The Correlation Analysis On Urinary Albumin-to-Creatinine Ratio, Carotid Atherosclerosis And The Risk Factors Of CAS In Patients With Type 2 Diabetes

1 Background Atherosclerosis(AS) is a set of systemic disease, and a diffuse vascular lesions disease. It is characterized by lipid deposition, smooth muscle cells and collagen fiber hyperplasia, secondary necrosis, which can cause atheromatous plaque formation, even can cause vascular stenosis disease in blood vessels. AS is the mortality and morbidity of the highest kind of disease. Now we have further understanding about AS, with the progressing of research, especially the molecular biology. Compared with non-diabetic patients the incidence of the AS is higher, the progress is faster, the area of lesions is wider, the illness is worse in the patients with T2 DM. Urinary albumin- to- creatinine ratio(UACR) is one of the evaluation index of diabetic microvascular lesions. UACR is non-invasive, easy to promote, quickly, easy and accurate. Diabetic nephropathy and diabetic peripheral vascular disease are the common complication of diabetes. The previous researches always focus on the relationship of coronary heart disease, cerebral infarction and urine trace albumin. Toanalyze whether the relationship between carotid intima thickness(CIMT) and urinary albumin- to- creatinine ratio(UACR) of type 2 diabetes mellitus(T2DM) patients is existed; and to analyze the risk factors of carotid artery atherosclerosis. So we can know more about the complication of T2 DM patients.2 Object To analyze the clinical data of patients with type 2 diabetes, and explore the risk factors of carotid atherosclerosis and the relationship between UACR and carotid atherosclerosis. So we can evaluate the complications of patients, treat them timely, prolong the life of patients, and improve the quality of survival.3 Method The clinical data of 384 patients with T2 DM of hospitalization treatment in June 2014 to March 2016 were retrospectively analyzed. The data of age, gender, height, weight, the duration of diabetes, the duration of hypertension and blood pressure of patients were collected. The plaques in carotid arteries and intima-media thickness(IMT) were measured with high resolution ultrasound, and recorded the scores of plagues. UACR, fasting insulin(FINS), fasting blood glucose(FBG), total cholesterol(TC), triglyceride(TG), high-density lipoprotein(HDL-c), low density lipoprotein(LDL-c), glycosylated hemoglobin(HAb1C) were collected at the same time. Patients were divided into three groups according to the carotid artery intima thickness(CIMT), including the group with normal carotid intima– media(group A, n=72), the group with thickened carotid intima – media(group B, n=160) and the group with carotid artery plague(group C, n=152). Carotid artery plaque integral was calculated according to the number of carotid plaques and thickness of plaques, then statistical analysis them by SPSS 16.0 software.4 Results(1) The correlation analysis results showed that UACR was positively related to plaque integral(r =0.449, P<0.001).And age, duration of diabetes, duration of hypertension, SBP, creatinine, LDL-c were positively related to plaque integral(r = 0.369, 0.375, 0.326, 0.114, 0.168, 0.106, all P < 0.05). DBP was negatively related to plaque integral(r=-0.135,P=0.008).(2) Multi-factor logistic regression analysis showed UACR[OR(95%CI) =1.012(1.001~1.023)],age[OR(95%CI)= 1.050(1.013~1.089)], duration of diabetes[OR(95%CI)= 1.066(1.011~ 1.124)], duration of hypertension[OR(95%CI)= 1.062(1.011~1.115)],SBP[OR(95%CI)= 1.027(1.001~1.053)],Hb A1C[OR(95%CI)= 1.294(1.061~1.577)],were the risk factors of carotid atherosclerosis in patients with T2DM(all P<0.05).5 Conclusion UACR was positively related to plaque integral, which was the risk factor of carotid atherosclerosis in T2 DM patients. UACR can be regard as a predictor of CAS. Besides, age, duration of diabetes, duration of hypertension, SBP, Hb A1 C were the risk factors of atherosclerosis in T2 DM patients. From this study it suggests that smooth control of blood pressure,blood glucose,lowering urinary albumin and other measures can slow the progression of macro-vascular disease.