蛋白尿与估算肾小球滤过率联合对糖尿病患者新发心血管疾病的影响  

The combined effect of albuminuria and eGFR on cardiovascular disease in population with diabetes mellitus

作　　者：陶杰[1] 张欣欣[1] 李跃军[1] 张明[1] 桑大森[1] TAO Jie;ZHANG Xinxin;LI Yuejun;ZHANG Ming;SANG Dasen(Department of Cardiology,Baoding NO.1 Central Hospital,Baoding 071000,China)

机构地区：[1]保定市第一中心医院心内科,河北保定071002

出　　处：《医学研究与教育》2024年第3期31-39,共9页Medical Research and Education

基　　金：保定市科学技术研究与发展计划项目(2241ZF249)。

摘　　要：目的 观察估算肾小球滤过率(estimated glomerular filtration rate, eGFR)和尿微量白蛋白与肌酐比值(urine albumin-to-creatinine ratio, uACR)评估肾功能的一致性,探讨二者联合对糖尿病患者新发心脑血管疾病(cardia-cerebrovascular disease, CVD)(包括心力衰竭、心肌梗死、脑卒中)的影响。方法 选择参加开滦第5次或第6次健康体检且进行尿微量白蛋白及尿肌酐、血肌酐检测的8 791例2型糖尿病(type 2 diabetes mellitus, T2DM)患者为研究对象。依据基线uACR和eGFR水平分组:正常组(uACR<3 mg/mmol且eGFR≥90 mL·min^(-1)·1.73 m^(-2))、单纯eGFR下降组(uACR<3 mg/mmol且eGFR<90 mL·min^(-1)·1.73 m^(-2))、单纯uACR升高组(uACR≥3 mg/mmol且eGFR≥90 mL·min^(-1)·1.73 m^(-2))和uACR升高合并eGFR下降组(uACR≥3 mg/mmol且eGFR<90 mL·min^(-1)·1.73 m^(-2))。观察eGFR和uACR评估的肾功能是否一致。采用多因素Cox回归模型分析uACR和eGFR联合分组对CVD发病风险的影响。结果 (1)研究对象基线年龄为(60.97±9.99)岁,男性占79.05%,中位uACR为1.68(0.81,4.60)mg/mmol,平均eGFR为(92.14±16.52) mL·min^(-1)·1.73 m^(-2),uACR升高与eGFR下降不一致者占43.59%。(2)中位随访时间为3.83年,共发生CVD事件694例(7.89%),4组总CVD事件的发病密度分别为12.96/1 000人年、19.04/1 000人年、25.65/1 000人年和46.87/1 000人年。(3)与正常组相比,单纯eGFR下降组、单纯uACR升高组和uACR升高合并eGFR下降组新发总CVD事件的风险分别升高1.06(95%CI 0.73~1.55)倍、1.99(95%CI 1.41~2.80)倍和3.00(95%CI 2.12~4.25)倍。结论 eGFR下降和uACR升高所评估的肾功能不一致现象较为常见,二者对CVD发病的影响存在联合作用。Objective To investigate whether the renal function assessed by estimated glomerular filtration rate(eGFR)and urinealbumin-to-creatinine rate(uACR)is consistent and explore the effect of the combination of the two on new-onset Cardia-cerebrovascular disease(CVD)in population with type 2 diabetes mellitus(T2DM).Methods We included 8791 participants with T2DM but no CVD who were assessed with uACR and eGFR between 2014 and 2016.The participants were divided into four groups based on their baseline uACR and eGFR:normal(uACR<3 mg/mmol and eGFR≥90 mL·min^(-1)·1.73 m^(-2)),simple eGFR decreaed(uACR<3 mg/mmol and eGFR<90 mL·min^(-1)·1.73 m^(-2)),simple uACR increased(uACR≥3 mg/mmol and eGFR≥90 mL·min^(-1)·1.73 m^(-2)),uACR increased and eGFR decreaed(uACR≥3 mg/mmol and eGFR<90 mL·min^(-1)·1.73 m^(-2)).The relationship between uACR and eGFR and new-onset CVD was studied using Cox proportional hazard models.Results There were 79.05%males in all participants with an average age of 60.97 years old.Their median uACR was 1.68(0.81,4.60)mg/mmol and mean of eGFR was(92.14±16.52)mL·min^(-1)·1.73 m^(-2)),increased uACR and decreased eGFR were inconsistent in 43.59%.694 new-onset CVD cases(7.89%)were recorded after a median follow-up of 3.83 years.The incidence of CVD in all four groups was 12.96/1000 preson-years,19.04/1000 preson-years,25.65/1000 preson-years and 46.87/1000 preson-years,respectively.When compared with normal,multivariable-adjustted hazard ratios of CVD were 1.06(95%CI 0.73~1.55),1.99(95%CI 1.41~2.80)and 3.00(95%CI 2.12~4.25)in simple eGFR decreaed group,simple uACR increased group,uACR increased and eGFR decreaed group,respectively.Conclusion Inconsistencies in renal function assessed by decreased eGFR and increased uACR are common,there is a joint effect of the two methods on the prediction of new CVD.

关 键 词：心血管疾病 尿微量白蛋白与尿肌酐比值 估算肾小球滤过率 2型糖尿病 

分 类 号：R54[医药卫生—心血管疾病]