尿白蛋白与肌酐比值是 2 型糖尿病患者死亡的独立预测因子：一项回顾性队列研究。

Urinary non-albumin protein-creatinine ratio is an independent predictor of mortality in patients with type 2 diabetes: a retrospective cohort study.

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Taichung, 40705, Taiwan.

School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan.

出版信息

Sci Rep. 2024 May 8;14(1):10526. doi: 10.1038/s41598-024-61395-7.

DOI:10.1038/s41598-024-61395-7

PMID:38719892

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11078930/

Abstract

Albuminuria is a well-known predictor of chronic kidney disease in patients with type 2 diabetes mellitus (DM). However, proteinuria is associated with chronic complications in patients without albuminuria. In this retrospective cohort study, we explored whether non-albumin proteinuria is associated with all-cause mortality and compared the effects of non-albumin proteinuria on all-cause mortality between patients with and without albuminuria. We retrospectively collected data from patients with type 2 DM for whom we had obtained measurements of both urinary albumin-to-creatinine ratio (UACR) and urinary protein-to-creatinine ratio (UPCR) from the same spot urine specimen. Urinary non-albumin protein-creatinine ratio (UNAPCR) was defined as UPCR-UACR. Of the 1809 enrolled subjects, 695 (38.4%) patients died over a median follow-up of 6.4 years. The cohort was separated into four subgroups according to UACR (30 mg/g) and UNAPCR (120 mg/g) to examine whether these indices are associated with all-cause mortality. Compared with the low UACR and low UNAPCR subgroup as the reference group, multivariable Cox regression analyses indicated no significant difference in mortality in the high UACR and low UNAPCR subgroup (hazard ratio [HR] 1.189, 95% confidence interval [CI] 0.889-1.589, P = 0.243), but mortality risks were significantly higher in the low UACR and high UNAPCR subgroup (HR 2.204, 95% CI 1.448-3.356, P < 0.001) and in the high UACR with high UNAPCR subgroup (HR 1.796, 95% CI 1.451-2.221, P < 0.001). In the multivariable Cox regression model with inclusion of both UACR and UNAPCR, UNAPCR ≥ 120 mg/g was significantly associated with an increased mortality risk (HR 1.655, 95% CI 1.324-2.070, P < 0.001), but UACR ≥ 30 mg/g was not significantly associated with mortality risk (HR 1.046, 95% CI 0.820-1.334, P = 0.717). In conclusion, UNAPCR is an independent predictor of all-cause mortality in patients with type 2 DM.

摘要

尿蛋白是 2 型糖尿病患者慢性肾脏病的一个众所周知的预测因子。然而，蛋白尿与无蛋白尿患者的慢性并发症有关。在这项回顾性队列研究中，我们探讨了非白蛋白尿蛋白是否与全因死亡率相关，并比较了有无白蛋白尿患者中非白蛋白尿蛋白对全因死亡率的影响。我们回顾性地收集了 2 型糖尿病患者的数据，这些患者的同一份尿样同时测量了尿白蛋白与肌酐比值（UACR）和尿蛋白与肌酐比值（UPCR）。尿中非白蛋白蛋白与肌酐比值（UNAPCR）定义为 UPCR-UACR。在纳入的 1809 名受试者中，有 695 名（38.4%）患者在中位随访 6.4 年后死亡。该队列根据 UACR（30mg/g）和 UNAPCR（120mg/g）分为四个亚组，以检查这些指标是否与全因死亡率相关。与低 UACR 和低 UNAPCR 亚组作为参考组相比，多变量 Cox 回归分析表明，高 UACR 和低 UNAPCR 亚组的死亡率无显著差异（危险比 [HR] 1.189，95%置信区间 [CI] 0.889-1.589，P=0.243），但低 UACR 和高 UNAPCR 亚组（HR 2.204，95%CI 1.448-3.356，P<0.001）和高 UACR 与高 UNAPCR 亚组（HR 1.796，95%CI 1.451-2.221，P<0.001）的死亡率风险显著更高。在包含 UACR 和 UNAPCR 的多变量 Cox 回归模型中，UNAPCR≥120mg/g 与死亡率升高显著相关（HR 1.655，95%CI 1.324-2.070，P<0.001），但 UACR≥30mg/g 与死亡率风险无显著相关性（HR 1.046，95%CI 0.820-1.334，P=0.717）。总之，UNAPCR 是 2 型糖尿病患者全因死亡率的独立预测因子。