上海社区糖尿病及糖尿病前期慢性肾脏并发症患病现状调查

目的探讨糖尿病及糖尿病前期慢性肾脏并发症患病率及其主要危险因素。方法对上海社区已建立的糖尿病及糖调节受损队列人群进行筛查,收集空腹血和3～6个月内不同日期3次晨尿进行检测,以尿白蛋白/尿肌酐比值在30～299.9μg/mg 范围内判断为微量白蛋白尿,并以血肌酐浓度估计肾小球滤过率。结果共完成筛查406例,其中糖尿病者244例;糖调节受损者162例,平均年龄67.5岁±13.8岁。(1)糖尿病和糖调节受损人群中微量白蛋白尿患病率分别为20.9%和10.5%;(2)糖尿病人群中肾小球滤过率轻、中、重度下降的比例分别为41.6%、37.0%、1.2%,糖调节受损人群中为34.2%、47.25、1.9%。按肾小球滤过率分类计算的肾功能不全患病率在糖尿病和糖调节受损人群中为38.2%和49.1%;(3)高血压、中心性肥胖、血脂紊乱、心血管病史及高龄的糖尿病病人微量白蛋白尿患病率显著升高。收缩压、腰围、空腹血糖及心血管病史分别与高血糖人群发生微量白蛋白尿独立相关;(4)随年龄增高,肾小球滤过率明显下降。按肾小球滤过率分类计算的肾功能不全在高血压病人中比例较高(48.5%)。排除年龄影响后在尿白蛋白/尿肌酐比值<300μg/mg 范围内肾小球滤过率与尿白蛋白/尿肌酐比值正相关。血肌酐、年龄及收缩压分别与高血糖人群肾小球滤过率<60 ml·min~(-1)·(1.73 m~2)~(-1)独立相关。结论上海社区高血糖人群慢性肾脏并发症患病率已达到较高的水平,对于高血糖病人慢性肾脏并发症的检测除了检查尿白蛋白的排泄外,还应该对肾小球滤过率进行评价。

Chronic renal disease in diabetic and prediabetic subjects: a community-based study in Shanghai

OBJECTIVE: The aim of the present study was to assess the prevalence and risk factors of chronic renal disease in hyperglycemic population of Shanghai Caoyang Community. METHODS: Microalbuminuria was determined by measuring urinary albumin-to-creatinine ratio (ACR) and glomerular filtration rate (GFR) was estimated from fasting serum creatinine. RESULTS: A total of 406 Shanghai Chinese, with the average age of 67.5 +/- 13.8 years (244 with diabetes mellitus and 162 with impaired glucose regulation) from the established hyperglycemic cohort were included. (1) The prevalence of microalbuminuria was 20.9% and 10.5% in the subjects with diabetes and impaired glucose regulation (IGR); (2) The prevalence of a cGFR >or= 60 and < 90, >or= 30 and < 60, < 30 mlxmin(-1)x(1.73 m(2))(-1) were 41.6%, 37.0%, 1.2% respectively in the patients with diabetes, and 34.2%, 47.2%, 1.9% in the patients with IGR. Impaired renal function was 38.2% and 49.1% respectively in the subjects with diabetes and IGR; (3) The prevalence of microalbuminuria was significantly higher in the diabetic patients with hypertension, central obesity, dyslipidemia, history of cardiovascular disease or selinity. Systolic blood pressure, waist circumstance, fasting plasma glucose and history of cardiovascular disease were all independently associated with hyperglycemic microalbuminuria; (4) cGFR was diminished with increased age and the impaired renal function was more frequent in the patients with hypertension (48.5%). There was a significant positive correlation between a diminished cGFR and increasing levels of ACR after the patients with macroalbuminuria were deleted and adjusted age. Serum creatinine, age and systolic blood pressure were independently associated with diabetic cGFR < 60 ml/min/1.73 m(2). CONCLUSIONS: The high prevalence of microalbuminuria and impaired renal function in the hyperglycemic population of Caoyang Community underlines the need for cost-effective programs for the detection of chronic renal disease, and approaches to screen it in the hyperglycemic patients should incorporate assessment of GFR in addition to monitoring urine albumin excretion.