Relationship Between Renal Function And Carotid Atherosclerosis In Patients With Type 2 Diabetes Mellitus

Objective: To investigate the relationship between glomerular filtration rate(e GFR)and carotid atherosclerosis in patients with type 2 diabetes mellitus.Methods: 733 patients with type 2 diabetes mellitus(T2DM)were selected from the Department of Endocrinology of the first affiliated Hospital of Shenzhen University.The patients were divided into Q1 group(12.13-90.12 ml/(min·1.73m~2)),Q2(90.36-105.88 ml/(min·1.73m~2)),Q3(106.03-115.75 ml/(min·1.73m~2)),Q4(115.76-168.55 ml/(min·1.73m~2))four subgroups by e GFR quartile method.The patients were divided into two groups according to whether they had carotid atherosclerosis or not,and the differences in sex,age,BMI,duration of diabetes mellitus,history of hypertension,smoking history and other biochemical indexes were compared among each group.Univariate Logistic was used to analyze the risk factors of carotid atherosclerosis.Multivariate non-conditional logistic regression was used to analyze the relationship between e GFR and carotid atherosclerosis.A generalized linear model was used to identify the relationship between e GFR and carotid atherosclerosis and the linear relationship was obtained by curve fitting.The factors that may affect the relationship between e GFR and carotid atherosclerosis were analyzed by stratified interactive test.Finally,ROC curve was used to observe the effect of e GFR on carotid atherosclerosis,and the corresponding cut-off value was found.Results: compared with the four subgroups of e GFR,the duration of diabetes mellitus was shorter(P < 0.001),the age was younger(P < 0.001),the proportion of history of hypertension and carotid atherosclerosis was lower(all P < 0.001),and the systolic blood pressure(SBP),Homocysteine(HCY),serum uric acid(SUA),24 hours urine albumin level decreased(all P < 0.001),while diastolic pressure(DBP),serum albumin(ALB)increased with the increase of e GFR level(all P < 0.001).Compared with the non-carotid atherosclerosis group,the percentage of male patients was lower(P < 0.001),the duration of diabetes mellitus was longer(P < 0.001),and the body mass index(BMI)was bigger(P < 0.001),the proportion of patients with history of hyper-tension was higher(28.81% vs 54.91%,P < 0.001),SBP,triglyceride(TG),HCY,SCr,24 hours urine albumin(all P < 0.001),DBP,HDL,e GFR,ALB decreased(all P < 0.05)in the carotid atherosclerosis group.Univariate analysis showed that age,the duration of diabetes mellitus and BMI,SPB,HCY,SCr were risk factors for carotid atherosclerosis(all P<0.05),DBP,HDL,e GFR,ALB was protective factor(all P < 0 05).Multivariate non-conditional logistic regression analysis was used to evaluate the relationship between e GFR and carotid atherosclerosis.It was found that e GFR was a protective factor of carotid atherosclerosis after adjusting the related confounding factors(OR = 0.987,95%CI = 0.977 ~ 0.998,P = 0.019),and independent correlation.The e GFR quadrant method was divided into continuous variables,and its trend was still statistically significant(P=0.046).By smoothing curve fitting and adjusting the confounding factors,there was a linear correlation between e GFR and carotid atherosclerosis.Stratified interactive analysis showed that only sex,smoking history had an effect on the relationship between e GFR and carotid atherosclerosis,age,history of hypertension,duration of diabetes mellitus,SBP,DBP,BMI,Hb A1 c,fasting blood glucose(FBG),TG,TC,LDL,HDL,HCY,SUA,24 hours urine albumin and ALB had no effect on the relationship between them.The area under the ROC curve of e GFR for predicting carotid atherosclerosis in type 2 diabetic patients was 0.702,and the cut-off value was 106.2425(ml/(min·1.73m~2)).Conclusion: The level of renal function in type 2 diabetic patients is a protective factor of carotid atherosclerosis,and the two are independently correlated.