外源性胰岛素自身免疫综合征与糖尿病肾病关联性分析

doi:10.3969/j.issn.1004-583X.2025.11.005

摘要/Abstract

摘要：

目的探究外源性胰岛素自身免疫综合征(exogenous insulin autoimmune syndrome, EIAS)与糖尿病患者肾脏损害之间的关联性。方法连续收集2023年6月-2024年3月我院内分泌科收治的具有胰岛素自身抗体(insulin autoantibody, IAA)检测结果的糖尿病患者,根据IAA结果分为对照组与EIAS组,比较2组间临床特征与尿白蛋白肌酐比值(albumin-to-creatinine ratio, ACR);根据ACR 30 mg/g为界值进行分组,比较2组临床特征;采用单因素与多因素logistic回归分析EIAS与ACR升高的关联性。结果共纳入115例具有IAA检测结果的糖尿病患者,其中EIAS 36例(31.3%)。与对照组相比,EIAS组平均年龄更大、糖尿病病程更长、每日胰岛素用量更高,门冬胰岛素和预混人重组胰岛素制剂使用频率更高(均P<0.05)。EIAS组空腹血糖和糖化血红蛋白水平更低,空腹与餐后2 h胰岛素水平更高,胰岛素抵抗指数升高(均P<0.05)。单因素logistic回归分析显示,EIAS与ACR升高显著相关(OR=2.70, 95%CI: 1.20~6.60, P=0.016)。而在校正年龄、糖尿病病程、胰岛素剂量、肾小球滤过率、空腹血糖、空腹胰岛素及糖化血红蛋白后,关联显著性消失(OR=2.89, 95%CI: 0.95~8.79, P=0.062)。结论糖尿病合并EIAS患者更易出现血糖波动不稳,胰岛素抵抗与肾脏损害更为严重,临床医师应重视EIAS的筛查与管理。

关键词: 胰岛素自身免疫综合征, 尿白蛋白肌酐比值, 高胰岛素血症, 胰岛素抵抗

Abstract:

Objective To evaluate the association between exogenous insulin autoimmune syndrome (EIAS) and renal dysfunction in patients with diabetes mellitus. Methods We consecutively enrolled patients with diabetes mellitus admitted to the Department of Endocrinology between June 2023 and March 2024 who underwent insulin autoantibody (IAA) testing. Participants were stratified into an EIAS group (IAA-positive) and a control group (IAA-negative). Clinical characteristics and urine albumin-to-creatinine ratio (ACR) were compared between groups. Patients were further categorized by albuminuria severity (ACR threshold of 30 mg/g). Univariable and multivariable logistic regression models were used to assess the relationship between EIAS and elevated ACR. Results Among 115 eligible patients, 36 (31.3%) met the diagnostic criteria for EIAS. Compared with controls, EIAS patients exhibited distinct clinical profiles: Older age, longer diabetes duration, higher daily insulin requirements, and preferential use of insulin aspart or premixed human insulin formulations (all P<0.05). EIAS patients exhibited lower fasting plasma glucose and HbA1c but higher fasting and 2-h postprandial insulin concentrations and an elevated HOMA IR (all P<0.05). In univariable logistic regression, EIAS was significantly associated with elevated ACR (OR=2.70; 95%CI: 1.20-6.60; P=0.016). However, after adjustment for age, diabetes duration, insulin dose, estimated glomerular filtration rate (eGFR), fasting glucose, fasting insulin, and HbA1c, this association was attenuated and lost statistical significance (adjusted OR=2.89; 95%CI: 0.95-8.79; P=0.062). Conclusion Diabetes mellitus patients with concomitant EIAS are more likely to experience marked glycemic variability, increased insulin resistance, and more advanced renal impairment. Clinicians should therefore be vigilant in screening for EIAS and actively manage affected patients.

Key words: insulin autoimmune syndrome, urinary albumin-to-creatinine ratio, hyperinsulinemia, insulin resistance

中图分类号:

R587.3

阮鹏, 张能涵, 张春艳, 韩拓, 王聪霞. 外源性胰岛素自身免疫综合征与糖尿病肾病关联性分析[J]. 临床荟萃, 2025, 40(11): 999-1005.

