老年糖尿病估算肾小球滤过率水平与低血糖发生风险的相关性分析

Correlation between eGFR and the risk of hypoglycemia in elderly patients with diabetes mellitus

目的探讨老年糖尿病病人估算肾小球滤过率(eGFR)水平与低血糖发生风险的相关性。方法收集2020年7月至2021年4月四川大学华西医院住院老年糖尿病病人的临床资料。根据入院检测的eGFR水平将病人分为5组,其中eGFR≥90 mL/(min·1.73m^(2))为A组(n=80)、60 mL/(min·1.73m^(2))≤eGFR<90 mL/(min·1.73m^(2))为B组(n=201)、30 mL/(min·1.73m^(2))≤eGFR<60 mL/(min·1.73m^(2))为C组(n=84)、15 mL/(min·1.73m^(2))≤eGFR<30 mL/(min·1.73m^(2))为D组(n=81)、eGFR<15 mL/(min·1.73m^(2))为E组(n=86),比较各组间基线资料差异,采用Logistic回归分析老年糖尿病病人低血糖发生的危险因素。结果共入选532例老年糖尿病病人,低血糖总体发生率为13.9%(74/532),随着eGFR水平的降低,低血糖发生率由17.9%(15/84)增高至20.9%(18/86),差异有统计学意义(P<0.05)。Logistic回归分析显示,在校正年龄、性别、糖尿病病程、HbA1c、BMI、胰岛素使用等混杂因素后,eGFR仍为低血糖的独立危险因素,C组、D组、E组低血糖发生风险分别是A组的3.54倍(95%CI1.06~11.84,P<0.05)、3.92倍(95%CI1.14~13.44,P<0.05)和4.01倍(95%CI1.23~13.07,P<0.05)。结论老年糖尿病病人eGFR水平与低血糖风险增加存在显著相关,eGFR可用于临床老年糖尿病病人低血糖发生的个性化风险评估和预测。

Objective To explore the relationship between estimated glomerular filtration rate(eGFR)and the risk of hypoglycemia in the elderly patients with diabetes mellitus(DM).Methods The clinical data of 532 elderly patients with DM who were hospitalized in West China Hospital of Sichuan University from July 2020 to April 2021 were collected.According to the level of eGFR,the patients were divided into 5 groups eGFR≥90 mL/(min·1.73m^(2))(group A,n=80),60 mL/(min·1.73m^(2))≤eGFR<90 mL/(min·1.73m^(2))(group B,n=201),30 mL/(min·1.73m^(2))≤eGFR<60 mL/(min·1.73m^(2))(group C,n=84),15 mL/(min·1.73m^(2))≤eGFR<30 mL/(min·1.73m^(2))(group D,n=81),and eGFR<15(mL/min·1.73m^(2))(group E,n=86).The differences of baseline data among 5 groups were analyzed.Logistic regression analysis was used to analyze the risk factors of hypoglycemia.Results The overall incidence rate of hypoglycemia was 13.9%(74/532).The incidence rate of hypoglycemia increased from 17.9%(15/84)to 20.9%(18/86)with the decrease of eGFR,and the difference was statistically significant(P<0.05).After adjusting for age,gender,duration of diabetes,glycosylated hemoglobin(HbA1c),body mass index(BMI),insulin usage and other confounding factors,eGFR was still an independent risk factor for hypoglycemia.The risk of hypoglycemia in group C was 3.54 times higher than that in group A(95%CI 1.06-11.84,P<0.05);and 3.92 times(95%CI 1.14-13.44,P<0.05)in group D,4.01 times(95%CI 1.23-13.07,P<0.05)in group E,respectively.Conclusions eGFR is closely related to the risk of hypoglycemia in the elderly patients with DM.eGFR is expected to be used for personalized assessment and prediction of the risk of hypoglycemia in the elderly patients with DM.