2型糖尿病患者白蛋白尿与肾动态显像GFR的关系及影响因素  

The influencing factors and the relationship between urinary albumin excretion and glomerular filtration ratio measured by renal dynamic imaging

作　　者：陈燕[1] 叶山东[1] 金小毛[2] 邢燕[1] 王东[1] 

机构地区：[1]安徽省立医院内分泌科,安徽合肥230001 [2]安徽省立医院核医学科,安徽合肥230001

出　　处：《中华疾病控制杂志》2014年第2期143-146,共4页Chinese Journal of Disease Control & Prevention

基　　金：安徽省自然科学基金(01041181);安徽省卫生厅科学研究项目(2008B020x)

摘　　要：目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者尿白蛋白/肌酐比值(urinary albumin creatinine ratio,UACR)与肾动态显像法肾小球滤过率(glomerular filtration rate,GFR)的关系,分析糖尿病患者UACR与GFR的影响因素。方法收集167例病情稳定的T2DM患者资料,根据尿UACR进行分组,比较各组GFR及肾功能减低的发生率。并对UAER与GFR进行相关及回归分析。结果分组分析显示UACR各组间GFR差异有统计学意义(均有P<0.05);3组间肾功能减低的发生率差异有统计学意义(均有P<0.05),直线相关分析显示T2DM患者UACR与GFR呈明显负相关(r=-0.41,P<0.001);但在UACR正常的患者中仍有11.9%患者出现肾功能减低。糖尿病患者UACR与GFR均与病程、血压、血糖控制及血清肌酐有关(UACR与上述各因素呈正相关,GFR与上述各因素呈负相关);男性更易出现UACR升高、GFR下降;此外GFR还与体质指数(body mass index,BMI)及年龄呈负相关。多因素逐步回归分析显示影响UACR的主要因素是:舒张压、糖化血红蛋白、血清肌酐,影响GFR的主要因素是:血清肌酐、年龄、平均血压、糖化血红蛋白。结论 T2DM患者UACR与GFR有共同的危险因素亦有不同的影响因素,UACR仍然是T2DM肾病筛查的重要指标,但单独检测UACR可能会遗漏部分肾功能减低患者,因此结合GFR的测定能更好地反映患者肾受损的状态。Objective To explore the relationship between urinary albumin creatinine ratio（UACR） and glomeru- lar filtration ratio（GFR） and to analyze their respective spheres of influencing factors. Methods A total of 167 patients with type 2 diabetes were assigned to different groups according to the urinary albumin creatinine ratio. The value of GFR and the incidence of renal dysfunction were compared among different groups. Correlation and multiple regression analysis were applied in the clinical variables and experimental presentation. Results The GFR and the incidences of renal dys- function were different among the three groups of UACR（ all P 〈 0. 05 ）. UACR had negative correlation with GFR in type 2 diabetes （ r = -0. 41, P 〈 0. 001 ）. 11.9 % type 2 diabetes with normal urinary albumin ratio presented with renal dysfunc- tion. Both UACR and GFR were correlated with male, disease,blood pressure and serum creatinine. Moreover, GFR had negative correlation with BMI and age, respectively. Multivariate stepwise regression analysis indicated that diastolic pres- sure ,glycosylated hemoglobin A1 c, serum creatinine were independent risk factors for UACR. Serum creatinine, age, mean blood pressure, glycosylated hemoglobin Alc were independent influential factors for GFR. Conclusions There are some similarities between risk factors for UACR and risk factors for GFR, but not completely. UACR remain to be the important screening method for diabetic nephropathy in type 2 diabetes. Moreover, UACR detection combined with GFR measure- ments by dynamic renography could give better reflection of the kidney function.

关 键 词：糖尿病肾病 肾小球滤过率 肾动态显像 回归分析 

分 类 号：R587.1[医药卫生—内分泌] R181.2[医药卫生—内科学]