KDIGO慢性肾脏病分级系统在1645例2型糖尿病患者伴发肾脏疾病及相关血管性疾病中的应用  

Application of KDIGO classifcation of chronic kidney disease for analyzing the prevalence of kidney disease and other vascular diseases in 1645 type 2 diabetic patients

作　　者：李明[1] 陈慧卿[2] 赵文波[1] 刘迅[1] 司美君[1] 唐骅[1] 娄探奇[1] 

机构地区：[1]中山大学附属第三医院肾内科,广州510630 [2]中山大学附属第一医院儿科

出　　处：《中华肾脏病杂志》2013年第12期877-882,共6页Chinese Journal of Nephrology

基　　金：十二五国家支撑计划（2011BA110B05）;广东省科技计划（20098030801196）

摘　　要：目的采用KDIGO慢性肾脏病分级系统，研究2型糖尿病患者肾脏疾病的发病情况、危险因素及并发心脑血管性疾病、死亡情况，探讨KDIGO分级系统的意义。方法选取2008年6月至2012年12月于本院住院的1645例资料完整的2型糖尿病患者为研究对象，采用KDIGO慢性肾脏病分级系统进行分组，明确KDIGO分期下糖尿病患者的血管疾病发病情况，并对合并及不合并肾脏疾病两组间进行比较，分析。肾脏疾病的危险因素，另分析其死亡的危险因素。结果1645例2型糖尿病患者中男915例，女730例，平均年龄（57．86±12．54）岁，糖尿病病程（6．35±6．30）年。37．2％（612／1645）患者合并肾脏疾病，G3a、G3b期及G4＋G5期分别占5．7％、3．5％、7．6％，蛋白尿患者占33．4％，其中微量白蛋白尿患者19．5％，大量白蛋白尿患者13．5％。49．5％患者合并高血压，67．7％合并高脂血症，27．4％合并糖尿病视网膜病变（DR），18．5％合并心脑血管疾病（其中16．5％合并冠状动脉性疾病（CAD），8．8％患者合并脑血管疾病），G3a和G3b组在DR、CAD、脑血管疾病的比较差异均有统计学意义（P〈0．05）。糖尿病病程、合并高血压尤其是收缩压升高、糖尿病视网膜病变、高尿酸血症是2型糖尿病患者合并肾脏疾病的独立危险因素。而年龄、Scr、合并心脑血管疾病、高CKD分期是2型糖尿病合并肾脏疾病患者死亡的独立危险因素。结论KDIGO慢性肾脏病分级系统可以更准确划分糖尿病患者肾脏疾病的分期以指导临床和判断预后，糖尿病患者肾脏疾病和心脑血管疾病的患病率较普通人群更高，早期控制血压、血尿酸等因素可延缓肾脏疾病的进展，需重视糖尿病视网膜病变的预测作用。Objective To analyze the prevalence, risk factors of kidney disease in type 2 diabetic patients with KDIGO classification of chronic kidney disease, also to study cardiovascular and cerebrovascular diseases and death in these patients, so as to investigate the significance of the KDIGO classification system. Methods One thousand six hundred and forty-five type 2 diabetic patients who were in hospitalization from June 2008 to December 2012 were grouped according to the KDIGO classification of chronic kidney disease and the incidence of vascular disease was analyzed based on the classification. Clinical features were compared between patients with or without kidney disease. The risk factors of kidney disease and the death of diabetic patients were also investigated. Results There were 915 male and 730 female, aged a median （57.86＋_12.54） years with （6.35＋6.30） years duration of diabetes mellitus among the 1645 cases, and 37.2% of patients had concomitant kidney disease. According to the classi fi cation of CKD, patients in CKD group 3a, group 3b and CKD group 4-5 accounted for 5.7%, 3.5% and 7.6%, while 33.4% of patients had proteinuria, among which 19.5% with microalbuminuria, 13.5% with maeroalbuminuria. On complications, patients with hypertension accounted for 49.5%, hyperlipidemia 67.7%, diabetic retinopathy 27.4%, cardiovascular and cerebrovascular diseases 18.5% （coronary artery disease 16.5%, cerebrovascular diseases 8.8%）. Statistical difference was detected in the incidence of diabetic retinopathy, coronary artery disease and cerebrovascular diseases between CKD group 3a and 3b （P 〈 0.05）. The duration of diabetes, concomitant hypertention especially with elevated systolic blood pressure, diabetic retinopathy and hyperuricemia were the independent risk factors for type 2 diabetic patients with kidney disease. Age, Scr, complicating cardiovascular and cerebrovascular diseases and advanced CKD stage were the independent risk factors for the death of type 2 diabetic patients with kidney

关 键 词：糖尿病 肾疾病 危险因素 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]