2型糖尿病合并糖尿病肾病患者白蛋白尿和肾功能衰竭的影响因素分析

An analysis of influencing factors for albuminuria and renal failure in patients with type 2 diabetesmellitus and diabetic nephropathy

目的分析2型糖尿病(T2DM)合并糖尿病肾病(DN)患者白蛋白尿和肾功能衰竭的影响因素。方法收集138例T2DM合并DN患者临床资料,计算尿白蛋白/肌酐比值(UACR),根据UACR将T2DM合并DN患者分为无白蛋白尿(A1)组(UACR<3 mg/g,64例)、微量白蛋白尿(A2)组(3 mg/g≤UACR<30 mg/g,52例)和大量白蛋白尿(A3)组(UACR≥30 mg/g,22例)。根据估计肾小球过滤率(eGFR)将T2DM合并DN患者分为B1组(eGFR≥60 mL·min^(-1)·1.73 m^(-2),90例)和B2组(eGFR<60 mL·min^(-1)·1.73 m^(-2),48例)。采用Pearson相关分析UACR和eGFR与临床指标的关系,采用多因素logistic回归分析T2DM合并DN患者白蛋白尿和肾功能衰竭的影响因素。结果与A1组比较,A2组和A3组糖尿病病程较长,幽门螺杆菌(Hp)感染比例、UACR、SCr、BUN、同型半胱氨酸(Hcy)、HbA1c、TNF-α和IL-27较高,eGFR较低(P<0.05);与A2组比较,A3组糖尿病病程较长,Hp感染比例、UACR、SCr、BUN、Hcy、HbA1c、TNF-α和IL-27较高,eGFR较低(P<0.05)。与B1组比较,B2组糖尿病病程较长,Hp感染比例、UACR、SCr、BUN、Hcy、HbA1c、TNF-α和IL-27较高,eGFR较低(P<0.05)。UACR与糖尿病病程、Hcy、HbA1c、TNF-α及IL-27呈正相关(P<0.05),eGFR与糖尿病病程、SCr、Hcy、HbA1c、TNF-α、IL-27呈负相关(P<0.05)。HbA1c和IL-27水平较高、糖尿病病程较长以及Hp感染是T2DM合并DN患者白蛋白尿的独立危险因素(P<0.05)。Hcy、HbA1c和IL-27水平较高、糖尿病病程较长以及Hp感染是T2DM合并DN患者肾功能衰竭的独立危险因素(P<0.05)。结论HbA1c和IL-27水平较高、糖尿病病程较长以及Hp感染是T2DM合并DN患者白蛋白尿的独立危险因素。Hcy、HbA1c和IL-27水平较高、糖尿病病程较长以及Hp感染是T2DM合并DN患者肾功能衰竭的独立危险因素。

Objective To analyze the influencing factors for albuminuria and renal failure in the patients with type 2 diabetes mellitus(T2DM)and diabetic nephropathy(DN).Methods The clinical data of 138 patients with T2DM and DN were collected.The ratio of urinary albumin to creatinine(UACR)was calculated.The patients were divided into three groups of A1(UACR<3 mg/g,64 cases),A2(3 mg/g<UACR<30 mg/g,52 cases)and A3(UACR≥30 mg/g,22 cases).According to estimated glomerular filtration rate(eGFR),the patients were divided into two groups of B1(eGFR≥60 mL·min^(-1).1.73 m^(2),90 cases)and B2(eGFR<60 mL·min^(-1)1.73 m^(2),48 cases).Pearson correlation analysis was used to analyze the relationship of UACR and eGFR with the clinical indicators.Multivariate logistic regression was used to analyze the influencing factors for albuminuria and renal failure in patients with T2DM and DN.Results Compared with group Al,the course of diabetes was longer,the proportion of Helicobacter pylori(Hp)infection,UACR,SCr,BUN,homocysteine(Hcy),HbAlc,TNF-αand IL-27 were higher,and eGFR was lower in groups of A2 and A3(P<0.05).Compared with group A2,the course of diabetes was longer,the proportion of Hp infection,UACR,SCr,BUN,Hcy,HbAlc,TNF-αand IL-27 were higher,and eGFR was lower in group A3(P<0.05).Compared with group Bl,the course of diabetes was longer,the proportion of Hp infection,UACR,SCr,BUN,Hcy,HbAic,TNF-αand IL-27 were higher,and eGFR was lower in group B2(P<0.05),.UACR was positively correlated with diabetes course,Hcy,HbAlc,TNF-αand IL-27(P<0.05),while eGFR was negatively correlated with diabetes course,SCr,Hcy,HbAlc,TNF-αand IL-27(P<0.05).Higher levels of HbAlc and IL-27,longer course of diabetes and Hp infection were the independent risk factors for albuminuria in patients with T2DM and DN(P<0.05).Higher levels of Hcy,HbAlc and IL-27,longer course of diabetes and Hp infection were the independent risk factors for renal failure in patients with T2DM and DN(P<0.05).Conclusion Higher levels of HbAlc and IL-27,longer course of diabetes and Hp infection are the independent risk factors for albuminuria in patients with T2DM and DN.Higher ievels of Hcy,HbAlc and IL-27,longer course of diabetes and Hp infection are the independent risk factors for renal failure in patients with T2DM and DN.