109例(21.2%)和55例(10.7%)。CRP水平四分位数组的微量白蛋白尿患病率显示出有意义的组间升高趋势,分别为17.4%、21.1%、30.3%和31.2%(P趋势=0.002)。此外,微量和大量白蛋白尿患者的CRP中位数浓度显著高于无白蛋白尿患者。逐步逻辑回归分析显示,CRP与异常白蛋白尿显著相关(OR=1.36,95%CI=1.12-1.64,P=0.002)。排除使用血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂或/和他汀类药物的受试者后,血清CRP水平与白蛋白尿之间的观察关系仍然存在(OR=1.61,95%CI=1.24-2.08,P<0.001)。此外,在未使用利尿剂、促尿酸排泄药或酒精的患者中,高尿酸血症与异常白蛋白尿显著相关。血清CRP水平和高尿酸血症均与糖尿病患者白蛋白尿的存在显著相关。此外,中国2型糖尿病患者血清CRP水平与其他种族群体一样处于较低范围时也可导致微量白蛋白尿的发生。

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