初诊2型糖尿病患者肾小球滤过率影响因素的相关分析

目的:探讨各种危险因素对初诊2型糖尿病(T2DM)患者肾小球滤过率(GFR)的影响,以及早期干预对阻止或延缓糖尿病肾病(DN)发生发展的临床意义。方法:采用99mTc-DTPA肾动态显像法对初诊T2DM进行GFR检测,并据美国K/DOQI慢性肾脏病分期,将患者分为GFR正常组(GFR≥90ml/min)及GFR下降组(GFR<90ml/min)。检测血压(BP)、体重指数(BMI)、空腹血糖(FBG)、空腹胰岛素(FIns)、血脂谱、血肌酐(Cr)、糖化血红蛋白(HbA1c)、尿白蛋白/肌酐(UALB/UCR),利用HOMA2计算器分别计算胰岛素敏感性指数(HOMA2-%S)和分泌功能指数(HOMA2-%B)并比较分析。结果:年龄、FBG、HbA1c、UALB/UCR、HOMA2-%S、HOMA2-%B两组有明显差异(P<0.05);影响初诊T2DMGFR的主要因素为年龄、FBG、HbA1c、UALB/UCR、HOMA2-%S、HOMA2-%B。结论:早期干预、阻止或延缓DN的发生发展需要控制血糖达标,防治尿白蛋白,改善胰岛功能。

Correlation between glomerular filtration rate and multiple risk factors in newly diagnosed type 2 diabetic patients

Objective:To evaluate the importance of different risk factors and their mutual interactions on glomerular filtration rat in newly diagnosed type 2 diabetes mellitus(T2DM),and discuss their clinical significance of in early precluding or mitigating diabetic nephropathy.Methods:GFR of newly diagnosed T2DM were measured by 99mTc-DTPA,renal dynamic imaging.According to CKD stages of K/DOQI,all individuals were categorized into two groups:GFR normal group(GFR≥90ml/min)and GFR dropped group(GFR< 90ml/min).BP,BMI,FBG,Cr,lipid profile,FIns,HbA1c and UALB/UCR were also measured.Insulin sensitivity indices(HOMA2-%S) and insulin secretion function indices(HOMA2-%B) were calculated by the HOMA2 calculator.Result:The values of age,FBG,HbA1c,UALB/UCR,HOMA2-%S and HOMA2-%B were significantly different between the two groups(P<0.05).And age,FBG,HbA1c,UALB/UCR,HOMA2-%S and HOMA2-%B were independent risk factors for GFR.Conclusion:To delay the decline of GFR and prevent the occurrence of diabetic nephropathy,it is important not only to control blood glucose,but also to prevent albuminuria and improve islet function.