新诊断糖尿病患者肾损害的相关因素分析  

Risk factors of renal injury in newly diagnosed patients with type 2 diabetes

作　　者：李惠芝[1] 唐兆生[1] 王华[1] 于园[1] 冯波[1] 

机构地区：[1]同济大学附属东方医院内分泌科,上海200120

出　　处：《同济大学学报（医学版）》2017年第1期80-84,共5页Journal of Tongji University(Medical Science)

摘　　要：目的探讨新诊断糖尿病患者肾损害情况及相关因素。方法对263例新诊断糖尿病患者进行体格检查和生化指标检测,计算肾小球滤过率(estiated glomerular fitration,eGFR)、尿蛋白肌酐比(albumin-to-creatinine ratio,ACR)。按照ACR结果分为正常蛋白尿组、微量蛋白尿组和大量蛋白尿组。结果与正常蛋白尿组相比,大量蛋白尿组的FBG、TG明显升高(均P<0.05),eGFR明显降低(P<0.05);与eGFR正常和偏低组相比,eGFR>120 ml/(min·1.73 m^2)组年龄更低(P<0.01),男性更多(P<0.01),FBG、PBG、HbA1c、TG更高(均P<0.01),HOM A-β低(P<0.05)。Pearson相关分析显示:eGFR与年龄呈负相关(r=-0.811,P=0.000)。Logistic回归分析显示:FBG、HOMA-IR与蛋白尿呈显著正相关(P值分别为0.036、0.038),HbA1c、BMI、lgACR与eGFR高滤过呈正相关(P值分别为0.007、0.006、0.025),年龄与eGFR高滤过呈负相关(P=0.000)。结论新诊断糖尿病已存在肾损害,主要表现为蛋白尿和肾小球高滤过,在年龄较低的患者中表现更为明显,并与胰岛素抵抗、脂代谢紊乱等因素相关。Objective To investigate the risk factors of renal injury in newly diagnosed patients with type 2 diabetes. Methods Two hundred and sixty three newly diagnosed patients with type 2 diabetes were enrolled in this cross-sectional survey. Physical examination was performed; and blood glucose, creatinine, insulin, total cholesterol （TC）, triglycerides （TG）, high-density lipoprotein-cholesterol, low-density cholesterol, urine microalbumin, urine creatinine, insulin resistance index （HOMA-β）, β-cell index, albumin-to-creatinine ratio （ACR） and estimated glomerular filtration rate （eGFR） were measured. According to the ACR, patients were divided into three groups： normal albuminuria, microalbuminuria, macroalbuminurin. Results Compared with the normal albuminuria group, macroalbumin group had higher fast glucose （FBG） and TG, lower eGFR. Compared with the normal eGFR and reduced eGFR group, the renal hyperfiltration group had higher FBG, postprandial blood glucose （PBG） and TG, lower HOMA-[3. Pearson correlation analysis showed that eGFR was negatively correlated with age （r = -0. 811, P = 0. 000 ）. The multiple logistic regression analysis revealed that FBG, HOMA-IR were positively correlated with ACR （P = 0. 036, 0. 038 ）. HbAlc, BMI, lgACR were positively correlated with renal hyperfiltration （P = 0. 007,0. 006,0. 025 ）. Age was negatively correlated with renal hyperfiltration （P = 0. 000）. Conclusion The renal injury exists in newly diagnosed patients with type 2 diabetes and manifested albuminuria and glomerular hyperfiltration, which are correlated with insulin resistance and dyslipidemia.

关 键 词：糖尿病 蛋白尿 血脂紊乱 肾小球高滤过 胰岛素抵抗 

分 类 号：R582.7[医药卫生—内分泌]