尿白蛋白肌酐比值升高增加伴或不伴 2 型糖尿病的冠心病患者心血管死亡率：一项多中心回顾性研究。
Elevated urine albumin creatinine ratio increases cardiovascular mortality in coronary artery disease patients with or without type 2 diabetes mellitus: a multicenter retrospective study.
机构信息
Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
出版信息
Cardiovasc Diabetol. 2023 Aug 10;22(1):203. doi: 10.1186/s12933-023-01907-3.
BACKGROUND
Albuminuria has been suggested as an atherosclerotic risk factor among the general population. However, whether this association will be amplified in patients with coronary artery disease (CAD) is unknown. It is also unknown whether diabetes mellitus confounds the association. We aim to analyse the prognosis of elevated urine albumin creatinine ratio (uACR) in the CAD population with or without type 2 diabetes mellitus (T2DM).
METHODS
This multi-center registry cohort study included 5,960 patients with CAD. Patients were divided into T2DM and non-T2DM group, and baseline uACR levels were assessed on three grades (low: uACR < 10 mg/g, middle: 10 mg/g ≤ uACR < 30 mg/g, and high: uACR ≥ 30 mg/g). The study endpoints were cardiovascular mortality and all-cause mortality.
RESULTS
During the median follow-up of 2.2 [1.2-3.1] years, 310 (5.2%) patients died, of which 236 (4.0%) patients died of cardiovascular disease. CAD patients with elevated uACR had a higher risk of cardiovascular mortality (middle: HR, 2.32; high: HR, 3.22) than those with low uACR, as well as all-cause mortality. Elevated uACR increased nearly 1.5-fold risk of cardiovascular mortality (middle: HR, 2.33; high: HR, 2.34) among patients without T2DM, and increased 1.5- fold to 3- fold risk of cardiovascular mortality in T2DM patients (middle: HR, 2.49; high: HR, 3.98).
CONCLUSIONS
Even mildly increased uACR could increase the risk of cardiovascular mortality in patients with CAD, especially when combined with T2DM.
背景
白蛋白尿已被认为是普通人群中动脉粥样硬化的一个危险因素。然而，这种关联在冠心病（CAD）患者中是否会放大尚不清楚。也不知道糖尿病是否会使这种关联复杂化。我们旨在分析 CAD 患者中升高的尿白蛋白肌酐比值（uACR）与有无 2 型糖尿病（T2DM）的预后。
方法
本多中心注册队列研究纳入了 5960 例 CAD 患者。患者分为 T2DM 和非 T2DM 组，并评估了基线 uACR 水平的三个等级（低：uACR<10mg/g，中：10mg/g≤uACR<30mg/g，高：uACR≥30mg/g）。研究终点为心血管死亡率和全因死亡率。
结果
在中位数为 2.2[1.2-3.1]年的随访期间，310（5.2%）名患者死亡，其中 236（4.0%）名患者死于心血管疾病。与 uACR 较低的患者相比，uACR 升高的 CAD 患者有更高的心血管死亡风险（中：HR，2.32；高：HR，3.22）和全因死亡率。在无 T2DM 的患者中，uACR 升高使心血管死亡的风险增加近 1.5 倍（中：HR，2.33；高：HR，2.34），而在 T2DM 患者中则增加 1.5 倍至 3 倍的心血管死亡风险（中：HR，2.49；高：HR，3.98）。
结论
即使是轻度升高的 uACR 也会增加 CAD 患者心血管死亡的风险，尤其是在合并 T2DM 时。
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