GFR与UAC对2型糖尿病肾功能评价的价值

 目的 探讨110例2型糖尿病患者肾小球滤过率(glomerular filtration rate,GFR)及尿白蛋白浓度(urine albumin concentration,UAC)情况,对2型糖尿病肾功能评价的价值。方法 对110例于内分泌科住院治疗的2型糖尿病患者测定晨尿微量白蛋白浓度,行肾动态显像检查,收集患者的一般临床资料。评价UAC及GFR值对患者肾功能的诊断价值及关联性。结果 UAC值与GFR值存在负相关性(P<0.05);当GFR值<60 ml/(min·1.73 m²)时,以GFR值为状态变量,UAC值为检验变量绘制ROC曲线发现,敏感度和特异度最佳截断点UAC值为10.90 mg/L。当患者GFR≥60 ml/(min·1.73 m²)时,UAC异常人群高血压发病率高于UAC正常人群(P<0.05)。结论 在2型糖尿病患者中,GFR值随UAC值的升高而降低,即UAC值在一定程度上能够反映出患者肾功能变化情况,但部分患者在GFR值明显下降GFR<60 ml/(min·1.73 m²)]时,UAC仍可处于正常水平,此时评价2型糖尿病患者的肾功能情况不应该以传统标准(UAC<30 mg/L)为界限。在临床工作中需同时关注2型糖尿病患者,尤其是有高血压病史的老年患者的肾小球滤过率及尿蛋白情况,以免漏诊。

Effect of GFR and UAC to evaluate renal function in patients with type 2 diabetes

Objective Through the analysis of glomerular filtration rate (GFR) and urinary albumin concentration (UAC) in 110 patients with type 2 diabetes, to discuss whether there is relevance between GFR and UAC in patients with type 2 diabetes and its application value. Methods One hundred and ten patients with type 2 diabetes were enrolled in this study. All of the patients received measurement of morning urine trace albumin concentration, and renal dynamic imaging examination. General clinical data were collected. Results UAC value was negatively related to GFR value(P<0.05).When GFR<60 ml/(min·1.73 m²), with GFR value as the gold standard, ROC curves showed that the optimal UAC value cut-off values were 10.90 mg/L by maximizing the sum of sensitivity and specificity. In GFR≥60 ml/(min·1.73 m²)group,the incidence of hypertension in patients with normal UAC value was higher than that in UAC abnormal patients(P<0.05). Conclusions In patients with type 2 diabetes, by the rise of UAC value,GFR value would come down. To some extent, UAC value can reflect the renal function changes in patients,but the evaluation of renal function in patients with type 2 diabetes should not be based on the traditional standard (UAC<30 mg/L)as the boundary, in some patients GFR value decreased obviously GFR < 60 ml/(min·1.73 m²)] wheras UAC value can still be in a normal level. We need to focus on albuminuria and glomerular filtration rate at the same time in the clinical work in patients with type 2 diabetes especially in elderly patients with a history of high blood pressure in order to avoid misdiagnosis or missed diagnosis.