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投稿时间：2025-07-29 网络发布日期：2025-09-19
投稿时间：2025-07-29 网络发布日期：2025-09-19
中文摘要: 目的 探讨以身体质量指数（BMI）、腰围、内脏脂肪面积（VFA）、皮下脂肪面积（SFA）为主的肥胖评估参数与中老年 2型糖尿病（T2DM）患者尿白蛋白 /肌酐比值（UACR）的相关性。方法 选取 2022年 8月至 2025年 6月在南京医科大学附属老年医院就诊的 1 034例中老年 T2DM患者进行回顾性分析。收集患者一般资料，定肥胖评估参数指标、生化指标、 UACR等，以 UACR ≥30 mg/g定义为白蛋白尿，分为合并白蛋白尿组（n=293）和不合并白蛋白尿组（n=741），并分析肥胖评估参数与各项临床指标的相关性。绘制受试者工作特征（ROC）曲线评估各肥胖评估参数预测白蛋白尿的效能。结果 中老年 T2DM患者合并白蛋白尿组的年龄、糖尿病病程、吸烟率、收缩压、 BMI、腰围、血管紧张素转换酶抑制剂 /血管紧张素受体拮抗剂（ACEI/ARB）使用率、空腹葡萄糖（FPG）、糖化血红蛋白（HbA1C）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、尿素氮、血肌酐、 UACR、VFA、 SFA均显著高于不合并白蛋白尿组（P＜0.05）。二元线性回归分析显示，校正混杂因素后，中老年 T2DM患者发生白蛋白尿的危险因素包括高 VFA（OR= 1.010，95%CI:1.004~1.016，P= 0.001）、高 SFA（OR= 1.005，95%CI:1.002~1.009，P= 0.002）、高 BMI（OR= 1.107，95%CI:1.036~1.182，P= 0.003）和腰围大（OR= 1.048，95%CI:1.024~1.074，P＜0.01）。VFA、SFA、BMI、腰围评估中老年 T2DM患者出现白蛋白尿的曲线下面积（AUC）分别为 0.620、0.584、0.592和0.613，截断值分别为 79.2 cm2、162.9 cm2、24.3 kg/m2和 87.5 cm。结论 中老年 T2DM患者 VFA、SFA、BMI、腰围升高均为白蛋白尿的危险因素， VFA对白蛋白尿的预测效能优于 SFA、BMI、腰围。
Abstract:Objective To explore the correlation between obesity evaluation parameters [including body mass index (BMI), waist circumference (WC), visceral fat area (VFA), and subcutaneous fat area (SFA) ]and urinary albumin-to - creatinine ratio (UACR) in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM). Methods A retrospective analysis was conducted on 1 034 middle - aged and elderly T2DM patients who were admitted to the Geriatric Hospital of Nanjing Medical University from August 2022 to June 2025. General data, obesity evaluation parameters, biochemical indicators and UACR were measured. UACR ≥ 30 mg/g was defined as albuminuria. The patients were divided into two groups according to the presence or absence of albuminuria albuminuria group (n=293) and non-albuminuria group (n=741), and the correlation between obesity evaluation parameters and various clinical indicators were analyzed. Receiver operating characteristic (ROC) curves were drawn to evaluate the efficacy of various obesity evaluation parameters in predicting albuminuria. Results Age, duration of diabetes, the proportions of smoking, systolic blood pressure, BMI, WC, utilization rate of angiotensin-converting enzyme inhibitors (ACEI) /angiotensin receptor blocker (ARB), fasting plasma glucose (FPG), glycated hemoglobin (HbA1C), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), blood urea nitrogen (BUN), serum creatinine, UACR, VFA, and SFA in the albuminuria group were significantly higher than those in non-albuminuria group (P＜0.05). After adjusting for confounding factors in binary line regression analysis, the risk factors for albuminuria in middle-aged and elderly patients with T2DM were high VFA (OR= 1.010, 95%CI: 1.004-1.016, P= 0.001), high SFA (OR= 1.005, 95%CI: 1.002 1.009, P= 0.002), high BMI (OR= 1.107, 95%CI: 1.036-1.182, P= 0.003) and high WC (OR= 1.048, 95%CI: 1.024-1.074, P＜0.01). The area under curve (AUC) of VFA, SFA, BMI and WC for predicting albuminuria was 0.620, 0.584, 0.592 and 0.613, withthecut-offvalueof79.2cm2, 162.9cm2, 24.3kg/m2and87.5cm, respectively. Conclusion Elevated VFA, SFA, BMI and WC are the risk factors for albuminuria in middle-aged and elderly patients with T2DM. The predictive efficacy of VFA for albuminuria is superior to SFA, BMI, and WC.
keywords: Type 2 diabetes mellitus Urinary albumin-to-creatinine ratio Visceral fat area Subcutaneous fat area Body mass index Waist circumference Albuminuria
文章编号： 中图分类号：R587.1 文献标志码：A
基金项目:江苏省卫健委重点项目（K2024062）；江苏省重点研发计划社会发展项目（BE2023774）
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引用文本：
俞匀,唐伟.中老年2型糖尿病患者肥胖评估参数与尿白蛋白/肌酐比值的相关性[J].中国临床研究,2025,38(9):1324-1328.
俞匀,唐伟.中老年2型糖尿病患者肥胖评估参数与尿白蛋白/肌酐比值的相关性[J].中国临床研究,2025,38(9):1324-1328.