特发性膜性肾病患者免疫抑制剂治疗后新发糖尿病的危险因素分析  

Risk factors of new-onset diabetes mellitus after immunosuppressive therapy in patients with idiopathic membranous nephropathy

作　　者：任燕[1] 邵丽娜[1] 陈茂盛[1] 金娟[1] 龚建光[1] 李一文[1] 何强[1] REN Yan;SHAO Lina;CHEN Maosheng;JIN Juan;GONG Jianguang;LI Yiwen;HE Qiang(Nephrology Center,Zhejiang Provincial People's Hospital,People's Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)肾脏病中心,杭州310014

出　　处：《浙江医学》2021年第15期1668-1670,1673,共4页Zhejiang Medical Journal

摘　　要：目的分析特发性膜性肾病(IMN)患者采用免疫抑制剂治疗后新发糖尿病(NODM)的危险因素。方法选取2013年9月至2019年8月浙江省人民医院收治的IMN患者102例,均采用他克莫司联合低剂量皮质类固醇治疗,至少3个月。其中治疗后发生NODM患者38例(NODM组),未发生NODM患者64例(no-NODM组)。比较两组患者的临床特征,并分析影响患者NODM的危险因素。结果IMN患者免疫抑制剂治疗后NODM发生率为37.2%;疾病完全缓解55例,部分缓解25例,缓解率为78.4%。与no-NODM组相比较,NODM组患者年龄较大,空腹血糖水平较高,LDL-C水平较低(均P<0.05)。多因素logistic回归分析提示,年龄增长(OR=1.78,95%CI:1.27~2.51)、空腹血糖偏高(OR=2.54,95%CI:1.08~5.99)是IMN患者免疫抑制剂治疗后NODM的独立危险因素(均P<0.05)。结论他克莫司联合低剂量皮质类固醇治疗IMN是有效的,但存在NODM风险。年龄增长和空腹血糖水平偏高是接受他克莫司联合低剂量皮质类固醇治疗的IMN患者发生NODM的主要危险因素。Objective To investigate risk factors of new-onset diabetes mellitus(NODM)in patients with idiopathic membranous nephritis(IMN)receiving immunosuppressive therapy.Methods The clinical data of 102 IMN patients who received tacrolimus combined with low-dose glucocorticoid for at least 3 months in Zhejiang Provincial People’s Hospital from September 2013 to August 2019 were retrospectively analyzed.During follow-up,38 of the 102 patients developed NODM(37.2%,NODM group)and NODM did not occurred in 64 patients(non-NODM group).The demographic and clinical data at baseline and follow-up were compared and the risk factors of developing NODM were analyzed.Results Complete remission was achieved in 55 cases and partial remission in 25 cases,with a remission rate of 78.4%.The age of NODM patients was significantly higher than that of patients without NODM(median age:58.6 years vs.40 years).The baseline fasting blood glucose(FBG)levels in the NODM group were higher than those in non-NODM group(P<0.05).Multivariate regression analysis showed that age(OR=1.78,95%CI:1.27-2.51,P<0.05)and baseline FBG(OR=2.54,95%CI:1.08-5.99,P<0.05)were independent risk factors for NODM.Conclusion Low dose glucocorticoid combined with tacrolimus is an effective treatment regimen for IMN.However,patients with older age and elevated fasting blood glucose may be more likely to develop NODM.

关 键 词：特发性膜性肾病 免疫抑制 新发糖尿病 危险因素 

分 类 号：R692[医药卫生—泌尿科学] R587.2[医药卫生—外科学]