Ruan Peng, Tayyaba Khan, Zhang Nenghan, Zhang Chunyan, Han Tuo, Wang Congxia. Association between exogenous insulin autoimmune syndrome and diabetic kidney disease[J]. Clinical Focus, 2025, 40(11): 999-1005.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.11.005

https://www.lchc.cn/CN/Y2025/V40/I11/999

图/表 5

表1 EIAS组与对照组临床特征比较

Tab.1 Comparison of clinical characteristics between the EIAS group and the control group

变量	总体( $n$ =115)	对照组( $n$ =79)	EIAS组( $n$ =36)	$t$ /χ²值	$P$ 值
年龄(岁)	51.3±17.6	47.1±16.3	60.8±17.0	17.004	<0.01
性别[例(%)]
男性女性	66(57.4) 49(42.6)	49(62.0) 30(38.0)	17(47.2) 19(52.8)	2.216	0.137
BMI(kg/m²)	22.9±3.3	22.6±3.2	23.5±3.5	2.133	0.147
糖尿病类型[例(%)]
T1DM	11(9.6)	8(10.1)	3(8.3)
T2DM	92(80.0)	60(75.9)	32(88.9)		0.157
LADA	12(10.4)	11(13.9)	1(2.8)
病程(年)	10.0(2.0, 16.0)	6.0(1.0, 14.0)	12.5(7.8, 20.0)	7.876	0.005
胰岛素剂量(IU)	27.0(10.0, 42.0)	20.0(0.0, 38.0)	36.5(25.5, 49.2)	11.414	<0.01
吸烟史[例(%)]	43(37.4)	33(41.8)	10(27.8)	2.069	0.150
饮酒史[例(%)]	20(17.4)	17(21.5)	3(8.3)	2.993	0.084
血小板计数(×10⁹/L)	222.6±63.6	222.8±63.5	222.2±64.6	0.002	0.962
中性粒细胞计数(×10⁹/L)	4.0±1.5	3.9±1.6	4.3±1.3	1.216	0.272
单核细胞计数(×10⁹/L)	0.4±0.1	0.4±0.1	0.4±0.1	0.001	0.971
淋巴细胞计数(×10⁹/L)	1.7±0.7	1.7±0.7	1.6±0.7	0.451	0.503
谷丙转氨酶(IU/L)	18.5(13.2, 27.8)	17.0(13.0, 27.5)	20.0(15.0, 27.5)	0.474	0.491
谷草转氨酶(IU/L)	21.9±12.3	21.8±13.8	22.1±8.2	0.022	0.883
白蛋白(g/L)	44.6±3.7	44.7±3.3	44.2±4.5	0.486	0.487
血尿酸(μmol/L)	293.5±101.3	287.9±110.0	305.6±79.1	0.687	0.409
尿素氮(mmol/L)	5.5±2.1	5.5±2.1	5.6±2.1	0.107	0.744
血肌酐(mmol/L)	66.0±27.6	63.1±28.7	72.6±23.9	2.951	0.089
肾小球滤过率[ml/(min·1.73 m²)]	99.6±25.5	105.0±25.1	87.4±22.2	11.983	<0.01
总胆固醇(mmol/L)	4.6±1.6	4.8±1.7	4.3±1.3	1.960	0.164
甘油三酯(mmol/L)	1.4(1.0, 2.1)	1.4(1.0, 2.4)	1.4(0.9, 1.7)	0.946	0.331
低密度脂蛋白胆固醇(mmol/L)	1.3±0.3	1.3±0.3	1.3±0.3	0.029	0.865
高密度脂蛋白胆固醇(mmol/L)	2.7±1.0	2.8±1.0	2.5±1.0	1.275	0.261
空腹血糖(mmol/L)	11.5±5.3	12.4±5.9	9.6±3.0	7.616	0.007
空腹胰岛素(mU/L)	4.3(2.1, 14.7)	2.9(1.3, 6.2)	13.1(5.4, 35.0)	22.303	<0.01
空腹C肽(ng/ml)	0.9(0.6, 1.6)	0.8(0.6, 1.5)	1.1(0.7, 1.8)	3.463	0.063
餐后2 h血糖(mmol/L)	15.1±4.5	15.0±4.2	15.4±5.2	0.109	0.742
餐后2 h胰岛(mU/L)	10.5(4.5, 20.4)	8.2(3.6, 14.7)	19.5(10.8, 41.8)	14.863	<0.01
餐后2 h C肽(ng/ml)	1.8(1.2, 3.0)	1.8(0.9, 2.9)	2.1(1.5, 3.5)	2.546	0.111
糖化血红蛋白(%)	9.4±2.3	9.9±2.5	8.3±1.6	13.022	<0.01
HOMA-IR	2.3(0.9, 6.1)	1.8(0.7, 3.6)	6.1(2.3, 14.2)	17.133	<0.01
ACR(mg/g)	17.1(7.1, 83.5)	14.8(6.6, 53.9)	51.8(8.1, 114.6)	4.034	0.045
ACR分级[例(%)]
<30 mg/g	67(58.3)	52(65.8)	15(41.7)
[30, 300) mg/g	35(30.4)	20(25.3)	15(41.7)		0.051
≥300 mg/g	13(11.3)	7(8.9)	6(16.7)

