2型糖尿病患者肾功能下降与尿白蛋白水平的关系及其影响因素

Relationship between renal function injury and urinary albumin level in type 2 diabetes and the risk factors

目的探讨2型糖尿病患者的肾功能下降与尿微量白蛋白水平的关系,并分析某些因素对其的影响。方法选取我院就诊的2型糖尿病患者400例,测定空腹血清胱抑素C(Cys C)、肌酐、同型半胱氨酸(Hcy)、总胆固醇(Tcho)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(GHbAlc),测定尿微量白蛋白浓度。用Cys C联合血肌酐公式计算肾小球滤过率估算值(eGFR),计算尿白蛋白/肌酐比值(ACR),分别对不同ACR时的各eGFR组间以及不同eGFR水平时的各ACR组间各项指标,如年龄、Hcy、T-cho、LDL-C、GHbAlc和Cys C水平等进行比较分析。结果不同程度尿白蛋白水平的eGFR构成比不全相同(χ2=43.958,P=0.000),两两比较,正常白蛋白尿组和微量白蛋白尿组eGFR构成比差异无统计学意义(χ2=3.010,P=0.222);大量白蛋白尿组与无或微量白蛋白尿组的eGFR构成比均不相同(χ2=43.396、27.271,P均=0.000)。相同ACR水平时,eGFR正常的患者年龄、血清Hcy浓度和血清Cys C浓度均低于eGFR降低的患者且差异均有统计学意义,血清LDL-C浓度、T-cho浓度、GHbAlc浓度组间差异均无统计学意义;相同eGFR水平时,除eGFR<60mL·min-1·1.73m-2时大量白蛋白尿组的eGFR和血清CysC浓度与正常白蛋白尿组比较差异有统计学意义外,其余指标组间比较差异均无统计学意义。结论 2型糖尿病患者尿白蛋白的出现与肾功能下降并不平行,肾小球损伤越严重,大量白蛋白尿的检出率越高,但微量白蛋白尿的出现与eGFR下降并没有明显的关联;年龄增大和高Hcy血症会明显增加2型糖尿病患者肾功能下降的风险,而与尿微量白蛋白的升高关系不大。

Objective To explore the relationship of the estimation of glomerular filtration rate and urinary microalbumin level in type 2 diabetes, and analyze the relation effects. Methods The serum concentrations of cystatin C, creatinine, Hcy, total cholesterol, low density lipid protein cholesterol, glycosylated hemoglobin and the concentration of urinary microalbumin in 400 patients were determined. The eGFR calculated by the combining Scr and serum Cys C equation and the urinary albumin/ creatinine ratio （ACR） were obtained. These dates were analyzed respectively in different ACR levels or different eGFR levels. Results The constitute rates of eGFR were different in different ACR groups （X2 =43. 958, P=0. 000）. The constitute rates of eGFR in the normal albuminuria group and the trace albuminuria group had no statistical difference yet （ 2 = 3. 010, P = 0. 222） . and those in the mass albuminuria group and the other groups were statistically different （P= 0. 000 in mass and two any groups）. In the same ACR groups, the age, the serum Hcy concentration and the serum cystatin C concentration were sig- nificantly lower when whose eGFR was normal than those patients whose eGFR had declined. The statistical significance was not found in LDL, T-eho and GHbAlc; In the same eGFR groups, only the eGFR level and the Cys C concentration were statis- tically significant, when eGFR〈60 mL· min^-1 · 1.73m^-2. Conclusion In patients with type 2 diabetes, urinary albumin con- centration increase and renal function decline are not parallel. Microalbuminuria isn＇t related with eGFR decline. Age and homo- cysteinemia may significantly increase the risk of renal function decline in type 2 diabetes patients, but the same phenomenon is not found in the urinary albumin increase.