2型糖尿病患者早期糖尿病肾脏病与肾脏异位脂肪沉积的关系

Association between early diabetic kidney disease and ectopic fat deposition in kidney in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者早期糖尿病肾脏病(DKD)与肾脏异位脂肪沉积的关系。方法本研究为横断面研究。收集2021年7月至2023年7月于天津医科大学朱宪彝纪念医院住院且资料完整的375例T2DM患者作为研究对象,其中男性226例,女性149例。将所有研究对象分为早期DKD组(129例)和正常白蛋白尿组(246例)。检测糖化血红蛋白(HbA1c)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)、高密度脂蛋白胆固醇(HDL-C)、可溶性CD36(sCD36)等生化指标及视黄醇结合蛋白(RBP)、β2-微球蛋白(β2-MG)、N-乙酰氨基葡萄苷酶(NAG)等肾小管功能指标,并计算稳态模型评估胰岛素抵抗指数(HOMA-IR)和动脉硬化指数(AI)。按照随机数字表法每组选取20例患者,应用MR mDixon-Quant技术检测肾脏脂肪含量,计算肾脏脂肪分数(RFF)。采用独立样本t检验或χ^(2)检验进行组间比较,采用二元logistic回归分析法分析早期DKD的影响因素。结果早期DKD组HbA1c、HOMA-IR明显高于正常白蛋白尿组[分别为(8.1±2.0)%和(7.7±1.7)%、4.0±1.1和3.1±1.0,t=2.03、7.99,均P<0.05]。早期DKD组TG、LDL-C、VLDL-C、sCD36、AI均高于正常白蛋白尿组(t=3.14、2.20、3.07、18.39、2.50,均P<0.05),HDL-C低于正常白蛋白尿组(t=2.72,P<0.05)。早期DKD组RFF为(3.8±0.7)%,高于正常白蛋白尿组的(3.1±0.5)%(t=10.09,P<0.05)。早期DKD组RBP、β2-MG、NAG均高于正常白蛋白尿组(t=24.66、25.50、4.09,均P<0.05),且肾小管功能指标2项异常和3项异常的比例高于正常白蛋白尿组(χ^(2)=22.27、8.42,均P<0.05)。二元logistic回归分析结果显示,早期DKD与HbA1c、sCD36、LDL-C、RFF有关(OR=1.241、1.006、1.005、5.035,均P<0.05)。结论 T2DM患者早期DKD与血脂异常和肾脏异位脂肪沉积可能有关。

Objective To investigate the relationship between early diabetic kidney disease(DKD)and ectopic fat deposition in kidney in patients with type 2 diabetes mellitus(T2DM).Methods A cross-sectional study was used to collect 375 T2DM patients with complete data who were hospitalized from July 2021 to July 2023 at Tianjin Medical University Chu Hsien-I Memorial Hospital,among which there were 226 males,149 females.Patients were divided into early DKD group(129 cases)and normoalbuminuria group(246 cases).Biochemical indicators including glycated hemoglobin A1c(HbA1c),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),very low-density lipoprotein cholesterol(VLDL-C),high-density lipoprotein cholesterol(HDL-C),soluble CD36(sCD36)and renal tubular function indicators such as retinol binding protein(RBP),β2 microglobulin(β2-MG)and N-acetyl-β-D-glucosa minidase(NAG)were detected.The homeostasis model assessment of insulin resistance(HOMA-IR)and arteriosclerosis index(AI)were calculated.Twenty patients were selected in each group according to the method of random number table.MR mDixon-Quant technique was used to detect renal fat content and renal fat fraction(RFF)was calculated.Independent sample t test orχ^(2) test was used for comparison between the two groups.Binary logistic regression analysis was performed to evaluate influencing factors on early DKD.Results The levels of HbA1c and HOMA-IR in early DKD group were significantly higher than those of normoalbuminuria group[(8.1±2.0)%vs.(7.7±1.7)%,4.0±1.1 vs.3.1±1.0,t=2.03,7.99,all P<0.05].Compared to normoalbuminuria group,the levels of TG,LDL-C,VLDL-C,sCD36,AI were significantly higher and HDL-C was significantly lower in early DKD group(t=3.14,2.20,3.07,18.39,2.50,2.72,all P<0.05).The RFF in early DKD group was(3.8±0.7)%,higher than that in the normal albuminuria group(3.1±0.5)%(t=10.09,P<0.05).The levels of RBP,β2-MG,NAG and the proportion of two and three abnormalities of renal tubular function indictors in early DKD group were higher than those in normoalbuminuria group(t=24.66,25.50,4.09,χ^(2)=22.27,8.42,all P<0.05).Binary logistic regression analysis showed that early DKD was related to HbA1c,sCD36,LDL-C and RFF(OR=1.241,1.006,1.005,5.035,all P<0.05).Conclusion Early DKD may be associated with dyslipidemia and ectopic fat deposition in kidney in patients with T2DM.