老年2型糖尿病患者肾小球滤过率的改变及影响因素分析

Changes of glomerular filtration rate in elderly diabetics and its influence factors analysis

目的 探讨老年 2型糖尿病患者的肾小球滤过率 (GFR)的变化特点并对其临床影响因素进行分析。方法 住院的 2型糖尿病人 173例分为 30～ 44岁、45～ 5 9岁及≥ 6 0岁三组进行放射性核素肾动态显像测定 GFR,同时测定血肌酐、糖化血红蛋白、尿白蛋白排泄率。结果 随着年龄的增加 ,GFR呈逐渐下降 ,尤以≥ 6 0岁组下降更为明显 (P<0 .0 1) ,尿白蛋白排泄率也呈逐渐增加 ,GFR与年龄及尿白蛋白排泄率分别呈显著负相关 (P<0 .0 0 1) ;合并高血压或 /和冠心病者加速 GFR下降 ;逐步回归分析显示年龄、尿白蛋白排泄率、高血压、冠心病是导致 GFR下降的主要因素。结论 老年糖尿病人在年龄等多因素作用下 GFR呈显著性下降。GFR是反映老年糖尿病人肾功能变化的敏感指标。GFR与尿白蛋白排泄率联合测定能更全面地反映老年糖尿病肾病的病变程度。

Objective To evaluate the changes of glomerular filtration rate (GFR) in elderly diabetics and analyze the influence factors on GFR.Methods 173 diabetic patients in hospital were divided into three groups: 30～44 year old,45～59 year old,and ≥60 year old group. GFR determination was performed by 99m Tc DTPA, with the assays of serum creatinine, glycosylated hemoglobin and urinary albumin excretion rate (UAER).Results Along with the ages getting older gradually GFR decreased obviously (from 91.3±24.5 to 79.7±15.6,and to 63.9±18.7 ml/min, P <0.01) and UAER increased obviously (from 12.1±6.0 to 13.7±6.0,and to 34.3±7.5 μg/min, P <0.01).GFR showed significant negative correlation with age or UAER respectively ( r =-0.5029 P <0.001, r =-0.4663 P <0.001).When diabetic patients complicated hypertension or/and coronary heart disease, GFR dropped down quickly.Multiple factors regression showed that age, UAER, hypertension and coronary heart disease were the primary factors which caused GFR come down.Conclusion Because of many pathogenic factors such as senile, microangiopathy, macroangiopathy and so on, GFR in elderly diabetics decreased obviously.GFR was a sensitive index reflecting renal function in elderly diabetic patients.The renal function of elderly diabetic nephropathy will be exactly judged by combining measurements of both GFR and UAER.