高血压合并2型糖尿病对慢性肾脏病的影响  

The prevalence of chronic kidney disease in hypertensives with type 2diabetes mellitus

作　　者：王猛 李云 赵权辉 于俊杏 张亚静 李蔚[2,3] 张芮英 陈朔华[3] 吴寿岭 WANG Meng;LI Yun;ZHAO Quan-hui;YU Jun-xing;ZHANG Ya-jing;LI Wei;ZHANG Rui-ying;CHEN Shuo-hua;WU Shou-ling(School of Public Health,North China University of Science and Technolog;Graduate School of North China University of Science and Technology,Tangshan Hebei 063000,China)

机构地区：[1]华北理工大学公共卫生学院,河北唐山063000 [2]华北理工大学研究生学院 [3]开滦总医院心内科

出　　处：《中华高血压杂志》2018年第9期832-836,共5页Chinese Journal of Hypertension

基　　金：2013年河北省高校百名优秀创新人才支持计划(BR2-215)

摘　　要：目的探讨高血压合并2型糖尿病对慢性肾脏病(CKD)的影响。方法在参加2012年开滦集团健康体检的人群中选择符合要求的研究对象100 261例,根据是否患有高血压和2型糖尿病,将研究对象分为无高血压无2型糖尿病组(n=54 377)、单纯高血压组(n=34 293)、单纯2型糖尿病组(n=4328)、高血压合并2型糖尿病组(n=7263),比较4组CKD发生率、估算的肾小球滤过率(eGFR)下降率和蛋白尿检出率。结果研究人群总CKD发生率为9.4%,eGFR下降率为5.6%,蛋白尿检出率为4.3%。高血压合并2型糖尿病组CKD发生率、eGFR下降率、蛋白尿检出率分别为21.3%、10.0%和13.4%,高于无高血压无2型糖尿病组(分别为6.0%、3.8%和2.4%)、单纯高血压组(12.0%、7.5%和5.2%)和单纯2型糖尿病组(11.6%、6.2%和6.1%)(均P<0.05)。校正其他影响因素后,与无高血压无2型糖尿病者比较,高血压合并2型糖尿病患者发生CKD风险为1.63(95%CI1.46~1.81),eGFR下降风险为1.53(95%CI1.33~1.76),发生蛋白尿风险为1.86(95%CI1.61~2.14)。结论高血压合并2型糖尿病患者CKD发生率显著增高,肾损害以蛋白尿增加为主。Objective To investigate the prevalence of chronic kidney disease（CKD） in hypertensives with type 2 diabetes mellitus. Methods A total of 100 261 participants meeting the inclusion and exclusion criteria were selected from Kailuan health survey cohort in 2012. All subjects were divided into 4 groups： without hypertension and type 2 diabetes mellitus group （n= 54 377）, isolated hypertension group （n= 34 293）, isolated type 2 diabetes group （n=4328）, and hypertension combined with type 2 diabetes mellitus group （n = 7263 ）. The incidence rate of CKD, decline rate of estimated glomerular filtration rate （eGFR） and detection rate of proteinuria were compared a- mong the four groups. Results The total incidence rate of CKD was 9.4%, decline rate of eGFR was 5.6 % and detection rate of proteinuria was 4.3% in all suhjeets. The incidence rate of CKD, decline rate of eGFR and detec tion rate of proteinuria in the subjects with hypertension and type 2 diabetes mellitus were 21.3%, 10.0% and 13.4%, respectively, which were higher than those in the subjects without hypertension and type 2 diabetes mellitus （6.0%, 3.8% and 2.4%, respectively）, subjects with isolated hypertension （12.0%, 7.5% and 5.2%, respective ly） and subjects with isolated type 2 diabetes （11.6%, 6.2% and 6. 1%, respectively） （all P〈0.05）. After ad- justing for other confounding factors, compared with the subjects without hypertension and type 2 diabetes mellitus, the patients with hypertension and type 2 diabetes had higher risks for CKD （OR-1.63, 95% CI 1.46- 1.81）, eGFR decline （OR=1. 53, 95% CI 1.33-1.76） and proteinuria （OR =1.86, 95% CI 1.61-2.14）. Conclusion The incidence rate of CKD was significantly increased and the major kidney damage was proteinuria in the patients with hypertension and type 2 diabetes mellitus.

关 键 词：高血压 糖尿病 慢性肾脏病 肾小球滤过率 蛋白尿 

分 类 号：R692[医药卫生—泌尿科学] R544.1[医药卫生—外科学] R587.1[医药卫生—临床医学]