摘要
目的:探讨2型糖尿病与慢性肾脏病(CKD)的相关性。方法:采用整群抽样方法调查了上海中心城区1039例30岁以上已确诊2型糖尿病患者,其中资料完整者共1005例患者,作为本研究对象。检测项目包括身高、体质量、腰围、臀围、血压、血糖、血脂、尿白蛋白肌酐比。采用不同的公式计算估算肾小球滤过率(eGFR)。采用卡方检验和Logistic回归分析进行统计。结果:(1)分别采用Cockcroft-Gault(C-G)公式、肾脏病膳食改良试验(MDRD)公式、根据中国人CKD患者校正后的MDRD(c-MDRD)公式计算eGFR,均显示低肾小球滤过率组(eGFR<60ml/min/1.73m2)较对照组年龄显著增高,病程显著延长,血尿素氮、血肌酐、血尿酸显著升高(P<0.05)。(2)采用C-G公式、MDRD公式和c-MDRD公式计算得出3种公式计算的低肾小球滤过率组大量蛋白尿的比率分别是11.9%、39.2%和44.1%,糖尿病视网膜病变的比率分别是29.3%、46.4%和50%,后两公式的筛出率明显高于C-G公式,其中c-MDRD公式最高(P<0.05)。(3)采用c-MDRD公式,逐步Logistic回归分析显示年龄、腰围、收缩压、肌酐和空腹血糖是CKD的独立危险因素,比数比(OR)值分别为1.014、1.020、1.028、1.010和1.129,P值均<0.05。结论:MDRD公式和c-MDRD公式比CG公式能更好的评估糖尿病的血管病变,c-MDRD公式更具有优越性。2型糖尿病与慢性肾脏病密切相关。
Objective：This study aimed to investigate the relationship between type 2 diabetes mellitus and chronic kidney disease （CKD）. Methods：We investigated 1039 patients diagnosed with type 2 diabetes, age over 30, by randomized cluster sampiing in Shanghai downtown. Body measurements including height, weight, waist circumference, hip circumference, resting blood pressure, fasting blood measures, and urinary albumin-to creatinine ratio（ACR）. Glomerular filtration rate （GFR） was estimated using three equations. The equations were compared using Chi-square test. The risk factors associated with CKD were evaluated by stepwise logistic regression. Results： （1） In lower glomerular filtration rate group, the urea nitrogen, plasma creatinine, and uric acid was significantly higher, age was older and duration was longer than the control one, using the formulae of Cockcroft - Gault, modification of diet in renal disease（MDRD） and c-MDRD based on Chinese patients with CKD, respectively. （2）In lower glomerular filtration rate patients, the prevalence rate of albuminuria were 11.9%, 39.2%, 44. 1%, and the incidence of diabetic retinopathy were 29.3%, 50%, 46.4%, using the equations of C-G, MDRD and c-MDRD, respectively. （3） Using the equation of c-MDRD, CKD was significantly associated with age, waist circumference,systolic blood pressure, plasma creatinine and fasting plasma glucose （OR = 1. 014, 1. 020, 1. 028, 1. 010, 1. 129, respectively, （P〈0.01） based on logistic regression analysis. The prevalence of diabetic vascular complications in lower GFR, using the formulae of c-MDRD based on Chinese patients with CKD,was significantly higher than the other two equations（P〈0.05）. Conclusion：In type 2 diabetes, the c- MDRD equation based on Chinese patients with CKD, but not the MDRD and C-G equations identifies a subgroup of patients who have a higher risk of diabetic vascular complications. Type 2 diabetes mellitus is closely related to the Chronic kidney disease.
出处
《中国临床医学》
2009年第4期575-577,共3页
Chinese Journal of Clinical Medicine
基金
国家自然科学基金重点项目(30230380)
上海市科委重大课题(04dz19504)
上海市卫生局青年基金(2006Y6)
复旦大学青年科学基金(08FQ37)
复旦大学附属华山医院青年基金(Y186)