表1 EIAS组与对照组临床特征比较

Tab.1 Comparison of clinical characteristics between the EIAS group and the control group

变量	总体( $n$ =115)	对照组( $n$ =79)	EIAS组( $n$ =36)	$t$ /χ²值	$P$ 值
年龄(岁)	51.3±17.6	47.1±16.3	60.8±17.0	17.004	<0.01
性别[例(%)]
男性女性	66(57.4) 49(42.6)	49(62.0) 30(38.0)	17(47.2) 19(52.8)	2.216	0.137
BMI(kg/m²)	22.9±3.3	22.6±3.2	23.5±3.5	2.133	0.147
糖尿病类型[例(%)]
T1DM	11(9.6)	8(10.1)	3(8.3)
T2DM	92(80.0)	60(75.9)	32(88.9)		0.157
LADA	12(10.4)	11(13.9)	1(2.8)
病程(年)	10.0(2.0, 16.0)	6.0(1.0, 14.0)	12.5(7.8, 20.0)	7.876	0.005
胰岛素剂量(IU)	27.0(10.0, 42.0)	20.0(0.0, 38.0)	36.5(25.5, 49.2)	11.414	<0.01
吸烟史[例(%)]	43(37.4)	33(41.8)	10(27.8)	2.069	0.150
饮酒史[例(%)]	20(17.4)	17(21.5)	3(8.3)	2.993	0.084
血小板计数(×10⁹/L)	222.6±63.6	222.8±63.5	222.2±64.6	0.002	0.962
中性粒细胞计数(×10⁹/L)	4.0±1.5	3.9±1.6	4.3±1.3	1.216	0.272
单核细胞计数(×10⁹/L)	0.4±0.1	0.4±0.1	0.4±0.1	0.001	0.971
淋巴细胞计数(×10⁹/L)	1.7±0.7	1.7±0.7	1.6±0.7	0.451	0.503
谷丙转氨酶(IU/L)	18.5(13.2, 27.8)	17.0(13.0, 27.5)	20.0(15.0, 27.5)	0.474	0.491
谷草转氨酶(IU/L)	21.9±12.3	21.8±13.8	22.1±8.2	0.022	0.883
白蛋白(g/L)	44.6±3.7	44.7±3.3	44.2±4.5	0.486	0.487
血尿酸(μmol/L)	293.5±101.3	287.9±110.0	305.6±79.1	0.687	0.409
尿素氮(mmol/L)	5.5±2.1	5.5±2.1	5.6±2.1	0.107	0.744
血肌酐(mmol/L)	66.0±27.6	63.1±28.7	72.6±23.9	2.951	0.089
肾小球滤过率[ml/(min·1.73 m²)]	99.6±25.5	105.0±25.1	87.4±22.2	11.983	<0.01
总胆固醇(mmol/L)	4.6±1.6	4.8±1.7	4.3±1.3	1.960	0.164
甘油三酯(mmol/L)	1.4(1.0, 2.1)	1.4(1.0, 2.4)	1.4(0.9, 1.7)	0.946	0.331
低密度脂蛋白胆固醇(mmol/L)	1.3±0.3	1.3±0.3	1.3±0.3	0.029	0.865
高密度脂蛋白胆固醇(mmol/L)	2.7±1.0	2.8±1.0	2.5±1.0	1.275	0.261
空腹血糖(mmol/L)	11.5±5.3	12.4±5.9	9.6±3.0	7.616	0.007
空腹胰岛素(mU/L)	4.3(2.1, 14.7)	2.9(1.3, 6.2)	13.1(5.4, 35.0)	22.303	<0.01
空腹C肽(ng/ml)	0.9(0.6, 1.6)	0.8(0.6, 1.5)	1.1(0.7, 1.8)	3.463	0.063
餐后2 h血糖(mmol/L)	15.1±4.5	15.0±4.2	15.4±5.2	0.109	0.742
餐后2 h胰岛(mU/L)	10.5(4.5, 20.4)	8.2(3.6, 14.7)	19.5(10.8, 41.8)	14.863	<0.01
餐后2 h C肽(ng/ml)	1.8(1.2, 3.0)	1.8(0.9, 2.9)	2.1(1.5, 3.5)	2.546	0.111
糖化血红蛋白(%)	9.4±2.3	9.9±2.5	8.3±1.6	13.022	<0.01
HOMA-IR	2.3(0.9, 6.1)	1.8(0.7, 3.6)	6.1(2.3, 14.2)	17.133	<0.01
ACR(mg/g)	17.1(7.1, 83.5)	14.8(6.6, 53.9)	51.8(8.1, 114.6)	4.034	0.045
ACR分级[例(%)]
<30 mg/g	67(58.3)	52(65.8)	15(41.7)
[30, 300) mg/g	35(30.4)	20(25.3)	15(41.7)		0.051
≥300 mg/g	13(11.3)	7(8.9)	6(16.7)

