1480例2型糖尿病患者估算肾小球滤过率的分布情况及影响因素

Distribution and Influencing Factors of Estimated Glomerular Filtration Rate in 1480 Patients with Type 2 Diabetes Mellitus

目的 探讨2型糖尿病(Type 2 diabetes mellitus, T2DM)患者的估算肾小球滤过率(Estimated glomerular filtration rate, eGFR)的分布情况及其影响因素。方法 选取北京市东城区38个社区卫生服务中心,在该社区居住了至少5年以上的T2DM患者,于2014年统一进行问卷调查、中医证型及实验室指标的采集。按纳入标准选择T2DM患者1480例,其中男559例和女921例,采用慢性肾脏病流行病学协作公式(The chronic kidney disease epidemiology collaboration equation, CKD-EPI)计算eGFR,并用SPSS 20.0统计学软件分析数据。结果 (1)T2DM患者eGFR水平分布:eGFR≥90 ml/(min·1.73 m^(2))组、60 ml/(min·1.73 m^(2))≤eGFR<90 ml/(min·1.73 m^(2))组、eGFR<60 ml/(min·1.73 m^(2))组占比分别为:51.7%、41.2%、7.1%。其中,性别、年龄、教育程度、糖尿病病程、饮酒史、合并脑血管疾病等各组间比较,差异有统计学意义(P<0.05)。(2)中医证候:总体证型分布:内热证>阴虚证>气虚证>血瘀证>痰湿证>阳虚证>气郁证>血虚证。(3)logistic回归分析显示,在T2DM患者中,高龄、女性人群、有吸烟饮酒史、舒张压(Diastolic blood pressure, DBP)、HDL(High-density lipoprotein, HDL)、空腹血糖(Fasting Blood Glucose, GLU)、尿酸(Uric acid, UA)、同型半胱氨酸(Homocysteine, Hcy)及痰湿证、内热证等与肾功能下降相关,差异有统计学意义(P<0.05)。结论 肾功能的轻中度下降在T2DM患者中并不少见,除性别、年龄等不可干预因素外,主要在于强化健康教育,改善患者的生活方式(戒烟限酒);在临床中要积极防治血压、血糖及血脂、UA、Hcy等可干预因素,同时针对中医证型分布,对糖尿病肾功能下降患者进行有效预防和中西医结合治疗。

Objective To analyze the distribution and influencing factors of estimated glomerular filtration rate(eGFR)in patients with type 2 diabetes mellitus(T2DM).Methods Patients with T2DM who had lived in 38 community health service centers in Dongcheng District, Beijing for at least five years were recruited to conduct a questionnaire survey, and traditional Chinese medicine syndromes and laboratory indexes were collected.A total of 1480 patients with T2DM were included according to the inclusion criteria, including 559 men and 921 women.eGFR was calculated by the chronic kidney disease epidemiology collaboration equation(CKD-EPI),and the data were analyzed by SPSS 20.0.Results(1)The distribution of eGFR of patients with T2DM in eGFR≥90 ml/(min·1.73 m^(2)),60≤eGFR<90 ml/(min·1.73 m^(2)),and eGFR<60 ml/(min·1.73 m^(2))groups was 51.7%,41.2%,and 7.1%,respectively.There were significant differences in gender, age, educational level, course of diabetes, history of drinking, and combined cerebrovascular disease among groups(P<0.05).(2)In terms of traditional Chinese medicine(TCM)syndromes, the distribution of TCM syndrome types was internal-heat syndrome>yin-deficiency syndrome>qi-deficiency syndrome>blood-stasis syndrome>phlegm-dampness syndrome>yang-deficiency syndrome>qi-depression syndrome>blood-deficiency syndrome.(3)Logistic regression analysis showed that in patients with T2DM,old age, female population, history of smoking and drinking, diastolic blood pressure(DBP),high-density lipoprotein(HDL),fasting blood glucose(FBG),uric acid(UA),homocysteine(Hcy),phlegm-dampness syndrome and internal-heat syndrome were related to the decline of renal function(P<0.05).Conclusion The mild to moderate decline of renal function is common in patients with T2DM.In addition to inevitable factors such as gender and age, the prevention and treatment of diabetic nephropathy mainly lies in strengthening health education and improving patients′ lifestyle, such as quitting smoking and limiting alcohol.In clinical, we should emphasize the management of interventional factors such as blood pressure, blood sugar, blood lipid, UA, and Hcy.Meanwhile, the distribution of TCM syndrome should be taken into consideration in the treatment and prevention of diabetic nephropathy, and western medicine should be integrated with TCM.