糖尿病肾病和血糖控制的关系及相关危险因素分析

Relationship between diabetic kidney disease and glucose control in type 2 diabetes mellitus patients and analysis of relative risk factors

目的探讨糖尿病肾病(DKD)与血糖控制指标关系以及相关危险因素。方法回顾性分析2010年3月至2016年12月在西京医院老年病科住院且使用持续血糖监测系统(CGMS)的2型糖尿病(T2DM)患者142例,根据是否伴有DKD分为DKD组(n=54)和非DKD组(n=88)。收集患者一般临床资料、实验室指标及CGMS结果,分析DKD与血糖控制指标关系并对其危险因素进行综合分析。采用SPSS 19.0统计软件对数据进行分析,组间比较采用t检验、非参数检验或χ~2检验。Spearman秩相关分析两变量相关性,多因素分析采用逐步二元logistic回归分析。结果相比非DKD组,DKD组患者年龄偏大、病程长、高血压病史比例较高、高密度脂蛋白胆固醇(HDL-C)水平偏低、双胍类降糖药物使用率明显降低,糖化血红蛋白A1c(Hb A1c)水平、完整24 h高血糖时间波动百分比、高血糖曲线下面积(AUC)、餐后2 h血糖(2h-PBG)和24 h平均血糖水平(MBG)显著升高,差异有统计学意义(P<0.05);胱抑素C(Cys C)、尿素氮(BUN)、血肌酐(SCr)水平显著高于非DKD组,估算肾小球滤过率(e GFR)显著低于非DKD组,差异有统计学意义(P<0.001)。Spearman相关分析结果显示,DKD与年龄、病程、高血压史、Hb A1c、24 h高血糖时间波动百分比、高血糖AUC、24 h MBG、2h-PBG均呈正相关,与HDL-C呈负相关(r=-0.205,P=0.014)。逐步二元logistic回归分析结果显示年龄(OR=1.048,95%CI 1.022~1.074;P=0.000)和Hb A1c(OR=1.569,95%CI 1.212~2.031;P=0.001)与DKD呈正相关。结论 Hb A1c是T2DM患者发生DKD的主要危险因素,DKD的发生与血糖波动并无显著相关。

ObjectiveTo investigate the relationship of diabetic kidney disease(DKD)with glucose control in the patients with type2diabetes mellitus(T2DM)and to analyze the related risk factors.MethodsA total of142T2DM patients who received con tinuous glucose monitoring(CGM)in the Geriatric Department of Xijing Hospital from March2010to December2016were recruited in the study.The patients were divided into DKD group(n=54)and non DKD group(n=88).The general clinical data,and laboratory indices and CGM data of the subjects were collected.The relationship between DKD and glucose control and the effect of risk factors were analyzed.SPSS statistics19.0was used to analyze the data.Student’s t test,non parametric test or Chi square test was employed for the comparison between groups.Spearman rank correlation analysis was adopted for the correlation of2variables,and stepwise binary logistic regression was used for multivariate analysis.ResultsCompared with the patients of the non DKD group,those in DKD group were older,and had longer duration of DM,higher ratio of hypertension,lower level of high density lipoprotein cholesterol(HDL C),lower utilization ratio of guanidine,higher glycosylated hemoglobin(HbA1c)level,larger percentage of24hour hyperglycemia fluctuation time,larger area under hyperglycemic curve(AUC),higher postprandial2hour blood glucose(2h PBG)and24hour mean blood glucose(24h MBG)(all P<0.05).They also had higher levels of cystatin C(CysC),blood urea nitrogen(BUN),and serum creatinine(SCr),but obviously lower estimated glomerular filtration rate(eGFR)than the patients of the non DKD group(P<0.001).Spearman’s correlation analysis showed that DKD was positively correlated with age,duration of the disease,hypertension history,HbA1c level,percentage of hyperglycemia fluctuation time,AUC of hyperglycemia,24h MBG and2h PBG,while negatively correlated with HDL C(r=-0.205,P=0.014).Logistic regression analysis indicated that age(OR=1.048,95%CI1.022-1.074,P=0.000)and HbA1c(OR=1.569,95%CI1.212-2.031,P=0.001)had positive correlation with DKD.ConclusionHbA1c is a major risk factor of DKD in T2DM patients,and the occurrence of DKD is not associated with glucose fluctuation.