2型糖尿病患者不同蛋白尿期肾小球滤过率的变化及影响因素

Glomerular filtration rate and its influential factors in type 2 diabetes mellitus at different stages of albuminuria

目的研究2型糖尿病（DM）患者不同蛋白尿期的。肾小球滤过率并探讨其影响因素。方法根据尿白蛋白量（24h）把630例2型糖尿病住院患者分成正常白蛋白尿组（A组）、微量白蛋白尿组（B组）及大量白蛋白尿组（C组），用放射性核素（＾99mTc—DTPA）肾动态显像测定肾小球滤过率（GFR），同时测定其体质量指数、血压、血糖、糖化血红蛋白、肾功能、血脂及尿白蛋白量（24h）。结果（1）A组GFR值平均为（99．8±26、3）ml／min；B组为（96．1±31．2）ml／min；C组为（69．7±29．8）ml／min。C组的GFR显著低于A组和B组（P〈0．01）。（2）3组患者的GFR均与年龄呈负相关（A组r=-0．533，B组r=-0．612，C组r=-0．412，均P〈0．01）。（3）有高血压史者的GFR平均值均低于同组无高血压史者（P均〈0．05）。（4）控制年龄后的偏相关分析结果显示，在B组及C组，GFR与尿白蛋白量（24h）呈负相关（r=-0．283及-0．240，均P〈0．05）。多元逐步回归分析结果显示，尿白蛋白量（24h）是影响异常蛋白尿组患者GFR的主要因素。结论放射性核素肾动态显像法测定GFR，同时联合尿白蛋白量检测，能更全面准确地评估糖尿病肾病的进展。应积极控制蛋白尿，尤其在微量白蛋白尿期。

Objective To study the characteristics of glomerular filtration rate （GFR） and its influential factors in type 2 diabetes mellitus at different stages of albuminuria. Method GFR was measured in 630 cases of type 2 diabetes mellitus between 2002 and 2005 by plasma disappearance of 99m-techmetium-diethylene- triamine- penta-acetic acid （^99mTc-DTPA）. Body mass index （BMI）, blood pressure, plasma glucose, HbAlc, Scr, BUN, uric acid （UA）, profile of plasma lipid and 24 h-urinary albumin excretion （24 h-UAE） were also measured. All the patients were divided into 3 groups according to their 24 h-UAE： normoalbuminuric group （group A, 24 h-UAE〈30 mg）, microalbuminuric group （group B, 24 h-UAE from 30 mg to 300 mg） and macroalbuminuric group （group C, 24 h-UAE〉300 mg）. Results （1） The mean GFR was （99.8±26.3） ml/min, （96.1±31.2） ml/min and （69.7±29.8） ml/min in A, B and C groups respectively. The GFR in group C was significantly lower than that in group A and group B （P〈 0.01）. （2） Negative correlations were found between GFR and age in all these groups （group A r= -0.533, group B r=-0.612 and group C r=-0.412,respectively, P〈0.01 ）. （3） In each group, GFR of patients with hypertension was significantly lower than that of patients without hypertension （P〈0.05）. （4） The Pearson correlation analysis adjusted by age showed that GFR was negatively correlated with 24 h-UAE in group B and group C （r=-0.283 and -0.24 respectively, all P〈0.05）. The multiple stepwise regression analysis showed that 24 h-UAE was the major influential factor of GFR in these 2 groups. Conclusions Measurement of both GFR performed by non-traumatic plasma disappearance of ^99mTc-DTPA method and UAE provides a more precise evaluation on the the development and progression of diabetic nephropathy. Albuminuria should be controlled, especially in microalbuminuric stage.