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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2026, Vol. 15 ›› Issue (03) : 151 -157. doi: 10.3877/cma.j.issn.2095-3216.2026.03.005

论著

糖尿病合并慢性肾脏病患者血清前白蛋白和白蛋白/球蛋白比值与肾功能及预后的相关性研究
杨卫红1, 郭向飞2,†()   
  1. 1101100　北京中医药大学东直门医院通州院区肾病内分泌科四区
    2101118　首都医科大学附属北京安贞医院麻醉中心疼痛科
  • 收稿日期:2025-11-24 出版日期:2026-06-28
  • 通信作者: 郭向飞
  • 基金资助:
    国家卫生健康委能力建设和继续教育中心项目(PMT1001-14); 北京市通州区科技计划项目(KJ2022CX064)

Study on the correlation of serum prealbumin and albumin-to-globulin ratio with renal function and prognosis in patients with diabetes mellitus complicated with chronic kidney disease

Weihong Yang1, Xiangfei Guo2,†()   

  1. 1Department of Nephrology and Endocrinology, Tongzhou Branch of Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 101100
    2Department of Pain Medicine, Anesthesiology Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 101118; China
  • Received:2025-11-24 Published:2026-06-28
  • Corresponding author: Xiangfei Guo
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引用本文：

杨卫红, 郭向飞. 糖尿病合并慢性肾脏病患者血清前白蛋白和白蛋白/球蛋白比值与肾功能及预后的相关性研究[J/OL]. 中华肾病研究电子杂志, 2026, 15(03): 151-157.

Weihong Yang, Xiangfei Guo. Study on the correlation of serum prealbumin and albumin-to-globulin ratio with renal function and prognosis in patients with diabetes mellitus complicated with chronic kidney disease[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2026, 15(03): 151-157.

目的

探讨糖尿病合并慢性肾脏病患者血清前白蛋白和白蛋白球蛋白比值与肾功能、预后的相关性。

方法

前瞻性纳入2022年11月1日至2024年10月31日在本院诊治的糖尿病合并慢性肾脏病患者，根据1年随访预后情况分为预后良好组与预后不良组，比较血清前白蛋白、白蛋白/球蛋白比值和肾功能指标。采用Spearman软件分析相关性，多因素Cox回归模型分析预后的影响因素，并以受试者工作特征曲线评估其预测效能。

结果

共纳入287例糖尿病合并慢性肾脏病患者，其中预后良好组208例、预后不良组79例。血清白蛋白/球蛋白比值与血尿素氮、血清肌酐、尿白蛋白/尿肌酐呈负相关(P<0.05)；血清前白蛋白与血尿素氮、血清肌酐呈负相关，与eGFR呈正相关(P<0.05)。与预后良好组相比，预后不良组的血清白蛋白、白蛋白/球蛋白比值、血清前白蛋白、eGFR均降低，而血清球蛋白、糖化血红蛋白、甘油三酯、血尿素氮、血清肌酐、尿白蛋白、尿白蛋白/尿肌酐升高(P均<0.05)。血清白蛋白/球蛋白比值(HR＝0.674)、血清前白蛋白(HR＝0.982)、血尿素氮(HR＝1.915)、eGFR(HR＝0.948)是预后不良的独立影响因素(P均<0.05)。血清白蛋白/球蛋白比值、血清前白蛋白、血尿素氮、eGFR单项检测预后不良的曲线下面积分别为0.799、0.722、0.887、0.632。

结论

糖尿病合并慢性肾脏病患者的血清前白蛋白、白蛋白/球蛋白比值与其肾功能和预后相关，具有一定的预测价值。

关键词: 糖尿病, 慢性肾脏病, 前白蛋白, 白蛋白/球蛋白比值, 肾功能, 预后
Objective

To explore the correlation of serum prealbumin and albumin-globulin ratio with renal function and prognosis in patients with diabetes mellitus complicated with chronic kidney disease.

Methods

Patients with diabetes mellitus complicated with chronic kidney disease treated in our hospital from November 1, 2022 to October 31, 2024 were prospectively enrolled. All subjects were followed up for 1 year and divided into good prognosis group and poor prognosis group according to follow-up outcomes. Serum prealbumin, albumin-to-globulin ratio and renal function parameters were compared. Correlation was analyzed using Spearman software, multivariate Cox regression model was adopted to analyze prognostic influencing factors, and receiver operating characteristic curve was used to evaluate its predictive efficiency.

