正常ACR的2型糖尿病早期肾损伤影响因素探讨

Influencing factors of early renal injury in type 2 diabetic patients with normal urinary ACR

目的:探讨尿微量白蛋白正常、尿微量白蛋白/肌酐比值(urinary albumin-to-creatinine ratio,ACR)正常的2型糖尿病患者早期肾损伤的影响因素。方法:用EPI公式计算e GFR,将e GFR≥90 m L/(min·1.73m^2)者划为无肾损伤组,eGFR<90 m L/(min·1.73m2)者划为肾损伤组,收集患者年龄、糖尿病病程、腹围、BMI,测定HbA1c、FG、TC、TG、HDL-C、LDL-C、TC/HDL-C、ALB、UA、收缩压、舒张压、双下肢平均ABI,比较2组以上指标差异以及探讨相关指标与e GFR的关系。结果:肾损伤组的年龄、病史、BMI、腹围、TG、TC/HDL-C、UA、收缩压明显高于或长于无肾损伤组;而ALB、舒张压、ABI均明显低于无肾损伤组。其中年龄、TG、UA水平与e GFR呈负相关;双下肢ABI与eGFR呈正相关。结论:对于正常尿微量白蛋白、ACR的2型糖尿病人群仍需注意肾损伤可能,特别对于老年、高三酰甘油血症、高尿酸血症、ABI值偏低人群,尽早计算eGFR评估肾损伤程度,早期干预,延缓肾损伤进展。

Objective： To explore the influencing factors of early renal injury in type 2 diabetic patients with normal urinary microalbumin and albumin-to-creatinine ratio（ ACR）. Methods： EPI formula was used to calculate e GFR,and then patients with e GFR≥90 m L/（ min·1. 73m^2） were classified as non renal injury group while those with e GFR 〈 90 m L/（ min·1. 73m^2） were classified as renal injury group. Age,history of diabetes,abdomen circumference and BMI of patients were collected. HbA1 c,FG,TC,TG,HDL-C,LDL-C,TC/HDL-C,ALB,UA,systolic pressure,diastolic pressure and average ABI of double lower limbs were compared between the two groups. The correlations between these factors and e GFR were analyzed. Results： Age,history of diabetes,abdomen circumference,BMI,TG,TC/HDL-C,UA and systolic pressure were significantly higher or longer in renal injury group than those in non renal injury group. ALB,diastolic pressure and ankle brachial index（ ABI） were significantly lower in renal injury group than those in non renal injury group. Age,TG,UA levels were negatively correlated with e GFR; the ABI of double lower limbs was positively correlated with e GFR. Conclusion： We should pay attention to the possibility of renal injury in type 2 diabetic patients with normal urinary microalbumin and ACR, especially in elderly, hypertriglyceridemia,hyperuricemia and lower ABI population. eGFR should be calculated as early as possible to evaluate renal injury,and early intervention should be taken to delay the progression of renal injury.