2型糖尿病患者肾窦脂肪体积与预估肾小球滤过率的相关性研究

Correlation between renal sinus fat volume and estimated glomerular filtration rate in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者肾窦脂肪(RSF)与预估肾小球滤过率(eGFR)的关系。方法回顾性纳入2014年1月至2018年7月于重庆医科大学附属第一医院就诊的T2DM患者260例。根据CT测定的RSF体积分为高分位组(RSF≥11.4 cm3,130例)和低分位组(RSF<11.4 cm3,130例)。检测血糖、血尿酸、血脂等代谢指标,计算体质指数、eGFR、尿微量白蛋白肌酐比(UACR)。组间比较采用t检验和χ2检验,Pearson相关和多元线性回归分析法分析RSF与eGFR及UACR的关系。结果与RSF低分位组相比,高分位组男性更多[68.5%(89/130)和43.5%(57/130)],合并高血压、吸烟及饮酒比例更高,体质指数[25.0(22.8,28.4)和24(21.5,26.2)kg/m2]及血尿酸[326(277,388)和293(228,361)μmol/L]水平更高,高密度脂蛋白胆固醇[0.9(0.80,1.20)和1.0(0.90,1.38)mmol/L]及eGFR[(85.2±30.3)和(93.0±29.4)ml·min-1·(1.73 m2)-1]水平明显降低(均P<0.05)。Pearson相关分析结果显示,eGFR与空腹血糖、糖化血红蛋白、低密度脂蛋白胆固醇及高密度脂蛋白胆固醇呈正相关(r= 0.160、0.166、0.134、0.143,均P<0.05),与性别、年龄、病程、高血压病史、血肌酐、血尿酸、RSF及UACR呈负相关(r=-0.587^-0.134,均P<0.05)。多元线性回归分析结果显示,在校正相关影响因素后,RSF与eGFR呈负相关(β=-0.155,P=0.021),与UACR无相关性(β=0.136,P=0.073)。结论在中国T2DM患者中,RSF与eGFR下降独立相关。

Objective To study the relationship between renal sinus fat(RSF)and estimated glomerular filtration rate(eGFR)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 260 hospitalized T2DM patients in The First Affiliated Hospital of Chongqing Medical University from January 2014 to July 2018 were recruited in this study.The volume of the RSF were assessed with CT.Patients were divided into 2 groups:high percentile group(RSF≥11.4 cm³,130 cases),and the low percentile group(RSF<11.4 cm³,130 case).Fasting plasma glucose,blood uric acid,blood lipids and other metabolic indicators were measured,and the body mass index,eGFR and urine albumin-to-creatinine ratio(UACR)were calculated.The t test andχ2 test were used to compare the differences between the two groups.The relationship between RSF and eGFR or UACR were analyzed by Pearson correlation analysis and multivariate linear regression analysis.Results In Chinese T2DM patients,compared with the low percentile group,there was a larger proportion of male patients[68.5%(89/130)vs 43.8%(57/130)],with long history of hypertension(HBP),smoking and drinking in high percentile group.Body mass index[25.0(22.8,28.4)vs 24(21.5,26.2)kg/m2]and blood uric acid levels[326(277,388)vs 293(228,361)μmol/L]were higher in higher group,while the level of high-density lipoprotein-cholesterol(HDL-C)[0.9(0.80,1.20)vs 1.0(0.90,1.38)mmol/L]and eGFR[(85.2±30.3)vs(93.0±29.4)ml·min-1·(1.73 m2)-1]were significantly lower(all P<0.05).The univariate linear correlation analysis showed that eGFR were positively correlated with fasting plasma glucose,glycated hemoglobin A1c,low-density lipoprotein-cholesterol and HDL-C(r=0.160,0.166,0.134,0.143,all P<0.05),whereas negatively correlated with gender,age,duration of diabetes,HBP,serum creatinine,serum uric acid,RSF and UACR(r=-0.587--0.134,all P<0.05).The multiple linear regression analysi revealed that RSF was inversely related with eGFR(β=-0.155,P=0.021)and but not with UACR(β=0.136,P=0.073).Conclusion In Chinese T2DM patients,the RSF is independently related to the decline of eGFR.