表2 EIAS与对照组降糖药物使用情况[例(%)]

Tab.2 Use of hypoglycemic drugs in the EIAS and control groups(n, %)

降糖药物	总体( $n$ =115)	对照组( $n$ =79)	EIAS组( $n$ = 36)	χ²值	$P$ 值
门冬胰岛素	57(49.6)	34(43)	23(63.9)	4.301	0.038
甘精胰岛素	46(40.0)	28(35.4)	18(50.0)	2.184	0.139
赖脯胰岛素	8(7.0)	6(7.6)	2(5.6)	-	0.999
地特胰岛素	13(11.3)	7(8.9)	6(16.7)	-	0.223
德古胰岛素	40(34.8)	31(39.2)	9(25.0)	2.211	0.137
预混人胰岛素	19(16.5)	9(11.4)	10(27.8)	4.814	0.028
二甲双胍	59(51.3)	43(54.4)	16(44.4)	0.987	0.320
α糖苷酶抑制剂	31(27.0)	21(26.6)	10(27.8)	0.018	0.893
钠-葡萄糖共转运蛋白2抑制剂	16(13.9)	10(12.7)	6(16.7)	0.332	0.565
二肽基肽酶4抑制剂	13(11.3)	9(11.4)	4(11.1)	-	1.000
磺脲类	5(4.3)	3(3.8)	2(5.6)	-	0.648
噻唑烷二酮类	5(4.3)	5(6.3)	0(0.0)	-	0.323
胰高血糖素样肽1受体激动剂	8(7.0)	5(6.3)	3(8.3)	-	0.704

表2 EIAS与对照组降糖药物使用情况[例(%)]

Tab.2 Use of hypoglycemic drugs in the EIAS and control groups(n, %)

