2型糖尿病血压控制与未来出现肾病终点的观察性研究

Effect of blood pressure control on nephropathic end-point in type 2 diabetes mellitus in an observational cohort

目的探讨血压控制水平对2型糖尿病患者未来出现肾病终点的影响。方法对210例入组时肾功能良好的2型糖尿病患者进行观察性研究。收集患者的一般资料,对患者进行体格检查及实验室检测。将首次住院的时间作为研究起点,之后的每次住院及随访均视为随访,最后一次随访时间作为研究终点。终点事件定义为患者出现肾功能下降,即肾小球滤过率(estimated glomerular filtration rate,eGFR)<60 mL-1.min-1.1.73m-2。根据血压水平将患者分组,绘制并比较两组的生存曲线。结果入选患者210例(男109例,女101例),经过5.22(4～7)年的随访,共有23例患者出现肾功能下降,终点事件的发生率为10.95%。将患者按收缩压(systolic blood pressure,SBP)水平分组,SBP<140 mmHg(1 mmHg=0.133 kPa)组(n=130)与SBP≥140 mmHg组(n=80)相比,其出现肾功能下降的概率更低,生存时间更长,两者的差异具有统计学意义(P=0.047 5)。将患者按舒张压(diastolic blood pressure,DBP)水平分组,DBP<90 mmHg组(n=154)与DBP≥90 mmHg组(n=56)相比,其出现肾功能下降的概率更低,生存时间更长,两者的差异具有统计学意义(P=0.000 4)。结论收缩压与舒张压均是2型糖尿病患者出现肾功能下降的影响因素。对于在基线时肾功能较好的2型糖尿病患者,血压控制水平与未来出现肾病终点有明显的相关性。将血压控制在140/90mmHg以下的患者出现肾功能下降更晚,且概率更低。

To investigate the effect of blood pressure control on nephropathic end-point in patients with type 2 diabetes. Methods Totally 210 type 2 diabetic inpatient without renal function decline at the starting point participated in the follow up study. Clinical data and results of laboratory tests were collected. The end point event was defined as eGFR〈60 mL-l ~ min-1 ~ 1.73m-2. The subjects were divided into 2 groups based on the level of blood pressure, and survival curves were made. Results Renal function was initially normal for all 210 patients, but by the completion of follow-up, 23 patients（ 10.95% ） progressed to renal function decline（ eGFR 〈60 mL-1 ~ rain-1 ~ 1.73m-2 ）. The subjects were divided into 2 groups based on the level of SBP. By comparing the survival curves in 2 groups, SBP〈 140 mmHg （1 mmHg = 0.133 kPa） group showed a significantly higher survival rate and longer survival time than SBP 〉/140 mmHg group （P = 0. 047 5）. The subjects were divided into 2 groups based on the level of DBP. By comparing the survival curves in 2 groups, DBP〈90 mmHg group showed a significantly higher survival rate and longer survival time than DBP I〉 90 mmHg group （P = 0.000 4）. Conclusion It was found that both SBP and DBP are strong predictors of renal function decline. The study documented a strong association between blood pressure level and renal function decline in type 2 diabetic patients without renal function deline（ eGFR〉 70 mL-1 ~ min-1 ~ 1.73m-2 ） at baseline. The patients with blood pressure under 140/90 mmHg showed a statistically significantly higher survival rate and longer survival time than those with blood pressure〉140/90 mmHg.