Research On Relationship Between Ankle-Brachial Index Along With Urinary Albumin To Creatinine Ratio And Neutrophil Lymphocyte Ratio And Its Risk Factors In Type 2 Diabetic Patients

Objective Discussion of the relationship between ankle-brachial index(ABI)along with urinary albumin to creatinine ratio(UACR)and neutrophil lymphocyte ratio(NLR)in type 2 diabetic patients,and analyze the risk factors of abnormal ABI and abnormal UACR.Method A total of 1009 patients with type 2 diabetes mellitus(T2DM)in Department of Endocrinology,Anhui Provincial Hospital between September 2014 and August 2016 were retrospectively studied for gender,age,duration of diabetes,height,weight,blood pressure,smoking history,history of coronary heart disease and cerebral infarction and laboratory related examination parameters.According to the different ABI value,the patients were divided into two groups: group I(normal ABI group,ABI>0.9)and group II(abnormal ABI group,ABI≤0.9).According to the different UACR value,the patients were divided into three groups: group A(group normal proteinuria,UACR<30mg/gCr)、group B(group microalbuminuria,30mg/gCr≤UACR<300mg/gCr)and group C(group a lot of proteinuria,UACR≥300mg/gCr).These groups will be analyzed with statistical method between each other.Result 1.A total of 1009 patients with type 2 diabetes mellitus were included in this study,with 730 patients in group I,279 patients in group II,and an abnormal rate of ABI of 27.65%.The age,duration,smoking history,systemic blood pressure(SBP),body mass index(BMI),glycosylated hemoglobin A1c(HbA1c),NLR,total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),blood urea nitrogen(BUN),serum creatinine(Scr),the incidence of diabetic nephropathy(DN),the incidence of diabetic retinopathy(DR),prevalence of coronary heart disease and prevalence of cerebral infarction in group II were significantly older than the group I,while eGFR less than the group I.The differences were statistically significant(P <0.05).The diastolic blood pressure(DBP),high-density lipoprotein cholesterol(HDL-C)and uric acid(UA)between the two groups was no significant difference(P> 0.05).2.In our study,there were 564 cases in group A,300 cases in group B and 145 cases in group C.The incidence of UACR abnormalities(microalbuminuria + massive proteinuria,or UACR≥30mg/gCr)was 44%,of which microalbuminuria accounted for 30%,a large number of proteinuria accounted for 14%.(1)The duration,SBP,NLR,BUN,Scr,UA and the incidence of cerebral infarction of the three groups increased with the increase of UACR,eGFR decreased with the increase of UACR,the differences between the groups were statistically significant(P <0.05),while the comparison of HDL-C in the three groups was no significant difference(P> 0.05).(2)The age,BMI,HbA1 C and the incidence of coronary heart disease of group B were higher than that of group A,the differences were statistically significant(P <0.05),while there was no statistically significant difference in smoking history,TC,TG and LDL-C(P> 0.05).(3)The age,DBP,BMI,HbA1 C,TC,TG,LDL-C and the incidence of coronary heart disease of group C were higher than that of group A,the differences were statistically significant(P <0.05),while there was no statistically significant difference in smoking history(P> 0.05).(4)The smoking history,DBP,TC,TG and LDL-C of group C were higher than that of group B,the differences were statistically significant(P <0.05),while there was no statistically significant difference in age,BMI,HbA1 C and the coronary heart disease(P> 0.05).3.ROC curve analysis showed that:(1)The predicted value of abnormal ABI by NLR: The area under the ROC curve was 0.598(P <0.05).Calculate Youden index and determine the best value.When the Youden index was 0.182,the sensitivity was 44.1%,the specificity was 74.1% and the NLR was 2.345.(2)The predicted value of abnormal UACR by NLR: The area under the ROC curve was 0.63(P <0.05).Calculate Youden index and determine the best value.When the Youden index was 0.194,the sensitivity was 37.3%,the specificity was 82.1% and the NLR was 2.475.4.Logistic analysis showed that:(1)The long course,a history of smoking,increased SBP,increased HbA1 C,increased NLR and decreased eGFR were the independent risk factor of abnormal ABI(P <0.05,OR values were 1.071,1.587,1.016,1.158,1.091,0.987).(2)The long course,increased SBP,increased BMI,increased HbA1 C,increased NLR,decreased eGFR and decreased ABI were the independent risk factor of abnormal UACR(P <0.05,OR values were 1.044,1.027,1.063,1.192,1.183,0.99,1.808).Conclusion 1.The NLR value is closely related to the ABI value and the UACR value.The NLR value increases with the decrease of ABI level and increases with the increase of UACR level.The NLR level can predict the occurrence and severity of diabetic lower extremity vascular disease and diabetic nephropathy.In clinical,NLR value can be used to assess the occurrence and development of diabetic lower extremity vascular disease and diabetic nephropathy.And there can reduce the incidence of disease,delay disease progression,and improve prognosis by inhibiting the inflammatory response in the early stage of the disease.2.With the decrease of ABI and the increase of UACR,the prevalence of coronary heart disease and cerebral infarction in T2 DM patients also significantly increased.3.Patients with type 2 diabetes should lose weight and quit smoking,and strengthen the control of blood pressure and blood sugar to reduce the occurrence and development of diabetes-related complications.