2型糖尿病患者早期进行性肾功能减退的危险因素分析

Risk factors of early progressive renal function decline in type 2 diabetes mellitus patients

目的分析2型糖尿病患者发生早期进行性肾功能减退的危险因素。方法对107例2型糖尿病患者进行前瞻性随访研究。将入组患者按蛋白尿水平分为正常蛋白尿组（0~30 mg/24h）、微量白蛋白尿组（〉30~300mg/24h）。再将两组中估算的肾小球滤过率（eGFR）年下降率≥3.3%归为早期进行性肾功能减退亚组,〈3.3%归为肾功能稳定亚组。分析早期进行性肾功能减退的比例,分别比较正常蛋白尿组和微量白蛋白尿组中肾功能稳定亚组和早期进行性肾功能减退亚组的糖尿病病程、体质量指数（BMI）等一般资料和糖化血红蛋白（HbA1c）、肝功能、肾功能等实验室指标。结果合并微量白蛋白尿组发生早期进行性肾功能减退的比例更高。早期进行性肾功能减退组的收缩压（SBP）、脉压（PP）、HbA1c高于肾功能稳定组,而BMI低于肾功能稳定组。对正常蛋白尿组统计分析发现：高密度脂蛋白胆固醇（HDL-C）在两亚组间差异有统计学意义。结论 T2DM患者均可能发生早期进行性肾功能减退。对于正常蛋白尿患者的2型糖尿病患者,HDL-C水平的降低为其发生早期进行性肾功能减退的危险因素;对于合并微量白蛋白尿的2型糖尿病患者,高SBP、PP、HbA1c、低BMI为其发生早期进行性肾功能减退的危险因素。

Objective To examine the risks of early progressive renal function decline in patients with type 2diabetes mellitus（T2DM）with or without microalbuminuria and risk factors.Methods A total of 170T2 DM patients were selected for prospective follow-up study.According to 24 hurinary microalbumin（UMA）levels,the patients were divided into two groups,nonalbuminuriagroup（24hUMA 0-30mg/24h）,and UMA group（24hUMA30-300mg/24h）.At the end of the follow-up,the patients were subdivided into two groups by the glomerular filtration rate（GFR）fall per year：early progressive renal function decline subgroup（≥3.3% descent rate compared with initial estimated GFR（eGFR）and stable renal function subgroup（3.3% descent rate per year compared with initial eGFR）.The differences between early progressive renal function decline subgroup and stable renal function subgroup were analyzed,including the general data：T2DM duration,body mass index（BMI）,and the laboratory indexes：hemoglobin A1C（HbA1c）,liver function,renal function and others,respectively.Results The proportion of early progressive renal function decline in microalbuminuria group was higher.In microalbuminuria group：early progressive renal function decline subgroup had higher systolic blood pressure（SBP）,pulse pressure（PP）,HbA1 c and lower BMI compared with those of stable renal function subgroup.In nonalbuminuria group：early progressive renal function decline subgroup had lower HDL-C compared with that of stable renal function subgroup.Conclusion T2 DM patients may present early progressive renal dysfunction.In T2 DM patients without microalbuminuria,HDL-C decline is a risk for early progressive renal dysfunction.But,for the patients with microalbuminuria,higher SBP,PP,HbA1 c are the risks of early progressive renal dysfunction.