血红蛋白在鉴别糖尿病肾病与非糖尿病肾脏疾病中的作用  

Role of hemoglobin in the identification of diabetic nephropathy and non-diabetic renal disease

作　　者：刘沫言[1,2] 谢院生 董哲毅[1] 张雪光[1] 孙雪峰[1] 张冬[1] 周建辉[1] 朱晗玉[1] 陈香美[1] Liu Moyan;Xie Yuansheng;Dong Zheyi;Zhang Xueguang;Sun Xuefeng;Zhang Dong;Zhou Jianhui;Zhu Hanyu;Chen Xiangmei(Department of Nephrology,Chinese PLA General Hospital,Chinese PLA Institute of Nephrology,State Key Laboratory of Kidney Diseases,National Clinical Research Center for Kidney Diseases,Beijing Key Laboratory of Kidney Diseases,Beijing 100853;Second Department of Cadre Ward,Chinese PLA 960 Hospital,Jinan 250031,China)

机构地区：[1]解放军总医院肾脏病科、解放军肾脏病研究所、肾脏疾病国家重点实验室(2011DAV00088)、国家慢性肾病临床医学研究中心,肾脏疾病研究北京市重点实验室,北京100853 [2]解放军第960医院,250031

出　　处：《中华肾病研究电子杂志》2018年第6期271-276,共6页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：国家重点研发计划(2016YFC1305500);国家自然科学基金(No.61471399; No.61671479);中国人民解放军总医院苗圃基金(No.15KMZ04)

摘　　要：目的探讨血红蛋白在鉴别糖尿病肾病(DN)与非糖尿病肾脏疾病(NDRD)中的临床意义。方法对2004年1月至2012年4月在解放军总医院肾脏病科行肾活检、病理诊断明确且病史资料完整的66例DN、78例NDRD患者进行回顾性分析,比较两组临床指标及合并症的差异,采用多因素Logistic回归分析方法明确DN的独立危险因素;比较DN及NDRD组不同CKD分期的血红蛋白水平差异,明确其贫血性质及贫血相关的独立危险因素。结果 DN组糖尿病罹病时间、肾病罹病时间、平均动脉压、血清肌酐、尿素氮、24 h尿蛋白定量水平及合并糖尿病视网膜病变、心血管病、贫血的比例均高于NDRD组,差异具有统计学意义(P <0. 05);多因素分析显示糖尿病罹病时间长(OR=1. 012,95%CI 1. 005～1. 019)、合并糖尿病视网膜病变(OR=4. 265,95%CI 1. 616～11. 255)、血红蛋白水平低(OR=0. 952,95%CI 0. 929～0. 976)及合并心血管病(OR=2. 875,95%CI 1. 089～7. 593)是DN的独立危险因素; CKD1～3期DN组及NDRD组的血红蛋白水平均存在显著性差异(P <0. 05),该差异在CKD 4～5期消失; DN及NDRD组共有60例诊断为贫血,均为正细胞正色素性贫血;多因素Logistic回归分析显示白蛋白降低(OR=0. 928,95%CI 0. 879～0. 980)、血清肌酐升高(OR=1. 011,95%CI 1. 004～1. 019)、病理诊断为DN(OR=6. 213,95%CI 2. 690～14. 347)是贫血的独立危险因素。结论血红蛋白与DN显著独立相关,早期对血红蛋白水平的监测可能为临床鉴别DN与NDRD提供新线索。Objective To investigate the clinical significance of hemoglobin in the differential diagnosis of diabetic nephropathy(DN)and non- diabetic renal disease(NDRD).Methods A retrospective analysis was conducted in 66 patients with DN and 78 patients with NDRD,who underwent renal biopsy and had complete medical history data in the Department of Nephrology,PLA General Hospital from January 2004 to April 2012.The differences between the two groups in clinical indicators and comorbidities were compared,and multivariate logistic regression analysis was used to identify independent risk factors for DN.The differences in hemoglobin levels were compared between the DN group and the NDRD group at different stages of chronic kidney disease(CKD)to identify the anemia characteristics and independent risk factors associated with anemia.Results The history of diabetes,history of nephropathy,mean arterial pressure,serum creatinine,urea nitrogen,24- hour urine protein,and the proportions of diabetic retinopathy,cardiovascular disease,and anemia were higher in the DN group than in the NDRD group(P<0.05).Multivariate analysis showed the diabetes history(OR=1.012,95%CI 1.005- 1.019),diabetic retinopathy(OR=4.265,95%CI 1.616- 11.255),hemoglobin levels(OR=0.952,95%CI 0.929- 0.976),and cardiovascular disease(OR=2.875,95%CI 1.089- 7.593)were independently associated with DN.There were significant differences in hemoglobin levels at CKD stages 1- 3 between the DN group and the NDRD group(P<0.05),and the differences disappeared at CKD stages 4- 5.In the DN and the NDRD groups,there were altogether 60 patients with anemia which were all normocytic normochromic anemia.Multivariate logistic regression analysis showed decreased albumin(OR=0.928,95%CI 0.879- 0.980),elevated serum creatinine(OR=1.011,95%CI 1.004- 1.019),and pathologically diagnosed DN(OR= 6.213,95%CI 2.690- 14.347)were independent risk factors for anemia.]Conclusion Hemoglobin was significantly and independently associated with DN.Early monitoring of hemoglobin levels may provide

关 键 词：2型糖尿病 糖尿病肾病 非糖尿病肾脏疾病 血红蛋白 贫血 

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