糖化白蛋白对慢性肾脏病患者的血糖评估价值及其影响因素  

Value and related factors of glycated albumin in assessing glycemic levels in chronic kidney disease

作　　者：费杨[1] 程东生[1] 范瑛[1] 简桂花[1] 汪年松[1] 陈廷芳[1] 

机构地区：[1]上海交通大学附属第六人民医院肾脏科,上海200233

出　　处：《上海医学》2016年第5期272-276,共5页Shanghai Medical Journal

基　　金：国家自然科学基金面上项目(81270824);国家自然科学基金青年基金项目(81400735);上海交通大学医学院转化医学基金(152H2011)资助

摘　　要：目的探讨糖化白蛋白(GA)对糖尿病肾病(DN)与非DN的慢性肾脏病(CKD)患者的血糖评估价值及其影响因素。方法共入选782例CKD患者,其中DN患者579例,非DN患者203例。根据估算肾小球滤过率(eGFR)将患者分为CKD 1至2期组(374例),CKD 3至4期组(207例)和CKD 5期组(201例)。CKD 1至2期组中DN患者343例,非DN患者31例;CKD 3至4期组中DN患者108例,非DN患者99例;CKD 5期组中DN患者128例,非DN患者73例。收集所有患者的一般资料,测定其空腹血糖(FBG)、餐后2h血糖(2hPBG)、GA、糖化血红蛋白(HbA1c)、血红蛋白(Hb)、24h尿蛋白定量(24hUP)和各项生化指标的水平。采用单因素、多因素分析方法分析GA与其他变量间的相关性。结果 CKD 1至2期组、CKD 3至4期组和CKD 5期组中非DN患者的年龄、FBG、2hPBG、HbA1c、GA均显著低于同组DN患者(P值均<0.01)。CKD 3至4期组和CKD 5期组的DN患者的eGFR、FBG、2hPBG、HbA1c、GA、GA/HbA1c、血清血蛋白(sA)、Hb均显著低于CKD 1至2期组的DN患者(P值均<0.01),24hUP均显著高于CKD 1至2期组的DN患者(P值均<0.01);CKD 3至4期组和CKD 5期组的非DN患者的eGFR、sA、Hb均显著低于CKD 1至2期组的非DN患者(P值均<0.01),CKD 5期组的非DN患者的24hUP显著高于CKD 1至2期组的非DN患者(P<0.01)。CKD 5期组的DN患者的eGFR、FBG、2hPBG、HbA1c、GA、sA、Hb均显著低于CKD 3至4期组的DN患者(P值均<0.01),24hUP显著高于CKD 3至4期组的DN患者(P<0.01);CKD 5期组的非DN患者的eGFR、Hb均显著低于CKD 3至4期组的非DN患者(P值均<0.01),24hUP显著高于CKD 3至4期组的非DN患者(P<0.01)。在所有患者中,以GA为因变量行单因素线性回归分析显示,GA与FBG(R^2=0.145)、2hPBG(R^2=0.174)、HbA1c(R^2=0.649)呈正相关(P值均<0.01),与24hUP呈负相关性(R^2=0.187,P值均<0.01);多因素回归分析显示,BMI(β=-0.278)、FBG(β=0.334)、2hPBG(β=0.388)、24hUP(β=-1.044)和eGFR(β=-0.019)为GA的共同影响因素(R^2=0.414,P值均<0.05)。DN患者中GA�Objective To evaluate the value and related factors of glycated albumin （GA） in assessing glycemic levels in chronic kidney disease （CKD）. Methods A total of 782 CKD patients were enrolled in this study. Of them, 579 patients were diagnosed as diabetic nephropathy （DN）. The subjects were classified as different CKD stages according to the estimated glomerular filtration rate （eGFR）. There were 374 cases at CKD stage 1 -2, 207 cases at CKD stage 3- 4 and 201 cases at OKD stage 5. DN was diagnosed in 343 of the patients at CKD stage 1- 2, 108 of the patients at CKD stage 3- 4, and 128 of the patients at CKD stage 5. General information of the patients was collected. Biochemical indices, such as fasting blood glucose （FBG）, 2 hours postprandial blood glucose （2hPBG）, glycosylated hemoglobin （HbA^c）, hemoglobin （Hb） and 24 hour urine protein （24hUP） were detected. The univariate and multivariate regression analysis were used to analyze the relationship between GA and other variables. Results In CKD stage 1 -2, stage 3-4 and stage 5 groups, DN patients had older age, and higher FBG, 2hPBG, GA and HbA1c than non-diabetic patients （all P〈0. 01）, In DN patients, eGFR, FBG, 2hPBG, HbA1c GA, GA/HbA1c, serum albumin （sA） and Hb were significantly lower in CKD stage 3 - 4 and stage 5 than those in CKD stage 1 - 2, while 24hUP was conversely higher in CKD stage 3- 4 and stage 5 （all P〈0.01）. In non-DN patients, eGFR, sA and Hb were also significnatly decreased in CKD stage 3-4 and stage 5 than those in CKD stage 1 -2, while 24hUP was sighificantly increased （all P〈0. 01 ）. Both DN patients and non-DN patients in CKD stage 5 had even lower eGFR, FBG, 2hPBG, HbA1c, GA, sA and Hb than those in CKD stage 3- 4 but with a higher level of 24hUP （all P〈0.01）. The univariate regression analysis found that GA were positively correlated with FBG （R2 = 0. 145）, 2hPBG （ R2 = 0. 174）, HbA1c （R2 = 0. 649）, and inversely correlated with 24hUP （R2 = 0. 187, all P〈

关 键 词：糖化白蛋白 糖尿病肾病 慢性肾脏病 

分 类 号：R692[医药卫生—泌尿科学]