2型糖尿病患者肾小球滤过率与尿白蛋白排泄率的关系

Relationship between Glomerular Filtration Rate and Urinary Albumin Excretion in Type 2 Diabetic Patients

为探讨2型糖尿病患者的肾小球滤过率(GFR)与尿白蛋白排泄率(UAER)的变化特点并探讨其临床意义,将住院的2型糖尿病病人154例按UAER分为正常尿白蛋白排泄率组(A组)、微量尿白蛋白排泄率组(B组)和大量尿白蛋白排泄率组(C组)。3组分别进行放射性核素肾动态显像测定GFR,并测定UAER、血肌酐、糖化血红蛋白和血压。发现:C组GFR较A组及B组显著下降(P<0.01),UAER显著升高(P<0.01);C组及B组的收缩压、糖化血红蛋白也比A组显著升高(P<0.01)。GFR与UAER、年龄、血肌酐、收缩压、糖化血红蛋白分别呈显著负相关。多元逐步回归分析显示,影响糖尿病病人GFR改变的主要因素,按其对GFR影响的大小依次为UAER、年龄、血肌酐、收缩压、糖化血红蛋白。提示:GFR与UAER联合测定能更全面地反映糖尿病肾病的病变程度,收缩压、糖化血红蛋白的严格控制对延缓GFR下降及减少尿白蛋白排泄有一定意义,早期临床干预是必要的。

Objective: The purpose was to study the relationship between urinary albumin excretion rate (UAER) and glomerular filtration rate(GFR) in type 2 diabetic patients. 154 diabetic patients in hospital were divided on the basis of UAER into a normal albuminuria group (<20 μg/min), a microal-buminuria group (20-200 μg/min), and a overt albuminuria group ( >200 μg/min). GFR was measured by the 99mTc-DTPA single injection method. Glycosylated hemoglobin, plasma creatinine and systolic blood pressures were also analyzed. Result: GFR in the overt albuminuria group fell consistently (P<0.01), while its UAER rose significantly(P<0.01 ). Similarly, compared with the normal albuminuria group respectively, systolic blood pressures and glycosylated hemoglobin were significantly higher in the microalbuminuria group and overt albuminuria group(P<0. 01). GFR was independently negatively correlated to UAER, ages, plasma creatinine, systolic blood pressure and glycosylated hemoglobin. Multiple regression analysis disclosed that UAER, ages, plasma creatinine, glycosylated hemoglobin and systolic blood pressure were the primary factors which caused GFR to come down. Conclusion: Diabetic patients' renal function should be exactly judged by measuring both GFR and UAER. Intensive control of glycosylated hemoglobin and systolic blood pressure important for postponing the decline in GFR and the development of microalbuminuria.