高HbA_(1C)变异性增加老年2型糖尿病患者肾小球滤过率下降风险

HbA_(1C) variability increases the risk of decline in glomerular filtration rate in elderly patients with type 2 diabetes

目的:评估老年2型糖尿病患者HbA_(1C)水平及变异性与肾小球滤过率下降的相关性。方法:选取在江苏省某三级医院糖尿病中心接受随访且基线估算的肾小球滤过率(eGFR)≥60 mL·min^(-1)·(1.73 m^( 2))^(-1)的老年2型糖尿病患者527例,通过患者建档后平均随访19个月期间的HbA_(1C)测量值计算HbA_(1C)平均值(HbA_(1C)-mean)和变异性指标,包括标准差(HbA_(1C)-SD)、变异系数(HbA_(1C)-CV)以及调整后的标准差(Adj-HbA_(1C)-SD);依据随访期间eGFR的年下降率(△eGFR)分为△eGFR>5%组和△eGFR≤5%组。采用Cox比例风险回归模型评估HbA_(1C)变异性与肾小球滤过率下降发生风险的关系。结果:共176例患者△eGFR>5%,△eGFR>5%组的HbA_(1C)-mean及HbA_(1C)变异性均显著高于△eGFR≤5%组(P<0.05)。Cox回归分析显示,HbA_(1C)-mean、HbA_(1C)-SD、HbA_(1C)-CV和Adj-HbA_(1C)-SD与肾小球滤过率下降均具有显著相关性;在校正年龄、性别、HbA_(1C)-mean等因素后,仅Adj-HbA_(1C)-SD与肾小球滤过率下降相关[HR=3.32(1.68~6.57)]。结论:HbA_(1C)变异性与老年2型糖尿病患者的肾小球滤过率下降独立相关,其中在预测肾小球滤过率下降方面,Adj-HbA_(1C)-SD最为敏感。

Objective To evaluate the association of HbA_(1C) level and variability with annual decline in glomerular filtration rate in elderly patients with type 2 diabetes.Methods A total of 527 elderly type 2 diabetic patients with baseline estimated glomerular filtration rate(eGFR)≥60 mL·min^(-1)·(1.73 m^(2))^(-1) at the diabetes center of a tertiary hospital in Jiangsu province were included and followed up.The mean value and the variability of HbA_(1C),including standard deviation(HbA_(1C)-SD),variation coefficient(HbA_(1C)-CV),and adjusted standard deviation(Adj-HbA_(1C)-SD)were calculated.According to the annual decreased rate of eGFR,the patients were divided into△eGFR>5%group and△eGFR≤5%group.Cox proportional risk regression model was used to evaluate the relationship between HbA_(1C) variability and the risk of decreased glomerular filtration rate.Results With a mean follow-up time of 19 months,there were 176 patients whose△eGFR>5%.Compared with△eGFR≤5%group,the HbA_(1C)-mean and HbA_(1C) variability were significantly higher in△eGFR>5%group(P<0.05).Cox regression analysis showed that HbA_(1C)-mean,HbA_(1C)-SD,HbA_(1C)-CV,and Adj-HbA_(1C)-SD were significantly correlated with decreased glomerular filtration rate.After adjustment for age,gender,HbA_(1C)-mean,and other factors,only Adj-HbA_(1C)-SD was correlated with renal insufficiency[HR=3.32(1.68-6.57)].Conclusions HbA_(1C) variability is independently associated with annual decline in glomerular filtration rate in elderly patients with type 2 diabetes.The Adj-HbA_(1C)-SD is the most sensitive indicator in predicting decreased glomerular filtration rate.