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在一家三级医疗保健医院接受治疗的2型糖尿病黑人患者中的白蛋白尿状况和血脂异常模式:一项分析。

Albuminuria status and patterns of dyslipidemia among type 2 diabetes black patients managed at a tertiary health-care hospital: A analysis.

作者信息

Kajingulu Francois M, Lepira Francois B, Mbutiwi Fiston I, Makulo Jean-Robert, Sumaili Ernest K, Bukabau Justine B, Mokoli Vieux M, Longo Augustin L, Nseka Nazaire M

机构信息

Department of Internal Medicine, Division of Nephrology, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo.

Department of Internal Medicine, Division of Nephrology, University Hospital of Kinshasa, University of Kinshasa, Kinshasa; Faculty of Medicine, University of Kikwit, Kikwit, Democratic Republic of Congo.

出版信息

Saudi J Kidney Dis Transpl. 2018 May-Jun;29(3):649-657. doi: 10.4103/1319-2442.235175.

Abstract

Cardiovascular disease (CVD) risk in type 2 diabetes mellitus (T2DM) increases with the development of albuminuria and is related in part to dyslipidemia. The present analysis assessed lipid profile and patterns of dyslipidemia in T2DM patients according to albuminuria status. This was a post hoc analysis of data from 181 T2DM patients seen at a tertiary health-care hospital and enrolled in a cross-sectional study of albuminuria status. Abnormal albuminuria was defined as microalbuminuria [albumin to creatinine ratio (ACR) 30-299.9 mg/g] or macro-albuminuria (ACR ≥300 mg/g). Atherogenic dyslipidemia was defined as triglycerides (TGs) ≥150 mg/dL and/or high-density lipoprotein-cholesterol (HDL-c) <40 mg/dL in men and <50 mg/dL in women using international consensus criteria. High levels of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-c), HDL-c, non-HDL-c, TG, and low level of HDL-c were defined according to 2012 American Association of Clinical Endocrinologists' guidelines. Comparisons between T2DM patients with and without abnormal albuminuria were done using Chi-square test, Student's t-test, or two-sample t-test with equal variance and Mann-Whitney test as appropriate. P< 0.05 defined the level of statistical significance. Of the 181 T2DM patients, 93 (51%) had abnormal albuminuria with 32% and 19% having microalbuminuria and macro-albuminuria, respectively. Average TC, HDL-c, HDL-c, non-HDL-c, and TG levels were 171 ± 41, 111 ± 36, 38 ± 16, 133 ± 38, and 98 (45-234) mg/dL, respectively. These values were significantly lower for TC (P = 0.047), LDL-c (P = 0.030), and non-HDL-c (P = 0.05) in comparison with patients with normal albuminuria. Low HDL-c (64.5%) and high TG (9.7%) were, respectively, the most and less frequent patterns of isolated dyslipidemia in patients with abnormal albuminuria. Atherogenic dyslipidemia with mainly low HDL-c levels is common in T2DM patients with abnormal albuminuria and could contribute to CVD and renal disease progression.

摘要

2型糖尿病(T2DM)患者的心血管疾病(CVD)风险随蛋白尿的出现而增加,部分与血脂异常有关。本分析根据蛋白尿状况评估了T2DM患者的血脂谱及血脂异常模式。这是一项对在一家三级医疗保健医院就诊并参与蛋白尿状况横断面研究的181例T2DM患者的数据进行的事后分析。异常蛋白尿定义为微量白蛋白尿[白蛋白与肌酐比值(ACR)为30 - 299.9 mg/g]或大量白蛋白尿(ACR≥300 mg/g)。采用国际共识标准,将致动脉粥样硬化性血脂异常定义为男性甘油三酯(TGs)≥150 mg/dL和/或高密度脂蛋白胆固醇(HDL - c)<40 mg/dL,女性HDL - c<50 mg/dL。根据2012年美国临床内分泌医师协会指南定义总胆固醇(TC)、低密度脂蛋白胆固醇(LDL - c)、HDL - c、非HDL - c、TG的高水平以及HDL - c的低水平。对有和无异常蛋白尿的T2DM患者进行比较时,根据情况使用卡方检验、学生t检验、等方差双样本t检验或曼 - 惠特尼检验。P<0.05为统计学显著性水平。在181例T2DM患者中,93例(51%)有异常蛋白尿,其中32%和19%分别有微量白蛋白尿和大量白蛋白尿。TC、HDL - c、HDL - c、非HDL - c和TG的平均水平分别为171±41、111±36、38±16、133±38和98(45 - 234)mg/dL。与蛋白尿正常的患者相比,这些值在TC(P = 0.047)、LDL - c(P = 0.030)和非HDL - c(P = 0.05)方面显著更低。低HDL - c(64.5%)和高TG(9.7%)分别是异常蛋白尿患者中最常见和较不常见的单纯血脂异常模式。主要以低HDL - c水平为主的致动脉粥样硬化性血脂异常在有异常蛋白尿的T2DM患者中很常见,可能会促进CVD和肾脏疾病的进展。

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