The Relationship Between Urinary Albumin/Creatinine And Macroangiopathy And The Risk Factors Of Urinary Albumin/Creatinine In Patients With Type 2 Diabetes Mellitus

Objective: Microalbuminuria(MAU)is the early clinical manifestations of diabetic nephropathy(DN).Recently,many evidences indicated that MAU is a marker of systemic vascular endothelial cell damage,and a predictor for cardiovascular events.Study showed that A/Cr can be a simply,quickly and accurately marker to detect MAU.The UK chronic kidney disease guidelines recommend the cut point of A/Cr in diagnosis of MAU is ?2.5mg/mmol in males and ? 3.5mg/mmol in females,respectively.In this study we investigated urinary A/Cr in type 2 diabetes patients with or without macrovascular disease,and explore the relationship between urinary A/Cr and diabetic macrovascular disease and the risk factors of urinary albumin /creatinine.Methods:1 Subjects: A total of 84 patients(49 male,average 53.36 + 9.81 years,35 female,average 54.28 + 8.22 years)with type 2 diabetes were inrolled in this study from March 2014 to November 2014 in the Third Hospital of Hebei Medical University.This study was approved by the institutional review board of Hebei Medical University.Written informed consent was obtained from all subjects.Subjects with type 1 diabetes,specific type of diabetes or gestational diabetes,hyperglycemic crises(including diabetic ketoacidosis and hypergly--cemic hyperosmolar state),tumor,immune system disease,connective tissue disease,with primary nephropathy,urinary system diseases,heating,various stress state,taking the renal toxicity or medicines affecting urinary protein,blood uric acid,lipid profile and blood coagulation function were excluded.According to the physical examination and patients' history,electrocardiogram,CT or MRI/MRA imaging,myocardial perfusion imaging,coronary angiography imaging of carotid artery,double lower limbs artery ultrasonography,and cerebral blood flow imaging,the subjects were divided into two groups: type 2 diabetes without macroangiopathy group(n=40,24 male /16 female,average age 53.23 + 8.54 years)and type 2 diabetes with macroangiopathy group(n=44,25 male / 19 female,average age 54.57 + 8.69 years).GE Vivid7 color Doppler ultrasound was performed to detect the carotid artery and lower limbs artery,thickness of intima-media thickness(IMT),IMT thickness more than 1.2mm was considered atherosclerotic plaque[12].MRI/MRA,myocardial nuclide imaging,coronary angiography,and cerebral ultrasound examination was also performed.2 Methods:(1)physical indexes: including height,weight,systolic pressure,diastolic pressure,measured by the same person and calculated body mass index(BMI).(2)Biochemical parameters and urine A/Cr determination: venous blood samples were collected from all subjects who had been fasting over 8h overnight.Serum triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)were measured by automatic biochemistry analyzer(OLYMPUSAU-2700,Japan).Serum glucose was measured by glucose oxidase method.Uric acid was measured by enzyme colorimetric method.Serum creatinine was measured by picrate method.Plasma fibrinogen was measured by solidification method(FIB).Glycosylated hemoglobin(HbAlc)and uric albumin to creatinine ratio(A/Cr)was measured by rapid immune turbidimetric method(DCA2000? analyzer,Siemens).3 Satistical analysis: Data were analyzed by SPSS statistical software version 16.0.Normal distribution data were expressed as means ± SD.Data with distribution and homogeneity(?=0.10)were performed by one-way analysis of variance(ANOVA).LSD-t test was used between groups.Association between urinary A/Cr with other parameters were evaluated by Pearson correlation analysis.Multiple stepwise regression analysis was carried out for multivariate analysis.P < 0.05 was considered statistically significant.Results:1 Patients with macrovascular disease had longer course than patients without macroangiopathy.Compared with patients without macroangiopathy,the levels of TG,FIB,fasting blood glucose,blood creatinine,blood uric acid and HbAlc were significantly higher in patients with macroangiopathy(P < 0.05 or 0.01).2 Urinary A/Cr was significantly increased in type 2 diabetes patients with macroangiopathy than those without macroangiopathy(P < 0.01).3 Significant correlations between urinary A/Cr and serum creatinine,FIB,duration of diabetes,blood uric acid,fasting blood glucose,HbAlc,TG,TC(r=0.44,0.42,0.37,0.33,0.28,0.24,0.23,0.21,P < 0.05)were observed.Multiple regression analysis showed that FIB,duration of diabetes,blood uric acid,HbAlc,and TG were the independent predictor for urinary A/Cr.Y A/Cr = 0.132+0.021X1+0.016X2+0.019X3+0.014X4+0.025X5(X1: FIB,X2: HbAlc,X3: blood uric acid,X4: TG,X5: diabetes duration,P < 0.05).Conclusion:1 The urinary A/Cr is significantly elevated in type 2 diabetic patients with macroangiopathy.2 Urinary A/Cr can be a predicted factor to evaluate macrovascular disease in patients with type 2 diabetes.3 In type 2 diabetes patients,FIB,duration of diabetes,HbAlc,TG and blood uric acid are risk factors for urinary A/Cr increasing.