老年2型糖尿病患者估算的肾小球滤过率降低的危险因素分析

Risk factors of decreased estimated glomerular filtration rate in elderly patients with type 2 diabetes mellitus

目的:探讨老年2型糖尿病(T2DM)患者估算的肾小球滤过率(eGFR)下降的危险因素。方法:回顾性分析90例应用动态血糖监测(CGM)系统进行血糖监测的住院老年T2DM患者,根据eGFR分组,eGFR≥90 mL/(min·1.73m^(2))为eGFR正常组(51例);eGFR<90 mL/(min·1.73m^(2))为eGFR下降组(39例)。同时收集患者年龄、糖尿病病程、肾功能以及血脂、糖化血红蛋白(HbA1c)、尿微量白蛋白/肌酐比值(UACR)、平均血糖波动幅度(MAGE)等资料。比较两组患者各临床指标的差异,分析eGFR下降的危险因素。结果:两组患者在体质量指数(BMI)、HbA1c、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、肌酐(Cr)、UACR和MAGE上差异均有统计学意义(P<0.05)。相关分析结果显示,eGFR与年龄、BMI、HbA1c、LDL-C、Cr、UACR及MAGE均呈负相关(P<0.05)。Logistic回归分析显示,高BMI、HbA1c、Cr及MAGE水平是老年T2DM患者eGFR下降的独立危险因素(P<0.05)。结论:高BMI、HbA1c、Cr及MAGE是老年T2DM患者eGFR下降的独立危险因素。

Objective:To investigate the risk factors of decreased estimated glomerular filtration rate(eGFR)in elderly patients with type 2 diabetes mellitus(T2DM).Methods:Retrospective analysis was performed in 90 hospitalized elderly T2DM patients whose blood glucose were monitored by continuous glucose monitoring(CGM)system.Patients were grouped into normal eGFR[eGFR≥90ml/(min·1.73m^(2)),n=51]and declined eGFR[(eGFR<90ml/(min·1.73m^(2)),n=39]according to eGFR.Clinical indexes,including the age,duration of diabetes,renal function,serum lipid concentration,glycosylated hemoglobin(HbA1c)level,urinary albumin-to-creatinine ratio(UACR)and mean blood glucose fluctuation(MAGE),were collected and compared for the differences between the two groups to analyze the risk factors of declined eGFR.Results:The two groups were significantly different in the body mass index(BMI),levels of HbA1c,triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),creatinine(Cr),UACR and MAGE(all P<0.05).Correlation analysis showed that eGFR was negatively correlated with age,BMI,HbA1c,LDL-C,Cr,UACR and MAGE(all P<0.05),and logistic regression analysis indicated that higher BMI,levels of HbA1c,Cr and MAGE were independent risk factors for eGFR decline in T2DM patients(all P<0.05).Conclusion:Higher BMI and levels of HbA1c,Cr and MAGE are independent risk factors of decreased eGFR in elderly patients with T2DM.