血清肌酐正常的2型糖尿病患者肾小球滤过率水平与危险因素分析

目的 分析2型糖尿病(T2DM)患者的肾小球滤过率(glomerular filtration rate,GFR)异常与相应临床表现特点、主要危险因素,探讨临床观察和预防肾功能异常的关键点.方法 连续收集非急性并发症入院血清肌酐正常的T2DM患者381例,利用99mTc标记的二乙三胺五乙酸(99mTc-DTPA)肾动脉显像检测GFR,根据检测值范围分为:GFR≥90 mL·min-1为正常组,GFR≥60~90 mL·min-1为轻度异常组,GFR≥30~60 mL·min-1为中度异常组,对各组进行病史分析、体格检查、生化检查等,了解各组的临床指标特点与主要危险因素.结果 在入选的血清肌酐正常的T2DM患者中,GFR正常的占48.0%、轻度异常占40.8%、中度异常占11.2%;应用有序logistic(Ordinal)等级回归显示,性别、年龄、糖尿病病程、糖化血红蛋白(HbA1c)、血肌酐、尿 α1微球蛋白、尿肌酐、尿蛋白与尿肌酐比值是显著影响GFR的因素(β值分别为0.076、0.048、0.023、0.051、0.454、-0.072、0.324、-0.911,均P<0.05),校正影响因素发现GFR主要与HbA1c、血肌酐、尿蛋白有关.结论 血清肌酐正常的T2DM患者的GFR降低影响因素主要与高血糖有关,预防肾脏病变主要还是控制血糖,同时也要防止尿蛋白的出现.

Analysis of glomerular filtration rate and risk factors in type 2 diabetes mellitus patients with normal serum creatinine

Objective To detect the glomerular filtration rate (GFR) in patients with type 2 diabetes mellitus (T2DM ),and to analyze the abnormal GFR and its clinical features and the main risk factors for discussing the clinical observation and the key points of the pre -vention of renal dysfunction .Methods Clinical data from 381 diabetic patients without acute complications on admission were consec -utively collected.These patients were assigned into normal group (GFR≥90 mL· min -1 ),mildly reduced group (60≤GFR <90 mL · min-1 ),and moderately reduced group (30≤GFR <60 mL· min-1 ),according to the detection of GFR by 99mTc-diethylene tri-amine pentacetic acid (99mTc-DTPA) renal artery perfusion imaging.The medical history,physical examination and biochemical index were analyzed and the clinical indexes features and the risk factors in different groups were investigated .Results Of the enrolled T2DM patients,48.0% had normal GFR,40.8% had mildly reduced GFR and 11.2% had moderately reduced GFR.Results from or-dered Logistic (Ordinal) regression indicated that age,duration of diabetes,glycosylated hemoglobin (HbA1c) serum creatinine,uirineα1 microglobulin,urine creatinine,urine albumin-to-creatinine ratio and sex were the impact factors of GFR (β=0.076,0.048,0.023, 0.051,0.454, -0.072,0.324, -0.911,respectively,all P <0.05).Correcting the influencing factors found that GFR was mainly in -fluenced by HbA1c,serum creatinine and urine albumin .Conclusions Hyperglycemia was the main risk factor of reduced GFR in type 2 diabetic patients with normal serum creatinine ,therefore,preventive measures of nephropathy were controlling glycemic levels and pre -venting the occurrence of urinary protein .