Department of Endocrinology, Beijing Hospital, Ministry of Health, Beijing 100730, China.
Chin Med J (Engl). 2012 Dec;125(23):4181-4.
Coronary heart disease is the main complication of type 2 diabetes mellitus; its incidence is closely related to microalbuminuria. The aim of this study was to investigate the correlation between the urinary albumin excretion rate and the incidence and severity of coronary heart disease in elderly type 2 diabetes mellitus patients.
A total of 612 hospitalized type 2 diabetes mellitus patients aged 60 years or older, who were given coronary angiography for diagnosis of possible coronary heart disease, participated. Their urinary albumin excretion rate was measured, and the severity of coronary artery stenosis was quantified with the Gensini scoring system to analyze the incidence of coronary heart disease and the severity of coronary artery stenosis. The optimal urinary albumin excretion rate predictive value for coronary heart disease incidence in elderly type 2 diabetes mellitus patients was determined.
The incidence of coronary heart disease, the number of patients with coronary vascular disease and the Gensini scores were significantly different between the microalbuminuria group and the normal albuminuria group (P < 0.05). The urinary albumin excretion rate was independently correlated with the occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients (odds ratio (OR) = 1.058, P < 0.0001, 95% confidence interval (CI): 1.036 - 1.080). Urinary albumin excretion rate and the Gensini score were independently correlated in elderly type 2 diabetes mellitus patients (β = 0.476, P < 0.0001). The best predictive value of urinary albumin excretion rate was 10.45 µg/min for elderly type 2 diabetes mellitus patients. The area under the curve was 0.764, with a sensitivity and specificity of 70.0% and 72.2%, respectively.
The occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients with microalbuminuria was higher than that in patients with normal albuminuria, and the severity of the disease also increased in patients with microalbuminuria. In elderly type 2 diabetes mellitus patients, urinary albumin excretion rate was positively correlated with the incidence and severity of coronary heart disease and was also an independent factor contributing to coronary heart disease.
冠心病是 2 型糖尿病的主要并发症，其发生率与微量白蛋白尿密切相关。本研究旨在探讨老年 2 型糖尿病患者尿白蛋白排泄率与冠心病发生率及严重程度的相关性。
共纳入 612 例年龄在 60 岁及以上、因疑似冠心病而行冠状动脉造影检查的 2 型糖尿病住院患者。检测其尿白蛋白排泄率，采用 Gensini 评分系统量化冠状动脉狭窄程度，分析冠心病的发生率和冠状动脉狭窄程度。确定老年 2 型糖尿病患者尿白蛋白排泄率预测冠心病发生率的最佳临界值。
微量白蛋白尿组与正常白蛋白尿组的冠心病发生率、患冠状动脉疾病的患者数及 Gensini 评分差异均有统计学意义（P<0.05）。老年 2 型糖尿病患者尿白蛋白排泄率与发生冠心病独立相关（比值比（OR）=1.058，P<0.0001，95%置信区间（CI）：1.036-1.080）。老年 2 型糖尿病患者的尿白蛋白排泄率与 Gensini 评分独立相关（β=0.476，P<0.0001）。老年 2 型糖尿病患者尿白蛋白排泄率的最佳预测值为 10.45µg/min，曲线下面积为 0.764，敏感度和特异度分别为 70.0%和 72.2%。
伴有微量白蛋白尿的老年 2 型糖尿病患者冠心病发生率高于正常白蛋白尿者，且微量白蛋白尿患者的病情严重程度也增加。在老年 2 型糖尿病患者中，尿白蛋白排泄率与冠心病的发生率和严重程度呈正相关，也是冠心病的独立影响因素。
