成都市铁路职工糖尿病人群慢性肾脏病患病情况及相关危险因素

Epidemiologic study of chronic kidney disease in diabetes mellitus of Chengdu railway worker

目的探讨成都市铁路职工糖尿病人群慢性肾脏病(chronic kidney disease,CKD)的患病情况及相关危险因素。方法从2009年9月至2013年12月在成都铁路分局医院健康体检的铁路职工(分散居住在成都市各区)的资料中,选取有完整资料的967例糖尿病人群列入本次研究,资料包括问卷调查(性别、年龄、吸烟、饮酒、既往病史)、体格检查(血压、身高和体质量)、血液和尿液检测(尿素氮、血肌酐、血尿酸、血糖、胆固醇、三酰甘油、尿微量白蛋白、尿肌酐和尿常规)等,根据CKD诊断标准[白蛋白尿:尿微量白蛋白/肌酐≥30 mg/g;血尿:尿沉渣红细胞>3个/高倍镜;肾小球滤过率(estimated glomerular filtration rate,eGFR)下降:简化肾脏病饮食改良(modification of diet inrenal disease,MDRD)公式计算eGFR<60 ml·min^(-1)·(1.73 m^2)^(-1)]对资料进行分析。结果①糖尿病人群白蛋白尿、血尿和eGFR下降的发生率分别为28.02%、1.45%和13.75%。该人群中CKD的患病率为37.64%。糖尿病人群白蛋白尿发生率明显高于糖尿病前期人群和无高血糖的人群。糖尿病合并高血压、高血脂和高尿酸人群白蛋白尿、eGFR下降和CKD的患病率均明显高于单纯高尿酸血症人群。②空腹血糖水平与尿微量白蛋白/肌酐比值呈正直线相关。③年龄、体质量指数、高血压和空腹血糖水平是白蛋白尿的独立危险因素,女性是血尿的独立危险因素,年龄、高尿酸和空腹血糖水平是eGFR下降的独立危险因素,年龄、体质量指数、高血压、高尿酸和空腹血糖水平是CKD的独立危险因素。结论成都市铁路职工糖尿病人群,CKD的患病率与空腹血糖、体质量指数、血压、血尿酸和血脂相关。

Objective To identify the prevalence and related risk factors of chronic kidney disease（CKD） in diabetes mellitus of Chengdu railway worker. Methods 967 eligible samples of railway workers with diabetes mellitus, taken from Sep. 2009 to Dec. 2013 ＂ Health examination data of Chengdu urban groups＂ were selected. The data included questionnaire（sex, age, smoking, drinking and anamnesis）, somatoscopy （blood pressure, body height and body weight）, blood and urine examination indicators（urea nitrogen, blood creatinine, blood uric acid, blood glucose, cholesterol, triglyceride, urine microalbumin/urine creatinine ratio and routine urine examination）. According to the CKD criteria： albuminuria（urine microalbumin/urine creatinine ratio ≥30 mg/g）, hematuria（erythrocytes 〉3/HP in urinary sediment） and reduced estimated glomerular filtration rate[eGFR 〈60 ml. min-1 .（1.73 m2） -1], the data were analyzed. Results （1）Prevalence of albuminuria, hematuria, reduced eGFR and CKD in the diabetes mellitus group was 28. 02%, 1.45%, 13.75% and 37. 64% respectively. Prevalence of albuminuria in the diabetes mellitus group was obviously higher than in the non-diabetes mellitus group or prediabetic state group. Prevalence of albuminuria, reduced eGFR and CKD in the group of diabetes mellitus complicated with hypertension and hyperuricemia and hyperlipi-demia was obviously higher than in simple diabetes mellitus group. （2） Fasting blood glucose level had a positively linear correlation with urine microalbumin/urine creatinine. （3）Age, body mass index （BMI）, hypertension and fasting blood glucose level were independent risk factors of albuminuria. Female was independent risk factor of hematuria. Hyperurieemia and fasting blood glucose level were independent risk factors of reduced eGFR. Age, BMI, hypertension, hyperuricemia and fasting blood glucose level were independent risk factors of CKD. Conclusions The prevalence of CKD was higher than ordinary people in diabetes mellitus group of Chengdu railway worker and is related with fasting blood glucose level. Control of blood glucose, blood pressure, blood uric acid, blood fat and BMI helps reducing the occurrence and development of CKD.