降糖药物	总体( $n$ =115)	对照组( $n$ =79)	EIAS组( $n$ = 36)	χ²值	$P$ 值
门冬胰岛素	57(49.6)	34(43)	23(63.9)	4.301	0.038
甘精胰岛素	46(40.0)	28(35.4)	18(50.0)	2.184	0.139
赖脯胰岛素	8(7.0)	6(7.6)	2(5.6)	-	0.999
地特胰岛素	13(11.3)	7(8.9)	6(16.7)	-	0.223
德古胰岛素	40(34.8)	31(39.2)	9(25.0)	2.211	0.137
预混人胰岛素	19(16.5)	9(11.4)	10(27.8)	4.814	0.028
二甲双胍	59(51.3)	43(54.4)	16(44.4)	0.987	0.320
α糖苷酶抑制剂	31(27.0)	21(26.6)	10(27.8)	0.018	0.893
钠-葡萄糖共转运蛋白2抑制剂	16(13.9)	10(12.7)	6(16.7)	0.332	0.565
二肽基肽酶4抑制剂	13(11.3)	9(11.4)	4(11.1)	-	1.000
磺脲类	5(4.3)	3(3.8)	2(5.6)	-	0.648
噻唑烷二酮类	5(4.3)	5(6.3)	0(0.0)	-	0.323
胰高血糖素样肽1受体激动剂	8(7.0)	5(6.3)	3(8.3)	-	0.704

图1 EIAS与对照组ACR水平与分级比较

Fig.1 Comparison of ACR levels and grades between the EIAS group and the control group

表3 不同ACR分级组间临床特征比较

Tab.3 Comparison of clinical characteristics between different ACR subgroups

变量	总体( $n$ =115)	ACR<30 mg/g( $n$ =67)	ACR≥30 mg/g( $n$ =48)	$t$ /χ²值	$P$ 值
年龄(岁)	51.3±17.6	46.6±16.2	57.9±17.6	12.530	<0.01
性别[例(%)]
男性女性	66(57.4) 49(42.6)	37(55.2) 30(44.8)	29(60.4) 19(39.6)	0.308	0.579
BMI(kg/m²)	22.9±3.3	22.7±3.0	23.2±3.7	0.579	0.448
糖尿病类型[例(%)]
T1DM	11(9.6)	7(10.4)	4(8.3)
T2DM	92(80.0)	52(77.6)	40(83.3)		0.785
LADA	12(10.4)	8(11.9)	4(8.3)
病程(年)	10.0(2.0, 16.0)	7.0(1.0, 12.5)	10.5(5.0, 20.0)	7.025	0.008
胰岛素剂量(IU)	27.0(10.0, 42.0)	26.0(0.0, 40.5)	30.0(14.8, 46.2)	1.543	0.214
吸烟史[例(%)]	43(37.4)	23(34.3)	20(41.7)	0.643	0.423
饮酒史[例(%)]	20(17.4)	12(17.9)	8(16.7)	0.030	0.862
血小板计数(×10⁹/L)	222.6±63.6	224.3±68.2	220.1±57.0	0.122	0.728
中性粒细胞计数(×10⁹/L)	4.0±1.5	3.9±1.6	4.2±1.3	1.234	0.269
单核细胞计数(×10⁹/L)	0.4±0.1	0.4±0.1	0.4±0.1	3.659	0.058
淋巴细胞计数(×10⁹/L)	1.7±0.7	1.7±0.6	1.8±0.8	0.834	0.363
谷丙转氨酶(IU/L)	18.5(13.2, 27.8)	19.0(13.0, 26.5)	17.0(14.0, 28.0)	0.010	1.000
谷草转氨酶(IU/L)	21.9±12.3	20.2±7.7	24.3±16.7	3.055	0.083
白蛋白(g/L)	44.6±3.7	45.1±3.1	43.9±4.3	2.982	0.087
血尿酸(μmol/L)	293.5±101.3	280.7±96.4	311.2±106.3	2.337	0.129
尿素氮(mmol/L)	5.5±2.1	5.0±1.6	6.2±2.5	9.870	0.002
血肌酐(mmol/L)	66.0±27.6	60.9±17.0	73.3±36.9	5.847	0.017
肾小球滤过率[ml/(min·1.73 m²)]	99.6±25.5	105.4±23.0	91.6±26.9	8.073	0.005
总胆固醇(mmol/L)	4.6±1.6	4.3±1.1	5.0±2.0	5.989	0.016
甘油三酯(mmol/L)	1.4(1.0, 2.1)	1.4(0.9, 1.9)	1.5(1.1, 2.5)	1.196	0.274
低密度脂蛋白胆固醇(mmol/L)	1.3±0.3	1.2±0.3	1.3±0.3	0.511	0.476
高密度脂蛋白胆固醇(mmol/L)	2.7±1.0	2.6±0.9	2.9±1.1	2.612	0.109
空腹血糖(mmol/L)	11.5±5.3	11.6±5.5	11.5±5.2	0.006	0.938
空腹胰岛素(mU/L)	4.3(2.1, 14.7)	3.2(2.0, 8.4)	5.6(2.6, 31.9)	4.781	0.029
空腹C肽(ng/ml)	0.9(0.6, 1.6)	0.8(0.6, 1.5)	1.0(0.6, 1.7)	0.235	0.628
餐后2 h血糖(mmol/L)	15.1±4.5	15.6±5.1	14.4±3.3	1.731	0.191
餐后2 h胰岛(mU/L)	10.5(4.5, 20.4)	11.1(6.0, 20.1)	8.7(2.8, 21.2)	0.258	0.612
餐后2 h C肽(ng/ml)	1.8(1.2, 3.0)	2.0(1.3, 3.0)	1.6(1.0, 3.2)	0.932	0.334
糖化血红蛋白(%)	9.4±2.3	9.2±2.2	9.7±2.5	1.125	0.291
HOMA-IR	2.3(0.9, 6.1)	1.9(0.8, 4.2)	3.3(1.0, 12.6)	4.632	0.031
ACR(mg/g)	17.1(7.1, 83.5)	7.7(5.1, 13.1)	100.5(58.9, 444.1)	83.173	<0.01
EIAS[例(%)]	36(31.3)	15(22.4)	21(43.8)	5.934	0.015

