血糖控制水平对晚期糖尿病肾病患者肾脏终点事件的影响  

Effects of blood glucose control level on renal end events in patients with advanced diabetic nephropathy

作　　者：刘敏洁[1] 薛现军[1] 王玉路 张颖裕 LIU Min-jie;XUE Xian-jun;WANG Yu-lu;ZHANG Ying-yu(Department of Nephrology,Puyang Oilfield General Hospital,Puyang 457001,Henan,China;不详)

机构地区：[1]濮阳市油田总医院肾内科,河南濮阳457001 [2]河南科技大学第一附属医院肾内科,河南洛阳471003

出　　处：《广东医学》2023年第8期998-1002,共5页Guangdong Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190550)。

摘　　要：目的探讨血糖控制水平和晚期糖尿病肾病(diabetic kidney disease,DKD)患者肾脏终点事件的关系。方法应用回顾性队列研究方法。选择2016年4月至2020年2月住院治疗的晚期DKD的T2DM患者715例作为研究队列,收集患者的病历资料。根据患者纳入队列后1年内的平均糖化血红蛋白(hemoglobin A1c,HbA_(1C))水平将患者分为HbA_(1C)≥7.0%组与HbA_(1C)<7.0%组。对比分析两组患者的肾脏终点事件发生状况。结果HbA_(1C)≥7.0%组患者的基线静脉血浆空腹血糖水平为(159.44±35.66)mg/dL;HbA_(1C)<7.0%组患者的基线静脉血浆空腹血糖水平为(157.28±33.19)mg/dL。HbA_(1C)<7.0%组患者的肾移植率(1.97%)、透析率(5.92%)、血清肌酐水平加倍率(44.74%)、GFR持续<15[mL/(min·1.73 m^(2))]率(23.68%)与HbA_(1C)≥7.0%组患者(2.84%、5.86%、45.12%、26.11%)比较,差异无统计学意义(P=0.759、0.978、0.934、0.543)。回归分析发现,HbA_(1C)水平对患者肾移植、透析、血清肌酐水平加倍、GFR持续<15[mL/(min·1.73 m2)]均没有统计学意义的影响(P>0.05,OR=1.137、1.025、0.916、1.127)。结论强化血糖控制水平不能预防晚期DKD患者肾脏功能的恶化。Objective To explore the correlation between blood glucose control level and renal end events in patients with advanced diabetic kidney disease(DKD).Methods A retrospective cohort study was used.A total of 715 cases of T2DM patients with advanced DKD,who were hospitalized from April 2016 to February 2020,were selected as the study group.The medical records of the patients were collected.Patients were divided into HbA_(1C)≥7.0%group and HbA_(1C)<7.0%group according to the average HbA_(1C) level within one year after being included in the cohort.The renal end events between two groups were compared and analyzed.Results The baseline fasting venous plasma glucose level was(159.44±35.66)mg/dL in the HbA_(1C)≥7.0%group and(157.28±33.19)mg/dL in the HbA_(1C)<7.0%group.There was no statistically significant difference between the HbA_(1C)<7.0%group(1.97%)and the HbA_(1C)≥7.0%group(2.84%)in terms of renal transplantation rate(P=0.759).The dialysis rate was 5.92%in the HbA_(1C)<7.0%group and 5.86%in the HbA_(1C)≥7.0%group,with no statistically significant difference(P=0.978).The serum creatinine level doubling rate was 44.74%in the HbA_(1C)<7.0%group and 45.12%in the HbA_(1C)≥7.0%group,with no statistically significant difference(P=0.934).The rate of GFR(glomerular filtration rate)continuously less than 15 mL/(min·1.73 m^(2))was 23.68%in the HbA_(1C)<7.0%group and 26.11%in the HbA_(1C)≥7.0%group,with no statistically significant difference(P=0.543).Regression analysis showed that HbA_(1C) level did not have a statistically significant impact on patient′s renal transplantation,dialysis,serum creatinine level doubling,or GFR continuously less than 15 mL/(min·1.73 m2)(P>0.05,OR=1.137,1.025,0.916,and 1.127,respectively).Conclusion Strengthening blood glucose control level cannot prevent the deterioration of renal function in patients with advanced DKD.

关 键 词：血糖 肾病 临床结局 

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