尿白蛋白正常的2型糖尿病患者肾功能下降的影响因素

Renal insufficiency and its associated factors in type 2 diabetic patients with normoalbuminuria

目的探讨24h尿白蛋白排泄率正常的2型糖尿病患者估算的肾小球滤过率（eGFR）及其主要的影响因素。方法采用中华医学会糖尿病学分会对住院糖尿病患者慢性并发症调查的资料，以改良的肾脏病膳食改良试验（MDRD）公式计算eGFR并进行分析。结果正常白蛋白尿、微量白蛋白尿和大量白蛋白尿患者中分别有19．7％（149／755）、21．9％（102／466）和45．4％（59／130）出现eGFR的下降。正常白蛋白尿患者中eGFR下降组慢性并发症的发生率较eGFR正常组高。多因素logistic回归分析显示，年龄（OR=1．042，P〈0．001）、糖尿病病程（OR=1．038，P=0．045）和收缩压（OR=1．017，P〈0．001）是影响eGFR的主要因素，BMI（OR=0．868）及糖化血红蛋白（OR=0．898）亦与eGFR的下降有关。结论尿白蛋白正常的2型糖尿病患者已有部分出现肾功能损害，结合eGFR有助于更好地评价2型糖尿病患者的肾脏损害情况。

Objective To investigate the prevalence of renal insufficiency and its associated factors in type 2 diabetes mellitus with normoalbuminuria using estimated glomerular filtration rate （eGFR）. Methods We retrospectively analyzed 10-year data of chronic complications in type 2 diabetics in-patient from the Chinese Diabetes Society. eGFR was estimated using the equation from Modification of Diet in Renal Disease（MDRD） study. The clinical characteristics as well as associated factors for low eGFR were analyzed among the normoalbuminuric type 2 diabetic patients. Results A total of 1351 type 2 diabetic patients were included, 755 patients with normoalbuminuria, 466 patients with microalbuminuria and 130 patients with macroalbuminuria respectively. Among the patients, 310 （22. 9% ） had low eGFR （GFR 〈 60 ml · min^-1· 1.73 m^-2 ）, 19.7% （149/755） in the patients with normoalbuminuria, 21.9% （102/466） in microalbuminuria and 45.4% （ 59/130 ） in macroalbuminurim Patients with normoalhuminuria and low eGFR suffered more chronic complications than those with normoalbuminuria and normal eGFR, mainly retinopathy, cerebrovascular diseases and sensory neuropathy. Stepwise logistic regression analysis revealed that age （ OR = 1. 042, P 〈 0. 001 ）, diabetic duration （ OR = 1. 038, P = 0. 045） , systolic blood pressure （ OR = 1. 017, P 〈 0. 001 ） were independently associated with renal impairment among the patients with normoalbuminuria. Body mass index （ OR = 0. 868, P 〈 0. 001 ） and HbAlc （ OR = 0. 898, P = 0. 021 ） were also related with renal insufficiency. Conclusion A considerable proportion in type 2 diabetic patients without albuminuria may exist renal impairment, and eGFR estimation could benefit the evaluation of renal function in such patients.