Results

A total of 287 patients with diabetes mellitus complicated with chronic kidney disease were enrolled, including 208 cases in the good prognosis group and 79 cases in the poor prognosis group. The serum albumin-to-globulin ratio was negatively correlated with blood urea nitrogen, serum creatinine, and urinary albumin/creatinine ratio (P<0.05). Serum prealbumin was negatively correlated with blood urea nitrogen and serum creatinine, while positively correlated with eGFR (P<0.05). Compared with the good prognosis group, the poor prognosis group showed lower levels of serum albumin, albumin-to-globulin ratio, serum prealbumin, and eGFR, but higher levels of serum globulin, glycated hemoglobin, triglyceride, blood urea nitrogen, serum creatinine, urinary albumin, and urinary albumin/creatinine ratio (all P<0.05). Serum albumin-to-globulin ratio (HR=0.674), serum prealbumin (HR=0.982), blood urea nitrogen (HR=1.915), and eGFR (HR=0.948) were independent influencing factors for poor prognosis (P<0.05). The area under the curve for poor prognosis in single-item tests of serum albumin-to-globulin ratio, serum prealbumin, blood urea nitrogen, and eGFR was 0.799, 0.722, 0.887, and 0.632, respectively.

Conclusion

The serum prealbumin and albumin-to-globulin ratio in the patients with diabetes mellitus complicated with chronic kidney disease were correlated with the renal function and prognosis, possessing certain predictive value.

