老年与非老年2型糖尿病患者肾脏损害的特点及影响因素

Clinical features and risk factors of renal damage in elderly and non-elderly patients with type 2 diabetes mellitus

目的探讨老年与非老年2型糖尿病（T2DM）患者肾脏损害的特点及影响因素。方法回顾性分析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临床资料，筛选出符合要求T2DM患者共1351例，根据24h尿白蛋白排泄率（AER）水平分为正常白蛋白尿组（AER〈30mg／24h）、微量白蛋白尿组（30≤AER〈300mg／24h）和大量白蛋白尿组（AER≥300mg／24h）；采用改良的MDRD公式计算肾小球滤过率（eGFR），对老年（≥60岁）与非老年T2DM患者的肾脏损害特点，及其影响因素进行比较分析。结果（1）T2DM正常白蛋白尿组和微量白蛋白尿组伴eGFR下降的比例在老年组明显高于非老年组（26．7％比15．8％，P〈0．01；30．5％比21．3％，P〈0．05）；（2）正常白蛋白尿伴eGFR下降的T2DM患者中，老年患者糖尿病平均病程（7．7年比3．8年）、收缩压[（146±24）mmHg比（134±23）mmHg]、舒张压[（84±13）mmHg比（804-11）mmHg]、合并高血压（37．8％比21．1％）、发生糖尿病视网膜病变（34．1％比23．9％）、发生心、脑血管病变（31．6％比11．3％及24．4％比9．9％）均明显高于非老年（P〈0．05或0．01）；（3）多因素回归分析显示糖尿病病程（OR=1．046，P=0．013）和收缩压（OR=1．014，P=0．002）是影响老年T2DM正常白蛋白尿组eGFR下降的主要危险因素；收缩压（OR=1．042，P=0．000）和餐后2h血糖（OR=1．048，P=0．002）则是影响非老年T2DM正常自蛋白尿组eGFR下降的主要危险因素。结论老年T2DM患者较非老年T2DM患者更易出现以eGFR下降为早期表现的肾脏损害；收缩压是老年和非老年T2DM患者正常白蛋白尿期eGFR下降的主要危险因素，控制血压可能延缓肾功能损害。

Objective To investigate the clinical features and risk factors of renal damage in the elderly and non-elderly patients with type 2 diabetes mellitus. Methods The data were collected from a survey of 10-year retrospective study of chronic complications of hospitalized type 2 diabetics organized by Chinese Diabetes Society. A total of 1351 patients of type 2 diabetes were selected and divided into an elderly group（≥ 60 year）and a non-elderly group（ 〈 60 year）. The patients were also divided into three groups according to urinary albumin excretion rate （AER） ： normoalbuminuria group （AER 〈 30 mg/24 h）, microalbuminuria group （ 30 ~〈 AER 〈 300 mg/24 h） and macroalbuminuria group （ AER t〉 300 mg/24 h）. eGFR was estimated by the equation from the MDRD study. Clinical and laboratory parameters of all patients were analyzed. Results （ 1 ） The proportions of renal insufficiency in both normoalbuminuria and mieroalbuminuria groups of type 2 diabetes in the elderly patients were significantly higher than those in the non-elderly patients （26. 7% vs 15.8% , P 〈0. 01 ; 30. 5% vs 21.3%, P 〈0. 05 respectively） ; （2） in type 2 diabetic patients with renal insufficiency and normoalbuminuria, the diabetes duration （ 7.7 vs 3.8 years）, systolic blood pressure [ （ 146± 24 ） mm Hg vs （ 134 - 23 ） mm Hg ], diastolic blood pressure [ （84 ± 13） mm Hg vs （80 ± 11 ） mm Hg], proportion of hypertension （ 37.8% vs 21.1% ）, diabetic retinopathy（34. 1% vs 23.9% ）, cardiovascular diseases （31.6% vs 11.3% ） and eerebrovascular disease （ 24. 4% vs 9. 9% ） were significantly higher in the elderly group than in the non-elderly group （ P 〈 0. 05 or 0. 01） ; （3） multiple logistic regression analysis revealed that the duration of diabetes （ OR = 1. 046, P = 0. 013） and systolic blood pressure （ OR = 1. 01d, P = 0. 002 ） were independently associated with renal insufficiency in the elderly type 2 diabetic patients with normoalbuminuria, whereas systolic blood pressure （ OR = 1. 042, P = 0. 000 ） and 2-hour postprandial blood glucose （ OR = 1. 048, P = 0. 002 ） were independent risk factors for renal insufficiency of non-elderly patients. Conclusion The elderly type 2 diabetic patients are likely to suffer renal insufficiency initially from a lower glomerular filtration rate than the non-elderly patients. Systolic blood pressure is the main risk factor in both elderly and non-elderly type 2 diabetes with normoalbuminuria and a decreased renal function. Controlling blood pressure may delay the decline of renal function.