与传统血脂参数相比，非高密度脂蛋白胆固醇与肾功能正常的中国 2 型糖尿病患者的蛋白尿更为密切相关。

Non-high-density lipoprotein cholesterol is associated more closely with albuminuria in Chinese type 2 diabetic patients with normal renal function, compared with traditional lipid parameters.

机构信息

Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, No. 600, Yishan Road, Shanghai, PR China.

出版信息

J Clin Lipidol. 2012 Jul-Aug;6(4):382-7. doi: 10.1016/j.jacl.2012.01.008. Epub 2012 Jan 28.

DOI:10.1016/j.jacl.2012.01.008

PMID:22836076

Abstract

BACKGROUND

Urinary albumin excretion rate (UAER) is a remarkable index reflecting the progression of kidney disease in diabetic subjects. The link between UAER and lipid metabolism is still unclear. The correlation of Apolipoprotein B (ApoB) to albuminuria has been investigated. The National Cholesterol Education Program-Adult Treatment Panel III recommends that clinicians consider non-high-density lipoprotein cholesterol (non-HDL-c) as a surrogate marker for ApoB.

OBJECTIVE

We sought to evaluate the relationship of UAER with lipid profile, especially with non-HDL-c in type 2 diabetic patients without renal dysfunction.

METHODS

A total of 507 type 2 diabetic patients with normal renal function participated in this study. Demographic and anthropometric data were collected; 24-hour urine samples were collected for UAER measurement. Blood samples were collected for lipid parameters and HbA1c measurement.

RESULTS

The patients with albuminuria had greater levels of non-HDL-c and ApoB. The frequencies of albuminuria among the four quartiles of lipid parameters, ie, triglycerides, total cholesterol, non-HDL-c, and ApoB, demonstrated significantly linearly increasing (P for trend <.01). After adjustment, UAER was significantly correlated with total cholesterol, triglycerides, ApoB, and non-HDL-c but not with low-density lipoprotein cholesterol (LDL-c) or lipoprotein(a) [Lp(a)]. Stepwise regression analysis showed that age (β = .255, P = .000), systolic blood pressure (β = .261, P = .000), non-HDL-c (β = .164, P = .000), and duration of diabetes (β = .105, P = .024) were independently correlated with UAER in diabetic patients without renal dysfunction.

CONCLUSION

Compared with the lipid parameters of total cholesterol, triglycerides, HDL-c, LDL-c, ApoB, Apolipoprotein A-I (ApoA-I), and Lp(a), non-HDL-c was more closely associated with albuminuria in Chinese type 2 diabetic patients without impaired renal function.

摘要

背景

尿白蛋白排泄率（UAER）是反映糖尿病患者肾脏疾病进展的一项重要指标。UAER 与脂代谢之间的关系尚不清楚。已有研究探讨了载脂蛋白 B（ApoB）与白蛋白尿之间的相关性。国家胆固醇教育计划-成人治疗专家组 III 建议临床医生将非高密度脂蛋白胆固醇（non-HDL-c）作为 ApoB 的替代标志物。

目的

我们旨在评估 UAER 与血脂谱的关系，特别是在肾功能正常的 2 型糖尿病患者中非高密度脂蛋白胆固醇（non-HDL-c）与 UAER 的关系。

方法

共纳入 507 例肾功能正常的 2 型糖尿病患者，收集患者的人口统计学和人体测量学数据；收集 24 小时尿液样本测量 UAER；采集血样测量血脂参数和糖化血红蛋白（HbA1c）。

结果

白蛋白尿患者的 non-HDL-c 和 ApoB 水平更高。在血脂参数的四个四分位区间（即三酰甘油、总胆固醇、non-HDL-c 和 ApoB）中，白蛋白尿的发生频率呈明显线性增加（趋势 P<.01）。校正后，UAER 与总胆固醇、三酰甘油、ApoB 和 non-HDL-c 显著相关，但与低密度脂蛋白胆固醇（LDL-c）或脂蛋白（a）[Lp（a）]无关。逐步回归分析显示，年龄（β=0.255，P=0.000）、收缩压（β=0.261，P=0.000）、non-HDL-c（β=0.164，P=0.000）和糖尿病病程（β=0.105，P=0.024）与肾功能正常的糖尿病患者的 UAER 独立相关。