Analysis On Relationship Between Uirnary Protein Excretion Along With EGFR And Lower Extremity Arterial Disease And Its Related Factors In Type2Diabetic Inpatients

Objective Discussion of the relationship between diabetic nephropathy and lowerextremity arterial disease in patients with type2diabetes and its related factors, and toprovide basic information for the prevention and treatment of chronic complications oftype2diabetes.Method Complete information were collected from1225cases of type2diabetespatients who were hospitalized into the Endocrinology department of our hospital fromJanuary2009to October2012and met the inclusion criteria. The information includesthe course of the disease, age, sex, systolic blood pressure (SBP), height，body weight,fasting blood glucose (FBG),2-hour postprandial blood glucose (2hPBG), glycatedhemoglobin (HbA1c), lipids, creatinine, urinary albumin creatinine ratio (UACR),diabetic nephropathy, protein, ankle-brachial index, etc. According to K/DOQI chronickidney disease classification and the value of glomerular filtration rate (eGFR)calculated through Cockcroft-Gault function, the patients were divided into five groups:group A (eGFR in accordance with the glomerular filtration rate≥90ml/min), group B(60≤eGFR<90ml/min), group C (30≤eGFR<60ml/min), group D (15≤eGFR<30ml/min), E group (eGFR <15ml/min). According to urinary albumin creatinine ratio(ACR), the patients were also divided into three groups: group a (UACR <30mg/gCr),group b (30≤UACR<300mg/gCr), group c (UACR≥300mg/gCr). In addition, accordingto the value of the ankle-brachial index (ABI) calculated by ultrasonic flowmeterES-100V3, the patients were divided into2groups: group I (ABI>0.9), group Ⅱ(ABI≤0.9). These groups will be analyzed statistically between each other.Results1. Among the1225cases of type2diabetes patients, incidence of diabetic urineprotein (microalbuminuria+massive proteinuria) was38.8%, abnormal eGFR had a rate of75.4%, abnormal ABI was26.3%. Abnormal ABI accounted for22.5%out of thetotal of abnormal UACR, Abnormal ABI also accounted for16.7%out of the total ofabnormal eGFR, and ABI abnormality accounted for28.2%out of both abnormalUACR and abnormal eGFR. There was statistically significant difference in theseresults (P <0.05). Different gender in this study showed no statistically significantdifference (P>0.05).2.In different UACR groups, with the increase of UACR, eGFR, ALB, TRF, IgG andRBP also increased accordingly, and ABI, THP declined, difference of each group wasstatistically significant (P <0.05). In different eGFR groups, along with a decline ineGFR values, the UACR, ALB, TRF, IgG and RBP were higher, ABI, THP levelsdeclined, each group difference was statistically significant (P <0.05). In different ABIgroups, with the decline in ABI, UACR, ALB, TRF, IgG and RBP values increased andeGFR, THP levels declined, each group difference was statistically significant (P<0.05).3.Logistic regression analysis showed that: the increase of SBP（OR:1.487，P＜0.05）were the independent risk factor that had increased UACR; And the increase of SBP（OR:1.158，P＜0.05）, and UACR （OR:0.617，P＜0.05）were the independent riskfactor that had caused eGFR decline; the increase of HbA1C（OR:1.187，P＜0.05）,BMI（OR:1.504，P＜0.05）, SBP（OR:1.045，P＜0.05）, UACR（OR:1.557，P＜0.05）,and the decline of eGFR（OR:1.059，P＜0.05） were the independent risk factors thathad caused a decrease of ABI.Conclusion1.This study shows that with the increase of urinary protein excretion, eGFR and ABIdecreased;2.The results of this study shows the relationship between diabetic nephropathy anddiabetic lower extremity vascular disease. United UACR and eGFR significantlyimprove the diagnosis of diabetic patients with lower extremity vascular disease. 3.With the extension of the diabetes duration, diabetic nephropathy and lower extremityvascular disease incidence increased. Systolic hypertension and increased urinaryprotein will accelerate the progression of diabetic nephropathy.4.Long-term poor glycemic control and weight gain, and increased urinary proteinexcretion may predict diabetic lower extremity vascular disease.5.This study showed that gender and age had no statistically significant difference ondiabetic nephropathy and lower extremity vascular disease.