慢性肾脏病不同分期患者糖代谢异常及相关影响因素的调查研究

Investigation of glucose metabolism abnormalities and related influencing factors in patients with different stages of chronic kidney disease

目的探讨非糖尿病的慢性肾脏病(chronic kidney disease,CKD)不同肾功能分期患者中糖代谢异常的患病率及相关影响因素。方法选择2020年4月至2022年4月于中国康复研究中心北京博爱医院肾内科住院的140例CKD患者,其中CKD早期(CKD1-3a期)34例,中期(CKD3b-4期)35例,晚期(CKD5期)71例。记录入组患者的人口统计学资料以及临床生化指标,并进行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT),测定0、1、2h的血糖、胰岛素及C肽水平,共有71例患者完成了OGTT试验。结果(1)在CKD早期、中期、晚期的患者中,糖耐量减低的患病率分别为42.1%、41.2%、37.1%;糖尿病的患病率分别为42.1%、17.6%、34.3%;空腹血糖异常的患病率分别为29.4%、14.3%、14.1%;(2)在校正了性别、血白蛋白、血红蛋白、血压、血脂等因素后,多因素Logistic回归分析显示,CKD患者糖代谢异常的影响因素为年龄、体质量指数(body mass index,BMI)、尿酸,OR值分别为1.057、1.132、1.007,P值分别为0.028、0.035、0.012,即年龄每增加10岁,糖代谢异常发生的风险增加约57%,BMI每增加1 kg/m^(2),糖代谢异常发生的风险增加约13.2%,尿酸每增加100μmol/L,糖代谢异常发生的风险增加约70%。结论(1)CKD患者糖耐量减低的患病率高达39.4%,糖尿病患者比例达32.4%,均明显高于普通人群(15.5%和9.7%)。(2)CKD患者早期即出现糖代谢异常。(3)CKD患者糖代谢异常的影响因素为年龄、BMI和尿酸。

Objective To investigate the prevalence of glucose metabolism abnormalities and related influencing factors in patients with different stages of non-diabetic chronic kidney disease(CKD).Methods A total of 140 patients with CKD in each stage of the Department of Nephrology,Beijing Bo’ai Hospital,China Rehabilitation Research Center,were selected from April 2020 to April 2022.Among them,34 were early in CKD(CKD1-3a),35 were in middle(CKD3b-4),and late stage(CKD5)was 71 cases.The demographic data and clinical biochemical indexes of the patients were recorded,and oral glucose tolerance test(OGTT)was performed to measure blood glucose,insulin and C-peptide levels at 0,1,and 2 h,a total of 71 patients completed the OGTT.Results①The prevalence of impaired glucose tolerance in the early,middle and late stages of CKD was 42.1%,41.2%,and 37.1%;The prevalence of dominant diabetes in the early,middle and late stages of CKD was 42.1%,17.6%,34.3%;and the abnormal fasting blood glucose in the early,middle,and late stages of CKD was 29.4%,14.3%,and 14.1%;②Factors such as gender,blood albumin(ALB),hemoglobin,blood pressure,and blood lipid were corrected,and multivariate Logistic regression analysis revealed that the influencing factors of abnormal glucose metabolism in CKD patients were age,body mass index(BMI),and uric acid,the OR value was 1.057,1.132,1.007,with P values was 0.028,0.035,and 0.012,respectively.That is,the risk of abnormal glucose metabolism increased by about 57%for every 10 years of age,13.2%for every 1 kg/m^(2) of BMI,and 70%for every 100μmol/L of uric acid.Conclusions①The prevalence of impaired glucose tolerance in CKD patients is as high as 39.4%,and the proportion of patients with new-onset diabetes is 32.4%,which are significantly higher than the general population(15.5%and 9.7%).②Patients with CKD have abnormal glucose metabolism in the early stage.③The influencing factors of abnormal glucose metabolism in CKD patients are age,BMI and uric acid.