Ⅱ型糖尿病伴微量白蛋白尿或临床蛋白尿的肾功能变化及其影响因素

目的探讨Ⅱ型糖尿病伴微量白蛋白尿或临床蛋白尿的肾功能变化及其影响因素。方法以Ⅱ型糖尿病患者为研究对象,根据尿白蛋白排泄值分为3组:无蛋白尿组,尿白蛋白排泄值小于30mg/d;微量白蛋白尿组,尿白蛋白排泄值大于30mg/d小于300mg/d;临床蛋白尿组,尿白蛋白排泄值大于300mg/d。并以同期健康成人18例作为对照组。检测身高、体重、血压、空腹血糖、血清肌酐、胆固醇、甘油三酯、糖化血红蛋白及尿白蛋白排泄值,确定患病时间,计算肌酐清除率,并对数据进行统计学分析。结果糖尿病患者的血清肌酐值比正常对照组高,而当患者出现临床蛋白尿时,其肌酐清除率明显下降,与正常对照组及无蛋白尿组比较,有显著差异。相关分析显示,在微量白蛋白尿和临床蛋白尿组,肌酐清除率与体重指数、血清肌酐、收缩血压、患病时间及尿白蛋白排泄率呈显著负相关。多元线性逐步回归分析显示,在微量白蛋白尿组对肌酐清除率唯一有影响的因素是血清肌酐值,而在临床蛋白尿组,血清肌酐和体重指数的升高都是肌酐清除率下降的独立危险因素。结论Ⅱ型糖尿病患者出现白蛋白尿后,肌酐清除率会下降。对于微量白蛋白尿患者,肌酐清除率的下降可能是多种因素如高血压、高体重指数共同作用的结果;而对于临床白蛋白尿患者,体重指数的增高是导致肌酐清除率下降的独立危险因素。

The renal function abnormalities in type 2 diabetic patients with microalbuminuria or clinical proteinuria and the risk factor

Objective To explore the renal function abnormalities in type 2 diabetic patients with microalbuminuria or clinical proteinuria and main risk factor. Method Type 2 diabetic patients were enrolled to this study, 82 patients were divided into three groups based on the urinary albumin excretion rate (UAER): normo-albuminuria group(UAER<30mg/day), micro-albuminuria group(30mg300mg/day).18 health adults were treated as controls. The body height and weight, blood pressure, fasting plasma glucose, serum creatinine, creatinine clearance, total cholesterol and triglyceride, plasma HbAlc and UAER were measured and statistic analysis were performed.Result Serum creatinine levels of patients elevated, and the creatinine clearance decreased markedly when clinical proteinuria appeared, there was significant difference when compared to controls and normoalbuminuria patients (P<0.01 and P<0.05 respectively). Correlation analysis indicated that there were significant negative correlations between creatinine clearance and body mass index(BMI), systolic blood pressure, serum creatinine levels, duration of diabetes and UAER. Multiple factors step-wise regression analysis indicated: as the decline of creatinine clearance, in microalbuminuria group, only serum creatinine level was the independent risk factor;in clinical proteinuria group, both serum creatinine level and BMI were independent risk factors (P=0.001 and P=0.03 respectively). Conclusion The creatinine clearance decreases when albuminuria appeared in type 2 diabetic patients. The decline of creatinine clearance in microalbuminuria patients may be due to a multi-factor influence such as elevation of systolic blood pressure and BMI, while in clinical proetinuria patients, the elevation of BMI is the main risk factor.