2型糖尿病患者肾小球滤过率年下降率测定及其相关因素分析

目的探讨2型糖尿病（T2DM）患者肾小球滤过率（GFR）年下降率及其影响因素。方法1994-2008年进行两次核素测定GFR的T2DM住院患者309例，根据基线尿白蛋白排泄率（UAER）和血肌酐（Scr）分为3组：正常白蛋白尿（N-UAlb）组、微量白蛋白尿（M-UAlb）组、大量蛋白尿（L-UAlb）组；根据末次测定GFR时的UAER和Scr各组再分为无进展组与有进展组，计算GFR年下降率。结果3组GFR末次值与基线值比较，有进展组与无进展组差异均有统计学意义（P〈O．01）。GFR年下降率：N_UAlb无进展组为1．5±7．3ml／min，有进展组为3．2±3．9ml／minM．UAlb无进展组为2．7±9．2ml／min，有进展组为4．1±8．5ml／min;L-UAlb组为9．4±11．9ml／minN—UAlb组、M—UAlb组与L_UAlb组比较，GFR年下降率有进展组与无进展组差异均有统计学意义（P〈O．01）。HbA。C、收缩压与GFR年下降率呈独立正相关（r=0.92、0．06，P〈0．05）。结论T2DM患者GFR年下降率随UAlb的严重程度而逐渐增加，HbA1c、收缩压是GFR年下降率的独立危险因素。

Relation between the decline rate of glomerular filtration rate and clinical characteristics in diabetic nephropathy

Objective To observe relation between decline rate of GFR and clinical characteristics in diabetic nephropathy. Methods 309 type 2 diabetic patients in 1994-2008 were divided into three groups according to urinary albumin excretion rate（UAER） ：normal UAER, micro-UAER and large UAER group. Serum creatinine concentrations （Scr） and GFR were measured to observe GFR difference between nonprogress group and progress group after average 3.5-years. The decline rate of GFR was calculated. Results There was difference in GFR between last and baseline calculation in spite of nonprogress or progress of three groups （P 〈 0. 01）. The average annual decline of GFR was 1.5 ± 7. 3 ml/min in nonprogress group of normal albuminuria, 3.2±3, 9 ml/min in the progress group of normal albuminuria, 2.7±9.2ml/min in the nonprogress group of microalbuminuria,4. 1 ±8. 5ml/min in the progress group of microalbuminuria, whereas 9.4± 11.9 ml/min in the macroalbuminuric group. There were significant differences between normal albuminuric, microalbuminuric and macroalbuminuric groups in the decline rate of GFR in spite of nonprogress or progress（P〈0. 01）. HbA1 c and SBP were positively correlated with the decline rate of GFR （r= 0. 92,0. 06, P〈 0.05 ）. Conclusions With albuminuria becoming more serious, the rate of GFR decline is severer. HbA1 c and SBP are important dangerous factors for the decline rate of GFR.