葡萄糖在目标范围内时间与糖尿病肾脏疾病的相关性研究  

Analysis of the Correlation between Time in Range and Diabetic Kidney Disease

作　　者：舒涛 郭正 王飞[2] 陈书艳[2] SHU Tao;GUO Zheng;WANG Fei;CHEN Shuyan(Department of General Practice,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Geriatrics,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院全科医学科,上海市200092 [2]上海交通大学医学院附属新华医院老年医学科,上海市200092

出　　处：《中国全科医学》2023年第15期1873-1879,共7页Chinese General Practice

摘　　要：背景葡萄糖在目标范围内时间(TIR)是近年兴起的糖尿病血糖管理的新指标。研究证实TIR与糖尿病慢性并发症存在密切联系。目前对TIR与糖尿病肾脏疾病(DKD)的研究主要集中在蛋白尿方面,常忽视了估算肾小球滤过率(eGFR)在其中的作用,且对TIR评价血糖控制的切点划分的研究较少。目的探讨TIR与2型糖尿病(T2DM)发生DKD的关系,为临床及时发现、诊治T2DM患者出现DKD提供理论依据。方法纳入2021年7—12月在上海交通大学医学院附属新华医院内分泌科住院的214例T2DM患者,收集患者一般资料、实验室检查指标及用药情况。根据尿白蛋白/肌酐比值(UACR)和eGFR结果,将患者分为DKD组[UACR≥30 mg/g和/或e GFR<60ml·min^(-1)(1.73 m^(2))^(-1),n=58]和单纯T2DM组[UACR<30 mg/g和eGFR≥60 ml·min^(-1)(1.73 m^(2))^(-1),n=156];采用TIR值40%、70%、85%作为切点将患者分为TIR1组(TIR>85%,n=90)、TIR2组(70%<TIR≤85%,n=51)、TIR3组(40%<TIR≤70%,n=57)、TIR4组(TIR≤40%,n=16)。采用多因素Logistic回归分析探讨TIR与T2DM患者发生DKD的关系。结果随着TIR水平下降,T2DM患者DKD发生率呈升高趋势(P_(趋势)<0.05)。多因素Logistic回归分析结果显示,校正多种因素后,TIR是T2DM患者发生DKD的影响因素[OR=0.976,95%CI(0.953,0.999),P=0.047];调整各种混杂因素后,TIR3组、TIR4组相较于TIR1组是T2DM患者发生DKD的影响因素[OR=5.287,95%CI(1.897,14.737),P=0.001;OR=4.712,95%CI(1.143,19.424),P=0.032],随着TIR水平的降低,T2DM患者DKD发生风险呈增高趋势(P_(趋势)=0.010)。结论TIR是T2DM患者发生DKD的影响因素;随着TIR下降,T2DM患者DKD发生率明显增加。Background Time in range(TIR)is a new indicator of glycemic management in diabetes mellitus which has been thriving in recent years.Studies have confirmed that TIR is closely associated with chronic complications of diabetes.Previous studies have confirmed a close association between TIR and chronic complications of diabetes.Current studies on TIR and diabetic kidney disease(DKD)mainly focus on proteinuria,however the role of glomerular filtration rate(e GFR)in it is often neglected,and there are few studies on the cut points of TIR in evaluating glycemic control.Objective To investigate the relationship between TIR and the development of DKD in type 2 diabetes mellitus(T2DM),so as to provide theoretical foundations for the timely clinical detection,diagnosis and treatment of DKD in patients with T2DM.Methods A total of 214T2DM patients admitted to the Department of Endocrinology in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2021 to December 2021 were included.The general data,laboratory indices and medication use were collected.The included patients were divided into group of DKD[UACR≥30 mg/g and/or e GFR<60 ml·min^(-1)(1.73 m^(2))^(-1),n=58]and group of T2DM alone[UACR<30 mg/g and e GFR≥60 ml·min^(-1)(1.73 m^(2))^(-1),n=156]based on the urinary albumin/creatinine ratio(UACR)and eGFR results,the included patients were further divided into TIR1 group(TIR>85%,n=90),TIR2 group(70%<TIR≤85%,n=51),TIR3 group(40%<TIR≤70%,n=57),and TIR4 group(TIR≤40%,n=16)using TIR values of 40%,70%,and 85%as the cut points.Multivariate Logistic regression analysis was used to analyze the relationship between TIR and the development of DKD in T2DM patients.Results The detection rate of DKD in T2DM patients tended to increase with decreasing TIR levels(P_(trend)<0.05).The results of multivariate Logistic regression analysis showed that TIR was an influencing factor for the development of DKD in T2DM patients after adjusting for variables〔OR=0.976,95%CI(0.953,0.999),P=0.047〕;TI

关 键 词：糖尿病肾脏疾病 2型糖尿病 葡萄糖在目标范围内时间 肾小球滤过率 影响因素分析 LOGISTIC模型 

分 类 号：R587.24[医药卫生—内分泌]