Key words: Diabetes mellitus, Chronic kidney disease, Prealbumin, Albumin/globulin ratio, Renal function, Prognosis
表1 不同预后糖尿病合并慢性肾脏病患者临床资料比较
项目 纳入患者总体(287例) 预后良好组(208例) 预后不良组(79例) t/Z/χ2值 P值
性别[例(%)] 0.444 0.505
男 169(58.89) 120(57.69) 49(62.03)
女 118(41.11) 88(42.31) 30(37.97)
年龄(岁) 57.30±10.13 51.99±5.01 51.33±5.11 0.993 0.321
高血压[例(%)] 100(34.84) 69(33.17) 31(39.24) 0.928 0.335
冠心病[例(%)] 28(9.76) 19(9.13) 9(11.39) 0.331 0.565
高脂血症[例(%)] 29(10.10) 17(8.17) 12(15.19) 3.103 0.078
糖尿病家族史[例(%)] 67(23.34) 44(21.15) 23(29.11) 2.027 0.154
血糖控制方法[例(%)] 4.215 0.122
饮食和运动 61(21.25) 50(24.04) 11(13.92)
降糖药 155(54.01) 111(53.36) 44(55.70)
降糖药和胰岛素注射 71(24.74) 47(22.60) 24(30.38)
血清白蛋白(g/L) 48.40±0.89 48.79±1.74 47.64±1.65 5.063 <0.01
血清球蛋白(g/L) 30.76±2.33 30.61±1.43 31.57±1.57 －4.935 <0.01
血清白蛋白球蛋白比值 1.60±0.11 1.76±0.14 1.59±0.12 9.146 <0.01
血清前白蛋白(mg/L) 239.38±23.97 246.66±15.32 231.67±19.06 6.263 <0.01
空腹血糖(mmol/L) 9.05(7.62，10.56) 9.29(7.96，11.02) 9.73(8.32，11.00) －0.866 0.386
糖化血红蛋白(%) 6.90(6.40，7.40) 6.90(6.40，7.30) 7.10(6.60，7.50) －2.762 0.006
总胆固醇(mmol/L) 5.08(4.58，5.58) 5.25(4.71，5.75) 5.37(4.79，6.03) －1.458 0.145
甘油三酯(mmol/L) 1.91(1.68，2.15) 1.88(1.70，2.13) 2.02(1.80，2.25) －3.288 0.001
低密度脂蛋白胆固醇(mmol/L) 2.72(2.44，3.04) 2.77(2.50，3.07) 2.89(2.52，3.24) －1.652 0.098
高密度脂蛋白胆固醇(mmol/L) 1.15(1.04，1.31) 1.19(1.05，1.34) 1.19(1.10，1.29) －0.108 0.914
丙氨酸氨基转移酶(U/L) 17.00(15.00，20.00) 18.00(16.00，20.00) 19.00(18.00，20.00) －1.868 0.062
天门冬氨酸氨基转移酶(U/L) 18.00(17.00，20.00) 19.00(17.00，20.00) 19.00(18.00，20.00) －1.878 0.060
血清尿素氮(mmol/L) 12.46±1.43 12.00±1.14 13.87±0.96 －12.895 <0.01
血清肌酐(μmol/L) 68.43±7.75 65.79±6.87 69.19±7.65 －3.628 <0.01
估算肾小球滤过率[ml/(min·1.73 m2)] 48.85±6.40 48.88±7.63 45.10±7.00 3.831 <0.01
尿白蛋白(mg/L) 122.70(83.90，160.45) 100.55(72.03，124.88) 116.20(80.95，152.00) －3.017 0.003
尿肌酐(g/L) 1.30(1.00，1.50) 1.25(1.00, 1.50) 1.30(1.10, 1.50) －0.417 0.677
尿白蛋白/尿肌酐(mg/g) 116.88±14.30 113.76±15.31 125.18±18.37 －4.915 <0.01
表2 糖尿病合并慢性肾脏病患者血清白蛋白球蛋白比值、前白蛋白与肾功能指标的相关性分析
变量 血清尿素氮 血清肌酐 估算肾小球滤过率 尿白蛋白/尿肌酐
r值 P值 r值 P值 r值 P值 r值 P值
血清白蛋白球蛋白比值 －0.142 0.016 －0.141 0.017 0.096 0.105 －0.175 0.003
血清前白蛋白 －0.140 0.017 －0.185 0.002 0.154 0.009 －0.090 0.128
表3 糖尿病合并慢性肾脏病患者预后不良的单因素及多因素Cox回归分析
变量 单因素分析 多因素分析
β值 瓦尔德值 P值 HR (95%CI) β值 瓦尔德值 P值 HR (95%CI)
血清白蛋白球蛋白比值 －0.883 50.347 <0.001 0.414(0.324~0.528) －0.394 8.455 0.004 0.674(0.517~0.879)
血清前白蛋白 －0.040 36.023 <0.001 0.961(0.949~0.974) －0.018 6.867 0.009 0.982(0.969~0.996)
糖化血红蛋白 0.533 6.850 0.009 1.704(1.143~2.541) 0.085 0.119 0.730 1.088(0.673~1.760)
甘油三酯 1.383 9.821 0.002 3.986(1.679~9.467) 0.544 1.351 0.245 1.723(0.688~4.312)
血清尿素氮 0.907 74.190 <0.001 2.477(2.015~3.045) 0.650 30.167 <0.001 1.915(1.519~2.414)
血清肌酐 0.047 9.197 0.002 1.049(1.017~1.081) － － － －
估算肾小球滤过率 －0.061 14.811 <0.001 0.940(0.911~0.970) －0.053 9.405 0.002 0.948(0.917~0.981)
尿白蛋白/尿肌酐 0.033 20.226 <0.001 1.034(1.019~1.049) 0.012 2.895 0.089 1.012(0.998~1.026)
图1 血清白蛋白球蛋白比值、血清前白蛋白、血清尿素氮、估算肾小球滤过率评估糖尿病合并慢性肾脏病患者预后不良的受试者工作特征曲线
表4 血清白蛋白球蛋白比值、血清前白蛋白、血清尿素氮、估算肾小球滤过率对糖尿病合并慢性肾脏病患者预后不良的预测效能
指标 AUC 95%CI 敏感度 特异度 最佳截断值 P值
血清白蛋白球蛋白比值 0.799 0.747~0.852 44.70 96.20 1.785 <0.01
血清前白蛋白 0.722 0.653~0.791 97.60 40.50 222.500 mg/L <0.01
血清尿素氮 0.887 0.848~0.925 88.60 70.70 12.685 mmol/L <0.01
估算肾小球滤过率 0.632 0.563~0.702 22.10 98.70 55.920 ml/(min·1.73 m2) 0.001
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