2型糖尿病住院患者"肾功能不全"的患病率调查

目的 运用简化肾脏病膳食改良试验(MDRD)公式评估住院的2型糖尿病患者"肾功能不全"的患病情况.方法 对2002年7月至2007年10月住院的1576例2型糖尿病患者测定血肌酐、24 h尿白蛋白.同时记录患者的年龄、体重、糖尿病病程等.应用MDRD公式计算肾小球滤过率(GFRMDRD),GFRMDRD<60ml·min-1·1.73 m-2被定义为"肾功能不全".结果 (1)本研究人群中GFRMDRD≥90 ml·min-1·1.73 m-2、90～60 ml·min-1·1.73 m-2、<60 ml·min-1·1.73 m-2的患者分别为908例、503例、165例.随着年龄的增加,"肾功能不全"的患病率逐渐上升(P<0.01).(2)正常蛋白尿组、微量蛋白尿组、大量蛋白尿组伴"肾功能不全"的患者分别为52、50、63例.不同蛋白尿组伴"肾功能不全"的比例之间的差异均有统计学意义(均P<0.01).(3)在165例"肾功能不全"的患者中21例患者既无血肌酐水平异常又无尿蛋白异常.结论 在糖尿病患者中应用MDRD公式计算GFR,对及早发现肾功能受损、评价肾功能进展速度有重要的临床意义.

Use of modification of diet in renal disease equation in estimating renal insufficiency in type 2 diabetes patients

Objective To investigate the significance of use of modification of diet in renal disease (MDRD)equation in calculating glomemlar filtration rate(GFR)so as to estimate the prevalence of"renal insufficiency"in type 2 diabetes patients.Methods Serum creatinine(Scr)and 24h-urinary albumin excretion(24 h-UAE)were measured in 1576 hospitalized type 2 diabetes patients.MDRD equation was used to calculate the GFR(GFRMDRD).GFRMDRD<60 ml/min per 1.73m2 was defined as"renal insufficiency"RemlIs(1)Of the 1576 subjects,908(57.6%),503(31.9%),and 165(10.5%)had GFRMDRD≥90,90-60,and<60 ml/min per 1.73 m2 respectively.The prevalence of"renal insufficiency"was increased with aging(P<0.01).(2)The prevalence rates of"renal insufficiency"of the normo-,micro-,and macroalbuminuric groups were 4.8%,14.4%,and 43.4%respectively,with significant differences among them(all P<0.01).(3)Of the 165 subjects with"renal insufficiency",21(12.7%)had neither abnormal Scr nor abnormoalbuminuria.Conclusion Able to discover renal insufficiency early.MDRD equation has important clinical significance in evaluating the progression of renal dysfunction in type 2diabetes patients.