2型糖尿病患者皮肤晚期糖基化终末产物与肾脏相关疾病的相关性研究  

Association between skin advanced glycation end products and kidney disorder among patients with type 2 diabetes mellitus

作　　者：于家敏 王亚昕 倪佳英 王茗 曹力 姚远 陆蔚 朱玮[1] 陆静毅 周健[1] Yu Jiamin;Wang Yaxin;Ni Jiaying;Wang Ming;Cao Li;Yao Yuan;Lu Wei;Zhu Wei;Lu Jingyi;Zhou Jian(Department of Endocrinology and Metabolism,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai Clinical Center for Diabetes,Shanghai Diabetes Institute,Shanghai Key Laboratory of Diabetes Mellitus,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院内分泌代谢科、上海市糖尿病临床医学中心、上海市糖尿病研究所、上海市糖尿病重点实验室,上海200233

出　　处：《中华糖尿病杂志》2025年第2期220-226,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：上海市优秀学术带头人计划(22XD1402300)。

摘　　要：目的探讨2型糖尿病(T2DM)患者皮肤晚期糖基化终末产物(AGE)水平与肾脏相关疾病的关系。方法该研究为横断面研究。选取2017年5月至2024年4月于上海交通大学医学院附属第六人民医院内分泌代谢科住院检查治疗的T2DM患者为研究对象。收集研究对象年龄、性别、血肌酐并计算估算的肾小球滤过率(eGFR);收集研究对象尿白蛋白及尿肌酐,并计算尿白蛋白/肌酐比值(UACR);收集研究对象身高和体重并计算体重指数(BMI);收集研究对象糖尿病病程、吸烟和饮酒情况、收缩压、甘油三酯(TG)、总胆固醇(TC)、糖化血红蛋白(HbA1c)、降糖治疗、降压治疗、调脂治疗情况等资料。检测研究对象的皮肤AGE水平,并根据其四分位数切点将患者分为Q1组(AGE≤71.7)、Q2组(71.7<AGE≤77.7)、Q3组(77.7<AGE≤86.7)和Q4组(AGE>86.7)。将UACR≥30 mg/g定义为UACR升高,将eGFR<60 ml·min^(-1)·(1.73 m^(2))^(-1)定义为eGFR下降。采用二元logistic回归分析评估皮肤AGE水平与UACR升高、eGFR下降的相关性;基于二元logistic回归模型,分别计算加入皮肤AGE前后2个模型的C统计量。结果共纳入T2DM患者2169例,其中,723例(33.3%)患者UACR升高,224例(10.3%)患者eGFR下降。二元logistic回归分析结果显示,在校正年龄、性别、糖尿病病程、吸烟情况、饮酒情况、BMI、收缩压、TG、TC、HbA1c、降糖治疗、降压治疗、调脂治疗后,与Q1组相比,Q4组T2DM患者出现UACR升高的风险增加51%(OR=1.51,95%CI 1.16~1.96),出现eGFR下降的风险增加52%(OR=1.52,95%CI 1.05~2.21)。在包含变量年龄、性别、糖尿病病程、吸烟情况、饮酒情况、BMI、收缩压、TG、TC、HbA1c、降糖治疗、降压治疗、调脂治疗的模型中加入皮肤AGE后,以UACR升高作为因变量logistic模型的C统计量从0.725(95%CI 0.703~0.748)升高至0.730(95%CI 0.708~0.752)(P=0.036)。结论T2DM患者皮肤AGE水平升高与肾脏相关疾病风险增加相关。ObjectiveTo investigate the association between advanced glycation end products(AGE)and kidney disorder among patients with type 2 diabetes mellitus(T2DM).MethodsThis was designed as a cross-sectional study.Study subjects were selected from patients with T2DM who were hospitalized in the Department of Endocrinology and Metabolism,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2017 to April 2024.Age,sex and serum creatinine were collected and estimated glomerular filtration rate(eGFR)was calculated;urinary albumin and urinary creatinine were collected and the urinary albumin-to-creatinine ratio(UACR)was calculated;height and weight were collected and body mass index(BMI)was calculated;diabetes duration,smoking status,alcohol consumption,systolic blood pressure,triglyceride(TG),total cholesterol(TC),glycated hemoglobin A 1c(HbA 1c),hypoglycemic therapy,anti-hypotensive therapy and lipid-regulating therapy were collected.AGE accumulation was detected and the patients were divided into Q 1 group(AGE≤71.7),Q 2 group(71.7<AGE≤77.7),Q 3 group(77.7<AGE≤86.7)and Q 4 group(AGE>86.7)according to the quartile cut-off points of skin AGE levels.UACR≥30 mg/g was defined as higher UACR,eGFR<60 ml·min^(-1)·(1.73 m^(2))^(-1)was defined as lower eGFR.Binary logistic regression analysis was performed to assess the associations of skin AGE with higher UACR and lower eGFR.Based on the binary logistic regression model,the C-statistics of the two models before and after the addition of skin AGE were calculated respectively.ResultsA total of 2169 patients with T2DM were included in this study.Seven hundred and twenty-three(33.3%)participants had a higher UACR and 224(10.3%)participants had a lower eGFR.Binary logistic regression analysis revealed that after adjusting for age,sex,diabetes duration,alcohol consumption,drinking status,BMI,systolic blood pressure,TG,TC,HbA 1c and medication prescription,the Q 4 group had a 51%increased risk of higher UACR(OR=1.51,95%CI 1.1

关 键 词：糖尿病 2型 晚期糖基化终末产物 肾脏相关指标 

分 类 号：R587.1[医药卫生—内分泌] R692[医药卫生—内科学]