肾病综合征患者伴类固醇糖尿病的转归及影响因素

Clinical outcome of steroid diabetes in patients with nephrotic syndrome

目的:探究发生类固醇糖尿病的原发性肾病综合征(PNS)患者停糖皮质激素(GC)后转归为糖尿病(DM)的发生率和危险因素。方法:回顾分析2011年1月至2020年7月国家肾脏疾病临床医学研究中心收治的PNS患者,均在GC治疗后发生类固醇糖尿病,根据患者停GC后糖代谢水平分为DM组和非DM组,比较两组的临床、病理及实验室检查资料,采用Logistic回归分析转归为DM的危险因素。结果:220例PNS的类固醇糖尿病患者中58例(26.4%)转归为DM。DM组患者DM家族史阳性、发现血糖升高的时间较晚、高胆固醇血症、高三酰甘油(TG)/高密度脂蛋白胆固醇(HDL-C)比值明显高于非DM组(P<0.05)。两组患者GC治疗的中位起始剂量、累积剂量和总疗程无统计学差异。减停GC后DM组患者复发率更高(P<0.05)。多因素回归分析显示,DM家族史阳性、发现血糖升高的时间较晚、高胆固醇血症和高TG/HDL-C比值是类固醇糖尿病患者停GC后转归为DM的独立危险因素。结论:26.4%发生类固醇糖尿病的PNS患者停GC后糖代谢紊乱未能逆转,对于DM家族史阳性和脂代谢紊乱突出的PNS患者使用GC治疗前应当慎重决定。

Objective:To investigate the incidence and risk factors of conversion to diabetes mellitus(DM)in primary nephrotic syndrome(PNS)patients with steroid diabetes mellitus(SDM)after withdrawal of glucocorticoid(GC).Methodology:All SDM patients were divided into diabetes mellitus(DM)group and non diabetes mellitus(NDM)group according to glucose metabolism after stopping GC treatment.The clinical,pathological and laboratory data of the two groups were compared.Logistic regression analysis was used to analyze the risk factors of DM.Results:Among 220 SDM patients with PNS,58(26.4%)of them converted to DM.The positive family history of diabetes,the later detection of hyperglucemia,hypercholesterolemia,and the high ratio of triglyceride(TG)to high density lipoprotein cholesterol(HDL-C)were significantly higher in DM group.There were no difference in the median initral does of GC,the cumulative dose and the median total course of treatment between the two groups.The recurrence of proteinuria in DM group was higher after withdrawal of GC.Multivariate regression analysis showed that positive family history of diabetes,hypercholesterolemia and high TG/HDL-C ratio were independent risk factors for the conversion of SDM patients to DM after discontinuation of GC.Conclusion:The disorder of glucose metabolism could not be reversed in 26.4%of PNS patients with SDM after discontinuation of GC.PNS with positive family history of diabetes and prominent dyslipidemia should be carefully decided before GC therapy.