血磷水平与糖尿病肾病患者肾脏损伤及远期预后的关系  

Hyperphosphatemia:a marker of kidney injury and outcome in patients with diabetic nephropathy

作　　者：邱丹丹[1] 蒋松[1] 潘瑜[1] 安玉[1] 徐峰[1] 葛永纯[1] 刘志红[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所

出　　处：《肾脏病与透析肾移植杂志》2016年第3期208-213,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金(81500548);国家科技支撑计划课题(2013BAI09B04;2015BAI12B05)

摘　　要：目的:观察血磷水平与糖尿病肾病(DN)患者肾脏损伤和远期预后之间的关系。方法:回顾性分析2004年1月至2015年7月南京军区南京总医院肾脏科597例2型糖尿病肾病(DN)患者,中位随访时间36个月,观察高磷血症的发生率,血磷水平与肾脏损伤程度的相关性,并评估高磷血症对肾脏终点风险的预测价值。结果:基线估计的肾小球滤过率(eGFR)>90 ml/(min·1.73 m^2)、60~90 ml/(min·1.73 m^2)、<60 ml/(min·1.73m^2)的三组DN患者中,高磷血症(血磷>1.45 mmol/L)的发生率分别为11.7%(25/214)、16.7%(25/150)和30.5%(71/233)。血磷水平与尿液中肾小管间质性损伤标志物表达正相关(P<0.01),与肾小管间质损伤病理评分(间质纤维化和小管萎缩评分、间质炎症评分)存在相关性(P<0.05)。此外,随着血磷水平增加,患者发生终末期肾病(ESRD)的风险增加(对数秩检验,P<0.01)。校正年龄、性别、血压、血脂、体质量指数、24h尿蛋白定量、血钙和基线eGFR后,高磷血症仍然是进展至ESRD的高危因素(P<0.001)。结论:在DN患者[尤其eGFR≥60ml/(min·1.73 m^2)]中,高磷血症与患者肾小管间质性损伤显著相关,且是发生ESRD的独立风险因素。Objective： To investigate the association between hyperphosphatemia and renal injuries and long-term outcome in patients with type 2 diabetes and diabetic nephropathy（ DN）. Methodology： From January 2004 to July2015 in National Clinical Research Center of Kidney Diseases,Jinling Hospital,a total of five hundred ninety seven patients with type 2 diabetes and DN were enrolled in this retrospective study. The median follow-up period was 36 months.The prevalence of hyperphosphatemia and the association between hyperphosphatemia and renal injuries and the risk of renal outcome were analyzed. Results： The prevalence of hyperphosphatemia（ serum phosphate 1. 45 mmol / L） in the enrolled DN patients with eGFR 90,between 60 and 90,and 60 ml /（ min·1. 73 m^2） were 25 /214（ 11. 7%）,25 /150（ 16. 7%）,and 71 /233（ 30. 5%）,respectively. Hyperphosphatemia was associated with enhanced tubulointerstitial injury markers（ P〈0. 01） as well as a high rate of tubulointerstitial injury（ interstitial fibrosis tubular atrophy scores and interstitial inflammation scores,P〈0. 05）. Additionally,the patients with baseline serum phosphate levels in higher quartiles had a higher cumulative incidence of end- stage renal disease（ ESRD）（ log-rank,P〈0. 01）. Risk persisted after adjusting for age,sex,blood pressure,lipid level,body mass index,proteinuria,plasma calcium and eGFR（ P〈0. 001）. Conclusion：These findings suggested that hyperphosphatemia is an independent risk factor of ESRD and significantly associated with tubulointerstitial injury in patients with DN,especially in patients with eGFR ≥60 ml /（ min·1·73 m^2）.

关 键 词：糖尿病肾病 高磷血症 肾脏损伤 远期预后 

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