糖尿病肾病患者贫血的特点及其相关因素分析

Anemia in patients with diabetic nephropathy

目的:分析糖尿病肾病患者贫血的特点及其影响因素。方法:临床和肾活检明确诊断为2型糖尿病肾病患者235例,分析贫血的发生率、贫血的性质及其与肾小管功能、血清肌酐(SCr)和胱抑素C(cystatinC,Cys-C)水平以及代谢指标及其他血管并发症的关系。结果:235例糖尿病肾病患者总的贫血发生率为43.8%,SCr正常患者即已出现相当比例的贫血;患者大部分为正细胞正色素性贫血;血红蛋白(Hb)与RBP、NAG水平成负相关(r=-0.310,-0.353,P<0.01),贫血组肾小球滤过率(eGFR)正常者大部分已存在肾小管功能损害;SCr在正常情况下贫血组肾小管病变较非贫血组更重;Hb与eGFR、Cys-C成正相关(r=0.365,0.578,P<0.01),在eGFR下降前即出现贫血;Cys-C升高者小管病变更重;非贫血组胰岛素及C肽水平明显高于贫血组;非贫血者三酰甘油水平较高,贫血者高密度脂蛋白胆固醇更高;Hb与血清白蛋白及前白蛋白水平成正相关(r=0.504,0.282,P<0.05),非贫血组患者体重指数高于贫血组;贫血组视网膜病变及心脏病变发生率明显高于非贫血组(P<0.01)。结论:糖尿病肾病患者贫血的发生率高,并且出现时间早,它与患者的肾小管间质病变密切相关,在GFR下降前即可出现贫血。糖尿病肾病的贫血除与患者的肾功能有关外,还与体内存在的代谢异常及患者的营养状态相关。贫血是糖尿病肾病患者出现其他血管并发症的高危因素。因此,认识糖尿病肾病患者贫血的特点,早期纠正贫血对改善患者症状,减少并发症的发生,提高患者生活质量具有重要意义。

Objective ：To analyze the characteristics of anemia in patients with diabetic nephropathy （DN） and its relevant factors. Methodology：Two hundred and thirty five patients with DN who had been diagnosed by clinical information and renal biopsy were enrolled. The incidence and character of anemia was investigated, and the relationship between anemia and tubular function, serum creatinine, cystatin C, metabolism and other vascular complications was also analyzed. Results：In 235 cases of DN, the incidence of anemia was 43.8%. Anemia could be seen in some patients with normal serum creatinine. Most were normocyte and normochromic. Riboflavine-binding protein （ RBP）, N-acetyl-13-glucosaminidase （NAG） and hemoglobin in patients with DN had a negative correlation （ r = - 0. 310, - 0. 353, P 〈 0. 01 ）. Tabulointerstitial damage had existed in most patients with anemia before eGFR began to decline. When renal function was norreal, tubuIointerstitial damage was more severe in patients with anemia than in those without anemia. The level of hemoglobin had a positive correlation with eGFR （ r = 0. 398, P 〈 0. 01 ） and cystatin C （ r = 0. 578, P 〈 0. 01 ）. The anemia had been present before eGFR began to decline. Tubulointerstitial damage was more severe in patients with elevated cystatin C than those with normal cystatin C. Insulin and C peptide were higher in non-anemia group. Triglyceride was higher in nonanemia group than that in anemia. HDL-cholesterol was higher in anemia group. The hemoglobin was positively correlated with serum albumin （ r = 0. 504, P 〈 0. 05 ） and prealbumin （ r = 0. 282, P 〈 0. 05 ）. Body mass index was higher in nonanemia group. Retinopathy and angiocardiopathy had a higher percentage in patients with anemia than that in patients with-out anemia （P 〈 0. 01 ）. Conclusion：The incidence of anemia is high and anemia could occur at early stage in DN patients, which is associated closely with tubulointerstitial damage. Anemia could present before eGFR declined, which is not only associated with renal function, but also with metabolism abnormality and nutrition state in DN patients. So anemia is a risk factor of other types of vascular complications in DN patients. d