| 中老年人的糖代谢状态与慢性肾脏疾病的相关性 |
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| 引用本文： | 王强梅,甄洁玉,关聪会,赵 楠,刘进进,李红利,傅松波,汤旭磊,韩艳萍,苏 姗,张 迪,刘丽娟,甄东户.中老年人的糖代谢状态与慢性肾脏疾病的相关性[J].南方医科大学学报,2020,40(10):1457-1464. |
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| 作者姓名： | 王强梅 甄洁玉 关聪会 赵 楠 刘进进 李红利 傅松波 汤旭磊 韩艳萍 苏 姗 张 迪 刘丽娟 甄东户 |
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| 摘 要： | 目的 探讨兰州市中老年人不同糖代谢状态与慢性肾脏疾病（CKD）的相关性。方法 采用“REACTION”研究兰州地区的基线资料，随机抽取兰州市3个社区中40~75岁的符合条件的常住居民10038名为研究对象，根据其空腹血糖、负荷后2 h血糖和自报糖尿病分为正常糖耐量（NGT）组、糖调节受损（IGR）组和糖尿病（DM）组。分别用肾小球滤过率（eGFR）和尿白蛋白/肌酐比值（ACR）评价肾功能。采用协方差分析比较不同糖代谢状态下蛋白尿的患病率及eGFR的水平。采用Logistic回归分析探讨IGR和DM是否是蛋白尿和肾功能不全（RI）的危险因素。采用多元回归分析探讨eGFR随ACR增加的趋势。结果 在整个研究人群中，蛋白尿、CKD和RI的患病率分别为26.2%、27.4%和2.5%。DM组蛋白尿、CKD和RI的患病率明显高于IGR组和NGT组（P均<0.05）。无论是否合并糖代谢异常，高血压患者蛋白尿、CKD及RI的患病率均明显高于血压正常者（P<0.05）。随着CKD1期进展到CKD4期，高龄、DM病史、高血压病史、血脂异常病史、冠心病病史、DM、高血压及血脂异常人群的比例明显增加（P<0.05）。IGR人群中，年龄、高血压、高甘油三酯（TG）血症与RI的患病风险呈正相关（OR分别为：1.113、1.904、2.608，P均<0.05）。在DM人群中，年龄、冠心病、肥胖、高TG血症及高LDL-C血症与RI的患病风险呈正相关（OR分别为：1.069、2.535、3.359、1.827、2.690，P均<0.05）。logistic回归分析显示：DM显著增加蛋白尿和RI的风险，OR分别为1.543（P=0.000）和1.446（P=0.005）。logistic回归分析及多元回归分析综合显示：虽然eGFR在DM和IGR患者中的恶化趋势相似，但IGR不是蛋白尿或RI的显著危险因素（OR=1.057，P=0.355；OR=0.918，P=0.614）。结论 DM是蛋白尿及RI的显著危险因素，IGR不是蛋白尿及RI的显著危险因素。对于糖尿病、高血压、肥胖和心血管疾病患者，特别是老年人和女性，强烈建议筛查蛋白尿和eGFR，以预防终末期肾病。
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Correlation of type 2 diabetes and impaired glucose regulation with chronic kidney disease in middle-aged and elderly individuals |
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| Abstract: | Objective To explore the correlation of different glucose metabolism statues with chronic kidney disease (CKD) in middle-aged and elderly individuals in Lanzhou. Methods Based on the baseline data of REACTION Study in Lanzhou area, we randomly sampled 10 038 residents aged 40-75 years in 3 communities in Lanzhou, who were classified into normal glucose tolerance (NGT), impaired glucose regulation (IGR) and diabetes groups. The estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) were used to assess the renal function and albuminuria, respectively. Binary logistic regression was performed to analyze the contribution of the risk factors to CKD. Polynominal regression was used to determine the trends of eGFR with the increment of ACR. Results Among all the participants, the prevalences of albuminuria, CKD and renal insufficiency (RI) were 26.2%, 27.4% and 2.5%, respectively. The prevalence of albuminuria, CKD and RI were significantly higher in the diabetes group than in IGR and NGT groups (P<0.05). In IGR group, age, hypertension, and hypertriglyceridemia were positively correlated with the risk of RI (OR: 1.113, 1.904, and 2.608, respectively; P<0.05). In diabetes group, age, coronary heart disease, obesity, hypertriglyceridemia, and elevated LDL-C level were positively correlated with the risk of RI (OR: 1.069, 2.535, 3.359, 1.827, and 2.690, respectively; P<0.05). Logistic regression analysis showed that diabetes mellitus significantly increased the risk of albuminuria (OR: 1.543, P=0.000) and RI (OR: 1.446, P=0.005). Logistic regression analysis and multivariate regression analysis showed that although the deterioration trends of eGFR were similar in diabetes group and IGR group, IGR was not a significant risk factor for albuminuria or RI (OR:1.057, P=0.355; OR: 0.918, P=0.614). Conclusion Diabetes mellitus is a significant risk factor for albuminuria and RI, while IGR is not. Screening for albuminuria and eGFR is highly recommended for individuals with diabetes, hypertension, and obesity, especially in women and the elderly population. |
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