表3 不同ACR分级组间临床特征比较

Tab.3 Comparison of clinical characteristics between different ACR subgroups

变量	总体( $n$ =115)	ACR<30 mg/g( $n$ =67)	ACR≥30 mg/g( $n$ =48)	$t$ /χ²值	$P$ 值
年龄(岁)	51.3±17.6	46.6±16.2	57.9±17.6	12.530	<0.01
性别[例(%)]
男性女性	66(57.4) 49(42.6)	37(55.2) 30(44.8)	29(60.4) 19(39.6)	0.308	0.579
BMI(kg/m²)	22.9±3.3	22.7±3.0	23.2±3.7	0.579	0.448
糖尿病类型[例(%)]
T1DM	11(9.6)	7(10.4)	4(8.3)
T2DM	92(80.0)	52(77.6)	40(83.3)		0.785
LADA	12(10.4)	8(11.9)	4(8.3)
病程(年)	10.0(2.0, 16.0)	7.0(1.0, 12.5)	10.5(5.0, 20.0)	7.025	0.008
胰岛素剂量(IU)	27.0(10.0, 42.0)	26.0(0.0, 40.5)	30.0(14.8, 46.2)	1.543	0.214
吸烟史[例(%)]	43(37.4)	23(34.3)	20(41.7)	0.643	0.423
饮酒史[例(%)]	20(17.4)	12(17.9)	8(16.7)	0.030	0.862
血小板计数(×10⁹/L)	222.6±63.6	224.3±68.2	220.1±57.0	0.122	0.728
中性粒细胞计数(×10⁹/L)	4.0±1.5	3.9±1.6	4.2±1.3	1.234	0.269
单核细胞计数(×10⁹/L)	0.4±0.1	0.4±0.1	0.4±0.1	3.659	0.058
淋巴细胞计数(×10⁹/L)	1.7±0.7	1.7±0.6	1.8±0.8	0.834	0.363
谷丙转氨酶(IU/L)	18.5(13.2, 27.8)	19.0(13.0, 26.5)	17.0(14.0, 28.0)	0.010	1.000
谷草转氨酶(IU/L)	21.9±12.3	20.2±7.7	24.3±16.7	3.055	0.083
白蛋白(g/L)	44.6±3.7	45.1±3.1	43.9±4.3	2.982	0.087
血尿酸(μmol/L)	293.5±101.3	280.7±96.4	311.2±106.3	2.337	0.129
尿素氮(mmol/L)	5.5±2.1	5.0±1.6	6.2±2.5	9.870	0.002
血肌酐(mmol/L)	66.0±27.6	60.9±17.0	73.3±36.9	5.847	0.017
肾小球滤过率[ml/(min·1.73 m²)]	99.6±25.5	105.4±23.0	91.6±26.9	8.073	0.005
总胆固醇(mmol/L)	4.6±1.6	4.3±1.1	5.0±2.0	5.989	0.016
甘油三酯(mmol/L)	1.4(1.0, 2.1)	1.4(0.9, 1.9)	1.5(1.1, 2.5)	1.196	0.274
低密度脂蛋白胆固醇(mmol/L)	1.3±0.3	1.2±0.3	1.3±0.3	0.511	0.476
高密度脂蛋白胆固醇(mmol/L)	2.7±1.0	2.6±0.9	2.9±1.1	2.612	0.109
空腹血糖(mmol/L)	11.5±5.3	11.6±5.5	11.5±5.2	0.006	0.938
空腹胰岛素(mU/L)	4.3(2.1, 14.7)	3.2(2.0, 8.4)	5.6(2.6, 31.9)	4.781	0.029
空腹C肽(ng/ml)	0.9(0.6, 1.6)	0.8(0.6, 1.5)	1.0(0.6, 1.7)	0.235	0.628
餐后2 h血糖(mmol/L)	15.1±4.5	15.6±5.1	14.4±3.3	1.731	0.191
餐后2 h胰岛(mU/L)	10.5(4.5, 20.4)	11.1(6.0, 20.1)	8.7(2.8, 21.2)	0.258	0.612
餐后2 h C肽(ng/ml)	1.8(1.2, 3.0)	2.0(1.3, 3.0)	1.6(1.0, 3.2)	0.932	0.334
糖化血红蛋白(%)	9.4±2.3	9.2±2.2	9.7±2.5	1.125	0.291
HOMA-IR	2.3(0.9, 6.1)	1.9(0.8, 4.2)	3.3(1.0, 12.6)	4.632	0.031
ACR(mg/g)	17.1(7.1, 83.5)	7.7(5.1, 13.1)	100.5(58.9, 444.1)	83.173	<0.01
EIAS[例(%)]	36(31.3)	15(22.4)	21(43.8)	5.934	0.015

