尿微量白蛋白阴性的超重肥胖2型糖尿病患者估算的肾小球滤过率下降的相关危险因素分析

Estimated glomerular filtration rate and associated risk factors in overweight or obese patients with type 2 diabetes and normal urine microalbumin level

2011年8月至2012年3月，从广东省内60家医院收集门诊或住院已确诊2型糖尿病且合并体重指数≥24kg／m^2的患者5241例，其中随机尿微量白蛋白〈30mg／L的患者共2631例。根据估算的肾小球滤过率（eGFR）水平将其分为正常组及下降组，应用Binary logistic回归方法对eGFR的相关危险因素进行分析。结果显示，年龄、尿酸、尿素氮、冠心病史、高血压病史、糖尿病家族史、高尿酸血症与eGFR下降呈独立正相关（P〈0．05或P〈0．01），HbA1c达标、定期监测血糖、规律运动与eGFR下降呈独立负相关（均P〈0．01）。提示超重或肥胖的2型糖尿病患者应联合使用尿微量白蛋白及eGFR全面评估。肾功能情况，并严格控制血糖、血压及血尿酸水平以减少糖尿病肾病的发生风险。

From August 2011 to March 2012, 5 241 type 2 diabetic patients with body mass index ≥ 24 kg/m2 were enrolled from 60 hospitals in Guangdong Province. According to estimated glomerular filtration rate （eGFR） , a total of 2 631 subjects with normal urine microalbumin level （ 〈30 mg/L） were divided into normal eGRF group and decreased eGRF group. Binary logistic regression was used to analyze the associations between eGFR and its related risk factors. The results showed that age, blood uric acid, blood urea nitrogen, history of hypertension and coronary heart disease, family history of diabetes, and hyperurieemia were positively related to lowering of eGFR （ P〈 0.05 or P〈0.01 ）. HbA1c〈7% , regular glucose monitoring, and regular physical activity were negatively related to eGFR decrease （ all P 〈 0. 01 ）. These results suggest that urine microalbumin and eGFR should be applied to overweight or obese patients with type 2 diabetes in order to screen diabetic nephropathy. Furthermore, intensive control of blood glucose, uric acid, and blood pressure is beneficial to lowering the risk of diabetic nephropathy.