影响临床期2型糖尿病肾病病情转归的危险因素探讨

Investigation into risk factors affecting prognosis of patients with clinical course of type Ⅱ diabetic nephropathy

目的探讨影响临床期2型糖尿病肾病(DN)并高血压患者病情转归的危险因素。方法跟踪随访50例临床期2型DN合并高血压患者,所有患者均经积极降压、降糖、降脂等对症治疗,3年后将肾功能显著恶化[肾小球滤过率估算值(eGFR)较基线值下降30%]或发生心脑血管并发症列为观察终点事件并定义为预后不良。按有无终点事件(包括复合终点事件)分为两组,分析其体质量指数、糖化血红蛋白、血脂、尿蛋白排泄率、血压及血压变异性(BPV)等临床资料。结果单因素分析表明,两组患者3年前的年龄、性别、血压、尿蛋白排泄率、糖化血红蛋白、血脂、eGFR等基线资料无统计学差异(P>0.05)。但3年后,其体质量指数、收缩压变异系数(SBP-BPV)、尿蛋白排泄率、血胆固醇、血尿酸的检测指标比较均有统计学差异(P<0.05),且可能为影响预后的因素,经多因素logistic回归分析,SBP-BPV为本组病人预后不良的主要危险因素(B=0.969,OR=2.637,P=0.001)。结论临床期DN的预后同多种因素有关,其中SBP-BPV为预后不良的主要危险因素,应引起重视并进行积极干预。

Objective To investigate the related factors which affect the prognosis of patients with the clinical course of type Ⅱ diabetic nephropathy and hypertension. Methods Fifty patients with clinical course of type Ⅱ diabetic nephropathy and hypertension had received positive controlling of their blood pressure, plasma glucose and dyslipidemia in the survey of 3 years＇ follow-up. The end events consisted of worsening renal function Ⅰ a 30% decrease in glomerular filtration rate estimate （eGFR） under baseline Ⅰ and cardiovascular complications. According to whether there were end point events, the patients were divided into two groups, i. e. end point group and non-end point group. Such clinical data, as body mass index（BMI） , glycosylated hemoglobin, blood fats, urinary protein excretion and systolic blood pressure and blood pressure variability （SBP-BPV） were analyzed. Results Univariate analysis revealed that the factors impacting the prognosis were BMI, SBP-BPV, urinary protein excretion, blood cholesterol and blood uric acid, even though there were no differences of these indexes on baseline. The multivariate logistic regression analysis showed SBP- BPV was the major risk factor of poor prognosis （ B = 0. 969, OR = 2. 637, P = 0. 001 ）. Conclusion Many factors affect the prognosis of the clinical course of type Ⅱ diabetic nephropathy patients. Among them, SBP-BPV is the major risk factor that should be considered as well.