文献类型：期刊文献

中文题名：2型糖尿病患者尿白蛋白肌酸酐比值与心率变异性的相关性研究

英文题名：Relationship between urinary albumin creatinine ratio and heart rate variability in patients with type 2 diabetes mellitus

作者：刘胜男[1];王丽娟[1];武振亚[1];马红梅[1];王金羊[1,2]

第一作者：刘胜男

机构：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000;[2]甘肃省人民医院内分泌科,甘肃兰州730000

第一机构：甘肃中医药大学临床医学院

年份：2025

卷号：41

期号：7

起止页码：916

中文期刊名：中国临床药理学杂志

外文期刊名：The Chinese Journal of Clinical Pharmacology

收录：;北大核心:【北大核心2023】；

基金：国家自然科学基金资助项目(82360163);甘肃省自然科学基金资助项目(24JRRA589)。

语种：中文

中文关键词：2型糖尿病;蛋白尿;心率变异性;尿白蛋白肌酸酐比值

外文关键词：type 2 diabetes mellitus;proteinuria;heart rate variability;urinary albumin creatinine ratio

摘要：目的分析2型糖尿病(T2DM)患者尿白蛋白肌酸酐比值(UACR)与心率变异性(HRV)的相关性。方法将T2DM患者按队列法分为对照组(单纯T2DM患者)和试验组(T2DM合并蛋白尿患者),并将试验组进一步分为微量蛋白尿亚组(UACR 30~300 mg·g^(-1))和大量蛋白尿亚组(UACR≥300 mg·g^(-1))。收集患者的一般临床资料、生化指标及24 h动态心电图报告,记录各组患者HRV相关指标[相邻RR间期均值>50 ms心搏百分比(PNN50)、RR间期总体标准差(SDNN)等],计算体质量指数(BMI)和估算肾小球滤过率(eGFR)。比较各组临床资料和HRV参数的差异,分析UACR对HRV的影响及相互关系,用受试者工作特征(ROC)曲线预测T2DM患者出现蛋白尿的最佳切点。结果试验组入组190例,对照组入组184例;微量蛋白尿亚组入组120例,大量蛋白尿亚组入组70例。试验组和对照组的UACR水平分别为113.99和12.76 mg·mmol^(-1) Cr,尿白蛋白排泄率(UAER)水平分别为74.81和10.92μg·min^(-1),尿酸(UA)水平分别为(353.83±96.41)和(326.17±81.64)μmol·L^(-1),PNN50分别为2.25和3.95,SDNN分别为102.83±38.10和114.14±31.23,HRV三角指数分别为20.80和25.55,在统计学上差异均有统计学意义(均P<0.05)。大量蛋白尿亚组和微量蛋白尿亚组的UACR水平分别为1088.17和64.64 mg·mmol^(-1) Cr,UAER水平分别为878.65和44.26μg·min^(-1),UA水平分别为(375.88±97.58)和(340.97±93.74)μmol·L^(-1),PNN50分别为1.50和2.70,SDNN分别为88.00和108.00,HRV三角指数分别为19.49±7.77和24.48±8.84,在统计学上差异均有统计学意义(均P<0.05)。Logistic回归分析显示:糖尿病病程、空腹血糖(FPG)和HRV三角指数是T2DM患者出现蛋白尿的影响因素。ROC显示:HRV三角指数的ROC曲线下面积最大,灵敏度为66.10%,特异度为63.00%。结论T2DM患者的UACR与DM病程、FPG、HRV三角指数密切相关,随着T2DM患者UACR升高,心血管自主神经病变风险升高。
Objective To analysis the relationship between urinary albumin creatinine ratio(UACR)and heart rate variability(HRV)in patients with type 2 diabetes mellitus(T2DM).Methods Patients with T2DM were divided into control group(patients with T2DM only)and treatment group(patients with T2DM and proteinuria)using the cohort method.The treatment group was further divided into a microalbuminuria subgroup(UACR 30-300 mg·g^(-1))and a macroalbuminuria subgroup(UACR≥300 mg·g^(-1)).Collected general clinical data,biochemical indicators and 24-hour holter electrocardiogram reports from patients,recorded HRV-related indicators[including pairs of normal N-N Intervals differ by more than 50 ms(PNN50),standard deviation of normal-to-normal R-R intervals(SDNN),etc]of each group of patients,and calculated body mass index(BMI)and estimated glomerular filtration rate(eGFR).Compared the diferences in clinical data and HRV parameters among groups,analyzed the impact of UACR on HRV and their interrelationships,and used the receiver operating characteristic curve(ROC)to predict the optimal cutoff point for the occurrence of proteinuria in T2DM patients.Results The treatment group enrolled 190 cases,and the control group enrolled 184 cases;the microalbuminuria subgroup enrolled 120 cases,and the macroalbuminuria subgroup enrolled 70 cases.The levels of UACR in the treatment and control groups were 113.99 and 12.76 mg·mmol^(-1)Cr,the levels of UAER were 74.81 and 10.92μg·min^(-1),the levels of UA were(353.83±96.41)and(326.17±81.64)μmol·L^(-1),the levels of PNN50 were 2.25 and 3.95,the levels of SDNN were 102.83±38.10 and 114.14±31.23,the levels of HRV triangular index were 20.80 and 25.55,respectively;the differences of above results were statistically significant between two groups(all P<0.05).In the macroalbuminuria and microalbuminuria subgroups,the levels of UACR were 1088.17 and 64.64 mg·mmol^(-1)Cr,the levels of UAER were 878.65 and 44.26μg·min^(-1),the levels of UA were(375.88±97.58)and(340.97±93.74)μmol·L^(-1),the levels of PNN50 were 1.50 and 2.70,the levels of SDNN were 88.00 and 108.00,the levels of HRV triangular index were 19.49±7.77 and 24.48±8.84,respectively;the differences of above results were statistically significant between two subgroups(all P<0.05).Logistic regression analysis showed that the duration of diabetes mellitus,fasting blood glucose(FPG)and HRV triangle index were the influencing factors for the occurrence of proteinuria in patients with type 2 diabetes mellitus.ROC showed that HRV triangle index had the largest area under ROC curve,with 66.10%sensitivity and 63.00%specificity.Conclusion UACR in T2DM patients is closely related to the duration of DM,FPG and HRV triangle index,with the increase of UACR in T2DM patients,the risk of cardiovascular autonomic neuropathy increases.