基于TGF-β1基因T869C中CC/CT基因型糖尿病肾病患者危险因素生存分析

Survival analysis of risk factors for diabetic nephropathy in patients with CC / CT genotypes of TGFβ1(T869C)

目的探讨TGF-β1基因T869C在CC/CT基因型糖尿病肾病中的危险因素或潜在保护性因素。方法采用双向性队列研究,包括回顾性病例和前瞻性病例两部分内容,对150例糖尿病肾病患者进行流行病学调查,调查内容包括血脂、肾功能、血糖、餐后2 h血糖、24 h尿白蛋白定量、性别、年龄、高脂血症病史、糖尿病病程、高血压病史、吸烟史及是否合并糖尿病视网膜病变等其他慢性并发症、血压、体质指数等,调查是在被调查者知情并获得同意的基础上进行的,回顾性病例采用检索患者资料,电话联系患者来院检测和填写表格等方法。多因素分析用Cox比例风险回归模型。结果 Cox回归结果显示TGF-β1基因T869C基因多态性、吸烟、高血压是糖尿病肾病的独立危险因素(P<0.05),生存曲线显示,随着糖尿病发病时间的延长,尤其在糖尿病发病10年后,患者糖尿病肾病的发病率也在明显升高。结论本次研究表明,患有DN的2型DM患者其平均病程为糖尿病病程(11.3±2.4)年,与没有DN对照组相比,病程明显长于对照组。随着糖尿病发病时间的延长,尤其在糖尿病发病10年后,患者糖尿病肾病的发病率也在明显升高。此外,TGF-β1基因T869C基因多态性、吸烟、高血压是糖尿病肾病的独立危险因素。因此笔者认为在有遗传倾向的人群中,找到后天引发疾病的环境因素危险因子并加以干预,则会对疾病的预防起到深远的意义。

Objective To investigate the risk factors or potential protective factors for diabetic nephropathy （DN） in patients with CC/CT genotypes of TGF β1 （ T869C polymorphism）. Methods An ambispective cohort study was carried among 150 cases of diabetic nephropathy including retrospective cases and prospective cases. The epidemiologic investigation enrolled the gender, age, body mass index, blood fat, blood glucose ,2-hour postprandial blood glucose and 24-hour u- rine protein, renal function, blood pressure, history of hyperlipidemia and hypertension and smoking, duration of diabetes, diabetes retinopathy. The data were collected by retrieving patients＇ data, calling patients to receive the hospital inspection or fill out forms. Multivariate survival analysis was performed using Cox proportional hazard regression model. Results Cox regression analysis showed that T869C polymorphisms, smoking and hypertension were the independent risk factors for diabetic nephropathy （ P 〈 0.05 ） ; the survival curve showed that there was an increased incidence of diabetic nephropathy in the patients with a longer duration of diabetes, particularly in diabetes onset after 10 years. Conclusion The average duration of diabetes in type 2 DM patients with DN is （ 11.3 ± 2.4） years, which is significantly longer than that in the control group. With the prolonging course of diabetes, especially in the 10 years after the onset of diabetes, the inci- dence of DN has increased significantly. T869C polymorphisms, smoking and hypertension are the independent risk factors for diabetic nephropathy. It could have profound implications for the prevention of DN to find and manage the acquired diseases caused by environmental factors in the crowd with a genetic predisposition.