糖尿病肾病患者发生贫血的影响因素研究

背景 糖尿病肾病（DKD）患者较非糖尿病肾病（NDKD）患者更容易发生贫血,贫血不但加速DKD的进程,而且与心血管疾病等并发症的发生密切相关,研究DKD患者发生贫血的影响因素对降低贫血发生率及延缓DKD进展具有重要意义。 目的 探讨DKD患者发生贫血的影响因素。 方法 选取2019年1月至2020年9月在昆明医科大学第一附属医院肾脏内科住院的DKD患者254例为研究对象。回顾性收集患者一般资料〔性别、年龄、身高、体质量、血压、糖尿病病程（DD）、是否吸烟〕、实验室检查指标〔红细胞（RBC）、血红蛋白（Hb）、总蛋白（TP）、血清白蛋白（ALB）、血清球蛋白（GLB）、碱性磷酸酶（ALP）、胆碱酯酶（CHE）、血尿酸（SUA）、尿素氮（BUN）、血肌酐（Scr）、胱抑素C（Cys C）、视黄醇结合蛋白（RBP）、空腹血糖（FPG）、钙（Ca）、磷（P）、镁（Mg）、锌（Zn）、血清铁（SI）、非铁结合力（UIBC）、总铁结合力（TIBC）、血清铁蛋白（SF）、转铁蛋白（TRF）、C反应蛋白（CRP）、红细胞沉降率（ESR）、糖化血红蛋白（HbA1c）、尿白蛋白/肌酐（UALB/CRE）、24 h微量白蛋白（24 h-mALB）、24 h微量总蛋白（24 h-MTP）〕,计算体质指数（BMI）和估算肾小球滤过率（eGFR）。根据Hb将患者分为非贫血组（116例,男性Hb>130 g/L、女性Hb>120 g/L）和贫血组（138例,男性Hb≤130 g/L、女性Hb≤120 g/L）。采用Spearman秩相关分析及多元线性回归分析探究DKD患者发生贫血的影响因素。 结果 贫血组患者收缩压（SBP）高于非贫血组,DD长于非贫血组（P<0.05）。贫血组患者RBC、Hb、TP、ALB、GLB、CHE、eGFR、Ca、Zn、SI、UIBC、TIBC、SF、TRF水平低于非贫血组,BUN、Scr、Cys C、RBP、FPG、P、Mg、CRP、ESR、HbA1c、UALB/CRE、24 h-mALB、24 h-MTP水平高于非贫血组（P<0.05）。Spearman秩相关分析结果显示,Hb与TP、ALB、CHE、eGFR、FPG、Zn、SI、UIBC、TIBC、ESR呈正相关（P<0.05）,与SBP、DD、BUN、Scr、Cys C、P、CRP、HbA1c、UALB/CRE、24 h-mALB、24 h-MTP呈负相关（P<0.05）。多元线性回归分析结果显示,DD（β=-0.060）、ALB（β=0.755）、CHE（β=1.512）、Zn（β=1.173）、HbA1c（β=-5.766）、eGFR（β=0.341）是DKD患者Hb的独立影响因素（P<0.05）。 结论 DKD患者发生贫血受DD、ALB、CHE、Zn、HbA1c、eGFR的影响,临床上应积极纠正上述影响因素以降低DKD患者贫血的发生率,提高患者生活质量。

Influencing Factors of Anemia in Patients with Diabetic Kidney Disease

Background Patients with diabetic kidney disease(DKD)are more prone to anemia than those with non-diabetic kidney disease.Anemia quickens the progression of DKD,and is closely associated with cardiovascular disease and other complications.So studying the influencing factors of anemia in DKD is of great importance to the reduction of anemia incidence and the delaying of DKD progression.Objective To investigate the influencing factors of anemia in DKD.Methods Two hundred and fifty-four inpatients with DKD were selected from Department of Nephrology,First Affiliated Hospital of Kunming Medical University from January 2019 to September 2020.Data of them were retrospectively collected,including demographic information〔gender,age,height,weight,blood pressure,duration of diabetes,calculated body mass index(BMI),and smoke prevalence〕,and laboratory test indices〔red blood cells(RBC),serum hemoglobin(Hb),total protein(TP),albumin(ALB),globulin(GLB),alkaline phosphatase(ALP),cholinesterase(CHE),uric acid(SUA),blood urea nitrogen(BUN),creatinine(Scr),cystatin C(Cys C),retinol binding protein(RBP),fasting plasma glucose(FPG),calcium(Ca),phosphorus(P),magnesium(Mg),zinc(Zn),iron,unsaturatediron binding capacity(UIBC),total iron binding capacity(TIBC),ferritin,transferrin(TRF),C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR),glycated hemoglobin(HbA_1c),UALB/CRE,24-hour urine for microalbumin(24 h-mALB),24-hour urine for total protein(24 h-MTP)〕and estimated glomerular filtration rate(eGFR).One hundred and sixteen cases were diagnosed with anemia,and 138 without(anemia was defined as serum Hb≤130 g/L for men,and≤120 g/L for women).Spearman rank correlation analysis and multiple linear regression analysis were used to explore the factors associated with anemia in DKD.Results Compared with patients without anemia,those with anemia had higher systolic blood pressure,and longer duration of diabetes(P<0.05).Moreover,anemia patients had lower levels of RBC,Hb,TP,ALB,GLB,CHE,eGFR,serum Ca,Zn,iron,UIBC,TIBC,ferritin,and TRF,and higher levels of BUN,Scr,Cys C,RBP,FPG,serum P,Mg,CRP,ESR,and HbA_1c,UALB/CRE,24 h-mALB,as well as 24 h-MTP(P<0.05).Spearman rank correlation analysis showed that Hb was positively correlated with TP,ALB,CHE,eGFR,FPG,serum Zn,and iron,UIBC,TIBC,and ESR(P<0.05)and negatively correlated with SBP,duration of diabetes,BUN,Scr,serum Cys C,P,CRP,HbA_1c,UALB/CRE,24 h-mALB,and 24 h-MTP(P<0.05).Multiple linear regression analysis showed that duration of diabetes(β=-0.060),ALB(β=0.755),CHE(β=1.512),Zn(β=1.173),and HbA_1c(β=-5.766)in serum,and eGFR(β=0.341)were independently associated with serum Hb in DKD(P<0.05).Conclusion Anemia in DKD may be associated with the duration of diabetes,serum levels of ALB,CHE,Zn and HbA_1c,as well as eGFR.The above-mentioned influencing factors should be actively corrected to reduce the incidence of anem ia and to improve the quality of life in DKD patients.