尿白蛋白/肌酐比值正常的2型糖尿病患者肾脏损害的影响因素探讨  

Study on the Influencing Factors of Renal Damage in Type 2 Diabetes Patients with Normal Urine Albumin/Creatinine Ratio

作　　者：胡国红[1,2] 张婷婷 王煜[3] 童南伟[1] 王晓茜[4] 任艳[1] Hu Guohong;Zhang Tingting;Wang Yu(Department of Endocrinology and Metabolism,West China Hospital,Sichuan University,Chengdu,Sichuan 610041;Chengdu Guoguang Electric Co.,Ltd.Hospital,Chengdu,Sichuan 610000;Department of Endocrinology,Chengdu Sixth People's Hospital,Chengdu,Sichuan 610000,China)

机构地区：[1]四川大学华西医院内分泌代谢科,四川成都610041 [2]成都国光电气股份有限公司医院,四川成都610000 [3]成都市第六人民医院内分泌科,四川成都610000 [4]德阳市人民医院内分泌科,四川德阳618000

出　　处：《四川医学》2020年第2期113-117,共5页Sichuan Medical Journal

基　　金：四川省科技厅科技支撑计划项目(编号:2015SZ0228)。

摘　　要：目的了解尿白蛋白/肌酐比值(ACR)正常的2型糖尿病患者肾脏损害的状况,分析其临床与生化特征,探讨此部分患者中肾脏损害的影响因素及早期筛查指标,以期对临床诊断和治疗提供依据。方法收集成都市两家医院(成都国光电气股份有限公司医院、成都市第六人民医院)尿白蛋白/肌酐比值正常的2型糖尿病患者594例(国光医院397例、成都市第六人民医院197例)的完整病历资料。利用MDRD计算公式获得患者估算的肾小球滤过率(eGFR)。肾脏损害判定标准为eGFR<60mL/(min·1.73m^2)。研究这部分患者肾脏损害的状况及相关的影响因素。结果①594例中eGFR<60mL/(min·1.73m^2)的患者104例,ACR正常45例,占43.26%。②ACR正常的患者中eGFR<60mL/(min·1.73m^2)与eGFR60~90mL/(min·1.73m^2)及≥90mL/(min·1.73m^2)比较,冠心病、脑卒中、高血压患病率高于后两组(P<0.001);血尿酸(UA)、胱抑素(Cys-C)、尿β2微球蛋白(尿β2-MG)、血肌酐(Scr)高于后两组(P<0.05)。③ACR正常的患者eGFR与各因素Pearson直线相关分析显示eGFR与年龄、β2-MG、Cys-C、UA、BMI、糖尿病病程呈显著负相关(P<0.05)。eGFR与各因素多元线性逐步回归分析结果显示年龄、冠心病、脑卒中、尿β2-MG、Cys-C、UA是ACR正常患者肾脏损害的独立影响因素。结论本研究通过对2型糖尿病患者的调查发现,ACR正常的糖尿病患者中相当一部分已存在慢性肾脏损害,年龄、冠心病、脑卒中、血尿酸、尿β2微球蛋白、胱抑素C是这些患者肾脏损害的独立影响因素。对糖尿病患者慢性肾脏病变的早期筛查除ACR外,还应评估eGFR、胱抑素C及反映肾小管早期损害指标如尿β2微球蛋白等。Objective To understand the renal damage in type 2 diabetes patients with normal urinary albumin/creatinine ratio(ACR)and analyze its clinical and biochemical characteristics.And to explore the influencing factors and early screening indicators of renal damage,in order to provide evidence for clinical diagnosis and treatment.Methods A total of 594 complete medical cases of type 2 diabetes with normal urine albumin/creatinine ratio were collected from two hospitals in Chengdu(Chengdu Guoguang Electric Co.,Ltd.and Chengdu Sixth People's Hospital).The patient's estimated glomerular filtration rate(eGFR)was calculated by the MDRD calculation formula.The criterion of renal damage was defined as eGFR<60mL/min/1.73m^2.The status of renal damage and related factors were investigated.Results①Among 594 patients,104 patients had eGFR<60ml/min/1.73m^2,and 45 patients had normal ACR,accounting for 43.26%.②Compared with eGFR 60~90mL/min/1.73m^2 and≥90mL/min/1.73m^2 in patients with normal ACR,the prevalences of coronary heart disease,stroke and hypertension in eGFR<60mL/min/1.73m^2 were higher than those of the latter two groups(P<0.001).Serum uric acid(UA),cystatin(Cys-C),urineβ2 microglobulin(urineβ2-MG),and serum creatinine(Scr)were higher than those in the latter two groups(P<0.05).③Pearson linear correlation analysis of eGFR patients with normal ACR and various factors showed that eGFR was significantly negatively correlated with age,β2-MG,Cys-C,UA,BMI,and duration of diabetes(P<0.05).Multivariate linear stepwise regression analysis of eGFR and various factors showed that age,coronary heart disease,stroke,urineβ2-MG,Cys-C,and UA were independent influencing factors of renal damage in patients with normal ACR.Conclusion Through investigation of type 2 diabetes patients,this study found that a significant portion of normal ACR patients had chronic kidney damage.Age,coronary heart disease,stroke,serum uric acid,urinaryβ2-microglobulin and cystatin C were independent factors of renal damage in these patients.In a

关 键 词：2型糖尿病 尿白蛋白/肌酐比值 肾脏损害 影响因素 

分 类 号：R587.1[医药卫生—内分泌]