不同时期糖尿病肾病患者的肾小球滤过率的改变以及影响因素

Changes of glomerular filtration rate in different stages of patientswith diabetic nephropathy and its influence factors

为探讨不同时期糖尿病肾病（DN）患者的肾小球滤过率(GFR)的改变以及临床影响因素，应用99mTc DTPA肾动态显像测定216例 2型糖尿病人的GFR，根据尿白蛋白排泄率将糖尿病肾病分为四期，比较各期GFR改变以及多项临床指标对其影响。结果表明：随着DN的进展，各期GFR依次降低，尿白蛋白排泄率逐渐上升，二者呈显著负相关（r = - 0.5070, P＜0.001）。在任何一期DN患者中，有高血压史者的GFR均比同期无高血压史者明显下降（P＜0.05）；DN早期高血糖可以使GFR明显升高（P＜0.05），而DN晚期高血糖使GFR上升的作用不明显；多元逐步回归分析显示：年龄、动脉收缩压分别与GFR呈独立负相关（回归系数分别为－0.56，－0.28， P＜0.01）。GFR是反映不同时期DN患者肾小球滤过功能的敏感指标，DN患者要严格控制血糖和血压以延缓GFR下降。

Objective To evaluate the changes of glomerular filt ration rate (GFR) in patients with different stages of diabetic nephropathy (DN ) and analyse the influence factors of GFR. Methods Using 99m Tc-DTPA , the GFR of 216 2-type diabetes were measured. According to urinary albumin ex cretion rate (UAER ) and blood creatinine, the DN patients were divided into four stages. Results Along with the developing of DN, the patients' GFR decreased ( from 84.0±18.7 t o 79.0±21.0，69.0±15.9，53.7±18.2ml/min) and their UAER increased( from 4.5± 2.4 to 94.0±57.9，314.0±604.3，724.0±923.8μg/min) continuously in different DN stages. A significant negative correlation was found between GFR and UAER (r = - 0.5070, P ＜0.001). In each DN stage, GFR of patients with hypertension w as lower than that without hypertension (76.3±17.4 vs 84.9±18.7, 67.9±22.9 vs 82.1±19.6, 55.7±17.2 vs 69.2±12.0, 47.5±17.2 vs 57.7±17.9 ml/min, all P ＜0.05). GFR in stage-Ⅱ of DN patients with GHbA1c ≥10.0% were higher than that with GHbA1c＜10.0% (86.0±20.6 vs 73.3±19.8 ml/min, P ＜0.05 ). Backward regression analysis was performed. It was shown that only age and sy stolic blood pressure were independently negative correlated with GFR (β=－0.56 ， P ＜0.05；β=－0.28， P ＜0.05). Conclusion GFR was the sensitive indicat or represents glomerular filtration rate in patient with different DN stages. D N patients must strictly controlled blood glucose and blood pressure in order to delay the decrease of GFR.