表4 ACR升高的单因素与多因素logistic回归分析

Tab.4 Univariate and multivariate logistic regression of ACR elevation

变量	单因素回归		多因素回归
变量	$O R$ (95% $C I$ )	$P$ 值	$O R$ (95% $C I$ )	$P$ 值
年龄	1.04(1.02~1.07)	0.001	1.04(0.99~1.09)	0.100
DM病程	1.07(1.02~1.12)	0.005	1.06(0.98~1.15)	0.171
胰岛素剂量	1.01(0.99~1.03)	0.253	1.00(0.98~1.02)	0.968
肾小球滤过率	0.98(0.96~0.99)	0.008	0.98(0.96~1.01)	0.179
空腹血糖	1.00(0.93~1.07)	0.937	1.04(0.92~1.16)	0.549
空腹胰岛素	1.01(1.00~1.03)	0.095	1.00(0.99~1.01)	0.923
糖化血红蛋白	1.09(0.93~1.28)	0.289	1.46(1.10~1.93)	0.008
EIAS	2.70(1.20~6.06)	0.016	2.89(0.95~8.79)	0.062

表4 ACR升高的单因素与多因素logistic回归分析

Tab.4 Univariate and multivariate logistic regression of ACR elevation

变量	单因素回归		多因素回归
变量	$O R$ (95% $C I$ )	$P$ 值	$O R$ (95% $C I$ )	$P$ 值
年龄	1.04(1.02~1.07)	0.001	1.04(0.99~1.09)	0.100
DM病程	1.07(1.02~1.12)	0.005	1.06(0.98~1.15)	0.171
胰岛素剂量	1.01(0.99~1.03)	0.253	1.00(0.98~1.02)	0.968
肾小球滤过率	0.98(0.96~0.99)	0.008	0.98(0.96~1.01)	0.179
空腹血糖	1.00(0.93~1.07)	0.937	1.04(0.92~1.16)	0.549
空腹胰岛素	1.01(1.00~1.03)	0.095	1.00(0.99~1.01)	0.923
糖化血红蛋白	1.09(0.93~1.28)	0.289	1.46(1.10~1.93)	0.008
EIAS	2.70(1.20~6.06)	0.016	2.89(0.95~8.79)	0.062

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