中老年T2DM人群CKD的演变规律

Regularity for development of CKD in middle-aged and old patients with type 2 diabetes

目的:探讨中老年2型糖尿病(T2DM)人群慢性肾脏疾病(CKD)的发展变化及预后。方法:我院"两次入院,时间间隔0.5～5.5年"的CKD患者112例,统计不同血肌酐和尿蛋白组合的脑梗塞、ESRD和透析治疗等事件的5年累积率和发生率,以及各组5年后的eGFR水平和变化值,探讨CKD的演变规律。结果:四组的eGFR和SCr的变化速度由小到大依次为:"肌酐正常-尿蛋白正常组"<"肌酐正常-蛋白尿组"<"肌酐升高-尿蛋白正常组"<"肌酐升高-蛋白尿组",且"肌酐升高-蛋白尿组"的脑梗塞、ESRD和透析发生率明显高于其他组。影响血肌酐进展速度的逐步回归分析可见ACR、SCr和CA15-3对血肌酐进展速度有明显的线性影响,P<0.01。结论:"肌酐升高-蛋白尿组"CKD的进展最快,预后最差;微量蛋白尿、SCr和CA15-3是CKD危险因素。

Objective： To evaluate the risk factors for development of chronic kidney disease （ CKD ） in middle-aged and old patients with type 2 diabetes and to explore the prognosis and development rule of CKD. Methods： One hundred and twelve patients with type 2 diabetes over the age of 50 years, who were admitted twice to the Chinese PLA General Hospital between 2000 and 2008, were studied. The patients were divided into 4 groups according to their serum creatinine （ normal, high ） and urine protein （ normal, albuminuria ） levels. Serum creatinine and GFR levels were meausred and the incidence of cerebral infarction, ESRD and coronary heart disease was calculated. The risk factors and rule of serum creatinine occurrence were studied by correlation analysis. Data were analyzed using CHISS. Results： There was a positive correlation between TP, UA, TG, LP（ a ）, ACR, UAE, DR, CI, smoke and SCr progression. There was a negative correlation between SCr, BUN, P, Mg and SCr progression （ P〈0.05 ）. Stepwise regression analysis showed that there was a visible linear correlation between ACR, Cr, CA15-3 and SCr progression. Conclusion： UA, TG, LP （ a ）, SCr, BUN, CA15-3, urine protein, smoke and the course of hypertension contribute to the progression of CKD. Patients with high serum creatinine and micro-albuminuria levels are at a higher CKD stage with worse prognosis. Micro-albuminuria, SCr and CA15-3 are the risk fasters for CKD.