微量白蛋白尿阴性的2型糖尿病患者肾功能异常及其影响因素研究

Renal Impairment in Type 2 Diabetic Patients without Microalbuminuria and the Impacting Factors

目的探讨微量白蛋白尿阴性的2型糖尿病患者肾功能下降的发生率及其可能的影响因素。方法以8 h尿白蛋白排泄率(UAER)<20μg/m in为微量白蛋白尿阴性,以双血浆99mTc-DTPA血浆清除率方法测定肾小球滤过率(GFR),<90 m l.m in-1.1.73 m-2为肾功能下降,分析我院内分泌病房的121例2型糖尿病患者中微量白蛋白尿阴性的患者肾功能下降发生率,比较肾功能下降组和肾功能正常组的临床资料和实验室检查,Logistic回归分析肾功能下降的影响因素。结果 (1)在住院的2型糖尿病患者中,微量白蛋白尿阴性而肾功能下降的发生率达31%。(2)在微量白蛋白尿阴性的2型糖尿病患者中,肾功能下降组年龄显著高于肾功能正常组,差异有统计学意义(P=0.000)、踝肱指数(AB I)显著低于肾功能正常组,差异有统计学意义(P=0.011)、趾肱指数(TB I)显著低于肾功能正常组,差异有统计学意义(P=0.001)。(3)微量白蛋白尿阴性的2型糖尿病患者GFR与患者年龄和糖尿病病程呈显著负相关(r值分别为-0.449和-0.227,P值分别为0.000和0.043),与AB I、TB I呈显著正相关(r值分别为0.305、0.429,P值分别为0.007和0.000)。(4)TB I为微量白蛋白尿阴性的2型糖尿病患者肾功能下降的独立危险因素(B=-4.736,P=0.001)。结论微量白蛋白尿阴性2型糖尿病患者肾功能下降发生率可能较高,动脉硬化可能是其主要的危险因素。

Objective To determine the prevalence of renal impairment in type 2 diabetic patients without microalbuminuria and the relative factors.Methods The urine albumin excretion rate（UAER）20 μg/min in 8 hours period was taken as negative microalbuminuria.Glomerular infiltration（GFR） were measured by using 99mTc-Diethylene Triamine Pentaacetic Acid（99mTc-DTPA） plasma clearance with dual plasma sampling method,and GFR90 ml·min-1·1.73 m-2 was taken as renal impairment.The prevalence of microalbuminuria in 121 patients with type 2 diabetes admitted to Peking University first hospital were studied to compare the clinical data and laboratory results of the patients with and without microalbuminuria.Logistic regression analysis was used for the impacting factors of renal impairment.Results（1） The prevalence of GFR decline in type 2 diabetic patients without microalbuminuria was 31%.（2） The age of declined GFR group was remarkable lower than that of normal GFR group（P=0.000）,and so was the ankle-brachial blood pressure index（ABI）（P=0.011） and toe-brachial blood pressure index（TBI）（P=0.001）.（3） GFR was significantly negatively correlated with age（r=-0.449,P=0.000）,diabetic course（r=-0.227,P=0.043）,and positively correlated with ABI（r=0.305,P=0.007）and TBI（r=0.429,P=0.000）.（4） TBI was an independent risky factor of renal impairment in type 2 diabetic patients without microalbuminuria（B=-4.736,P=0.001）.Conclusion The prevalence of renal impairment with normal UAER in type 2 diabetic patients can be higher.Arteriosclerosis may be its main risk factor.