估算的肾小球滤过率轻度下降与白蛋白尿对2型糖尿病患者心血管疾病风险的交互作用研究  

Association of the interaction between mild decrease in estimated glomerular filtration rate and albuminuria with risk of atherosclerotic cardiovascular disease in patients with type 2 diabetes mellitus

作　　者：王铎霖 刘乙君 李萍[3] 王彦[3] 中国糖尿病慢性并发症研究工作组 Wang Duolin;Liu Yijun;Li Ping;Wang Yan;the China National Diabetic Chronic Complications(School of the Third Clinical Medicine,Shanxi Medical University,Taiyuan 030001,China;School of the First Clinical Medicine,Shanxi Medical University,Taiyuan 030001,China;Department of Endocrinology,First Hospital of Shanxi Medical University,Taiyuan 030001,China;不详)

机构地区：[1]山西医科大学第三临床医学院,太原030001 [2]山西医科大学第一临床医学院,太原030001 [3]山西医科大学第一医院内分泌科,太原030001 [4]不详

出　　处：《中华糖尿病杂志》2024年第7期746-754,共9页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的探讨估算的肾小球滤过率(eGFR)轻度下降与尿白蛋白/肌酐比值(UACR)对2型糖尿病(T2DM)患者10年动脉粥样硬化性心血管疾病(ASCVD)风险的交互作用。方法为横断面研究。依托中国慢性病及其危险因素监测系统,自2019年6至8月采用多阶段分层随机抽样方法选取山西省四个抽样点(太原市杏花岭区、晋中市榆次区、长治市壶关县和运城市绛县)1 891例糖尿病患者进行调查。收集研究对象年龄、吸烟情况、血脂异常史情况、腰围、收缩压、空腹血糖(FPG)、总胆固醇(TC)、估算的肾小球滤过率(eGFR)、UACR。基于中国动脉粥样硬化性心血管疾病风险预测研究(China-PAR)模型计算T2DM患者未来10年ASCVD患病风险,并根据此结果将患者分为ASCVD低危组(10年ASCVD发病风险<5.0%)、ASCVD中危组(5.0%≤10年ASCVD发病风险<10.0%)和ASCVD高危组(10年ASCVD发病风险≥10.0%)。根据UACR结果将T2DM患者分为无蛋白尿组(UACR<30 mg/g)和有蛋白尿组(UACR≥30 mg/g),按eGFR结果将T2DM患者分为eGFR正常组[eGFR≥90 ml·min^(-1)·(1.73 m^(2))^(-1)]和eGFR轻度下降组[60 ml·min^(-1)·(1.73 m^(2))^(-1)≤eGFR<90 ml·min^(-1)·(1.73 m^(2))^(-1)]。采用单因素方差分析、Kruskal-WallisH检验或χ^(2)检验进行组间比较,采用二元logistic回归模型分析ASCVD高危风险的影响因素,采用交互作用模型探讨eGFR与白蛋白尿对ASCVD高危风险的影响。结果最终纳入资料完整的T2DM患者875例,其中,ASCVD低危组174例、ASCVD中危组193例、ASCVD高危组508例。与ASCVD低危组相比,ASCVD高危组T2DM患者的eGFR水平降低,UACR水平升高(均P<0.001)。二元logistic回归分析结果显示,年龄≥60岁(OR=32.579,95%CI 18.199~58.323)、吸烟(OR=3.297,95%CI 1.906~5.701)、血脂异常史(OR=1.956,95%CI 1.253~3.054)、腹型肥胖(OR=1.712,95%CI 1.136~2.580)、收缩压≥140 mmHg(1 mmHg=0.133 kPa)(OR=12.676,95%CI 7.072~22.719)、FPG>7.0 mmol/L(OR=1.739,95%CI 1.048~2.885)、TC≥5.18 Objective To investigate the interaction between mild decrease in estimated glomerular filtration rate(eGFR)and urinary albumin-to-creatinine ratio(UACR)on the 10-year risk of atherosclerotic cardiovascular disease(ASCVD)risk in patients with type 2 diabetes mellitus(T2DM).Methods This was a cross-sectional study.A total of 1891 diabetic patients were randomly selected from four sampling sites in Shanxi Province(Xinghualing District,Taiyuan City;Yuci District,Jinzhong City;Huguan County,Changzhi City;and Jiangxian County,Yuncheng City)from June to August 2019 using the method of multi-stage stratification random sampling.Age,smoking status,history of dyslipidaemia,waist circumference,systolic blood pressure,fasting plasma glucose(FPG),total cholesterol(TC),estimated glomerular filtration rate(eGFR)and UACR were collected from study participants.The 10-year risk of ASCVD in T2DM patients was calculated based on the prediction for ASCVD risk in China(China-PAR)model,and the patients were categorized into ASCVD low-risk group(the 10-year risk of ASCVD<5.0%),ASCVD medium-risk group(5.0%≤the 10-year risk of ASCVD<10.0%),and ASCVD high-risk group(the 10-year risk of ASCVD≥10.0%).T2DM patients were divided into non-proteinuria group(UACR<30 mg/g)and proteinuria group(UACR≥30 mg/g)according to UACR results.T2DM patients were divided into eGFR normal group[eGFR≥90 ml·min^(-1)·(1.73 m^(2))^(-1)]and eGFR slightly decreased group[60 ml·min^(-1)·(1.73 m^(2))^(-1)≤eGFR<90 ml·min^(-1)·(1.73 m^(2))^(-1)]according to eGFR results,One-way analysis of variance(ANOVA),Kruskal-Wallis H test orχ^(2) test were used for between-group comparisons,binary logistic regression models were used to analyze the factors influencing the risk of high risk of ASCVD,and interaction models were used to explore the effects of eGFR and albuminuria on the risk of high risk of ASCVD.Results A total of 875 T2DM patients with complete data were included,of whom 174 were in the ASCVD low-risk group,193 in the ASCVD intermediate-risk group,a

关 键 词：糖尿病 2型 动脉粥样硬化性心血管疾病 尿白蛋白/肌酐比值 估算的肾小球滤过率 交互作用 

分 类 号：R587.2[医药卫生—内分泌]