The Relationship Between Type 2 Diabetic Nephropathy And Risk Factors Of Cardiovascular Disease

Objective: Epidemiologic data showed that patients with type 2diabetic nephropathy had a higher prevalence and mortality of cardiovascular diseases (CVD). Classical risk factors of CVD were involved in the development of diabetic nephropathy. The cluster state of risk factors of CVD was called metabolic syndrome (MS), insulin resistance was the common pathophysiologic background of MS. Serum free fatty acids and tumor necrosis factor-a played an important roles in obesity-mediated insulin resistance. The objective of this study was to investigate the relationship between type 2 diabetic nephropathy and risk factors of CVD through analyzing the distribution of risk factors of CVD and changes of insulin resistance, serum free fatty acids, tumor necrosis factor-a in patients with type 2 diabetic nephropathy.Method: (1) Medical records of 627 patients with type 2 diabeteswere analysed retrospectively. (2) 91 non-obese type 2 diabetic patients were divided into normal albuminuria group (n=24), microalbuminuria group (n=21) , macroalbuminuria group (n=24) and renal dysfunction group (n=22), according to criteria of diabetic nephropathy. Insulin sensitivity index (ISI) were calculated and compared between these groups using to the equation established by Prof.Li, serum free fatty acids and tumor necrosis-a were compared between these groups using ELISA.Result: (1) The prevalence of diabetic nephropathy in 627 type 2diabetic patients was 43.38%. As compared with patients with non-diabetic nephropathy, patients with diabetic nephropathy had higher the prevalence of CVD (x"=l 1.591, /M). 001) , higher prevalence of hypertension, dyslipidemia, overweight/obesity, hyperuricemia and hyperfibrinogenemia (44. 79% vs 66. 91%, 44. 79% vs 57.72%, 40. 85% vs 55. 51%, 6. 48% vs 18. 75%, 23. 66% vs 41. 54%, P=0. 000 — 0. 001) , and higher prevalence of MS(40.85% vs 64.71%, x'=35.092, P=0. 000). As compared with patients with non-diabetic nephropathy, there were much more features of metabolic syndrome appeared in these patients with diabetic nephropathy. Patients with diabetic nephropathy had higher level of systolic blood pressure, diastolic blood pressure , triglyceride, total cholesterol, low density lipoprotein cholesterol % body mass index, serum uric acid and plasma fibirnogen (P=0.000~ 0. 001), lower level of high density lipoprotein cholesterol (/M). 031) . Unconditional univariate Logistic regression analysis showed that diabetic nephropathy was significantly correlated with hypertension(0￡=2. 342, 95%CI: 1.664-3.298), dyslipidemia ( OR=L 656, 95%CI: 1.186-2.312), overweight/obesity (0AM. 814, 95%CI: 1.298-2.534), hyperuricemia (0#=1.982, 95%CI: 1.126-3.382), hyperfibrinogenemia(OR=2. 198,95%C/: 1. 535-3. 145) and MS (0^2. 505, 95%C7: 1.781-3.522). Unconditional multivariate Logistic regression analysis showed that diabetic nephropathy were significantly correlated with hypertension(0#=2. 104, 95%C7: 1.471-3.009), dyslipidemia ( 0^1. 471, 95%CI:...