The Relationship Between Albuminuria And Macroangiopathy In Patients With Type 2 Diabetes Mellitus

Objective: To study the relationship between albuminuria and macroangiopathy in patients with type 2 diabetes mellitus.Methods: Firstly,152 diabetic inpatients were selected during the year from March,2010 to March,2011.And all the patients conformed to 1999 WHO classification and diagnostic criteria of diabetes.According to Mogensen's DN stages,they were divided into three groups including normal albuminuria group (95 cases),microalbuminuria group (35 cases)and macro- albuminuria group (22 cases),and all the patients with proteinuria had eliminated other reasons which might lead to the increase of urinary protein such as urinary infections and so on. And then we analysed the proteinurial clinical characteristics of T2DM.Secondly,with accordance to having macrovascular diseases (on the basis of medical history and relevant tests) or not,these patients were divided into macroangiopathy group with T2DM (60 cases) or nonmacroangiopathy group with T2DM (92 cases),and then we analysed the macroangipathy clinical features of T2DM.Finally, we analysed and studied the relationship between albuminuria and angiopathy of T2DM.Results:1. Albuminuria of the patients with T2DM possesses the clinical features as follows:1) Among 152 cases of these patients with T2DM,the incidence rate of proteinuria was 37.5 percent(57/152),in which microalbuminuria accounted for 23 percent(35/152), which macroalbuminuria holded 14.5 percent(22/152); the incidence rate of proteinuria in male was 36.7 percent(29/79),while the incidence rate of proteinuria in female was 38.3 percent (28/73).Obviously,the differences have no sense in statistics (P> 0.05).2)Both the age(62.13±11.25years old)and BMI(26.31±2.38Kg/m2) in microproteinuria group and the age(62.56±10.27years old)and BMI(26.01±3.11 Kg/m2)in macroproteinuria group were remarkably higher than the age(59.53±10.22 years old)and BMI(24.96±2.41Kg/m2)in normal proteinuria group,and thus the discrepancy had statistically significance(P <0.01);The disease course of DM in normal proteinuria,micro normal proteinuria and macro normalproteinuria group was 7.94±4.57 years,9.67±4.16 years,and 10.28±4.24years respectively, and SBP was 136.54±12.39mmHg, 146.54±17.11mmHg and 168.45±24.2 mmHg respectively.Both of these were gradually increasing.Of course,these differences possess statistic meanings(P<0.001).DBP in macroproteinuria group(90.72±9.72mmHg) was clearly higher than normal albuminuria group and microalbuminuria group (respectively 80.99±8.41mmHg,80.54±8.90mmHg)(P <0.05).3)FBG(respectively 20±5.24mmol/l,9.60±3.48mmol/l,9.95±4.07mmol/l ), TC(respectively 4.72±1.02mmol/l,4.97±1.21 mmol/l,5.41±1.15 mmol/l), TG (respectively 1.83±1.61 mmol/l,2.41±2.84 mmol/l,2.52±1.95 mmol/l), UA(respectively 249.31±111.98 mmol/l, 277.40±100.24 mmol/l, 394.04±130.45 mmol/l),BUN(respectively 6.07±1.03 mmol/l,6.22±1.45 mmol/l,11. 19±6.86 mmol/l),SCr(respectively 68.83±26.8 /l,183.31±166.7 mmol/l),and UAER(respectively 11.08±8.33ug/24h, 85.76±45.21 ug/24h, 379.15±70.81 ug/24h)in normal normalproteinuria, micro proteinuria and macroproteinuria group indicated obviously increasing trends and the differences had the significance (P<0.01); (respectively9.05±2.42percent,8.6±2.48percent) in both microproteinuria group and macroproteinuria group was higher than HbA1c(8.17±2.25percent)in normal proteinuria group,which possesses stastical meaning(P<0.05). But there were no stastical differences in HDL-C as well as LDL-C among them.4) Regression analysis showed that there was correlation between 24h-UAER and age, DM disease course,BMI,SBP,DBP, HbA1c,UA,SCr, BUN,and among these,disease course, SBP as well as HbA1c are 24h- UAER's independence risk factors.2. Macroangiopathy of the patients with T2DM possesses the following clinical features:1)Among 152 cases of these patients with T2DM,there were 60 cases of macroangiopathy.The incidence rate of macroangiopathy was 39.5 percent,in which ischemic heart diseases accounted for 19.7percent(30/152), the incidence rate of cerebrovascular diseases was 23.1percent(35/152)and the incidence rate of peripheral vascular diseases was 21.7percent(33/152). Obviously,the incidence rate of cerebrovascular diseases was the highest. 2)Age(73.2±8.8years old),the course of DM(10.5±7.3years),BMI (25.2±3.1kg/m2), the incidence rate of hypertension(67.8percent),SBP(143.5±16.2 mmHg),DBP(80.2±14.3mmHg)in MA group were remarkably higher than age(63.1±8.2 years old),the course of DM(6.5±5.9 years),BMI(24.1±2.4 kg/m2), the incidence rate of hypertension(46.1 percent),SBP(123.3±17.1mmHg),DBP(70.1±8.0 mmHg)in non-MA group.,the difference possessed prominence (P<0.01).3)Fasting Blood Glucose(7.5±0.8mmol/l),glycatedhempoglobin ( 9.7±1.1), (5.1±1.1mmol/l),LDL(3.3±0.8mmol/l) , the excretion of 24H proteinuria (231.6±111.6mg/24h)in MA group were remarkably higher than Fasting Blood Glucose(5.8±0.7 mmol/l),glycated hempoglobin (7.2±0.4),TC(4.5±0.9 mmol/l),LDL(2.1±0.5 mmol/l),the excretion 24H proteinuria(85.7±45.2 mg/24h)in non-MA group. consequently,the difference possessed prominence(P<0.01).However,there were no obvious differences between them in TG,HDL,BUN,SCr and UA.4)Regression analysis found that age,the course of DM,SBP,HbA1C,LDL and 24H-UAER independent risk factors of T2DM.3. The relationship between albuminuria and macroangiopathy in T2DM:1)With the 24H-UAER increasing,the incidence of DM macroangiopathy was upgrading.That is,albuminuria and the incidence rate of macrovascular disease were positively correlated.2)UAER of patients of T2DM with macroangiopathy was significantly higher than patients of T2DM without macroangiopathy.3)Took IMT as dependent variables to carry out multiple regression analysis showed that 24H-UAER is an independent risk factor for IMT.Conclusions:1.The incidence rate of proteinuria in patients of DM was 37.5perecent, and there were correlation between 24H-UAER and age, diabetes duration, BMI, SBP, DBP, HbA1c, UA, SCr and BUN,in which duration, SBP as well as HbA1c were independent risk factors of 24H-UAER.2.The incidence rate of macroangiopathy of T2DM was 39.5percent. And ression analysis, age,the course of DM,SBP,HbA1c, LDL,24H-UAER had indenpently relationship with macroangiopathy.3.Albuminuria was independent risk factor of macroangiopathy of DM.As the proteinuria was increasing,the incidence rate of macroangiopathy was remarkably adding.24H-UAER was the indepent risk factor of IMT.