摘要
背景临床上20%~40%的2型糖尿病患者进展为糖尿病肾脏病(DKD),DKD的主要临床表现为微量尿蛋白和肾功能改变,肾小球滤过率(GFR)是反映肾功能的重要指标。在糖尿病患者中,室间隔(IVS)厚度与肾功能的关系已有文献证实,而左心室内壁(LVPW)厚度与肾功能的关系尚不明确。目的探讨2型糖尿病患者进展成为早期DKD的危险因素。方法选取2008年成都市第五人民医院收治的2型糖尿病患者,回顾性收集患者的临床资料、实验室检查结果,随访截至2018-12-31,随访时间120个月,根据患者是否出现大量尿蛋白,即同时满足24 h尿蛋白>500 mg/d及GFR<50 ml/min两项纳入DKD组,其余纳入非DKD组。生存分析采用Kaplan-Meier生存分析,比较采用Log-rank检验;DKD影响因素分析采用多因素Logistic回归分析;绘制受试者工作特征(ROC)曲线检验IVS及LVPW厚度预测2型糖尿病患者进展为DKD的价值。结果共纳入178例2型糖尿病患者,最终进展为DKD 48例(26.9%)。DKD组与非DKD组患者性别、年龄、BMI、总胆固醇、低密度脂蛋白(LDL)、尿素氮(BUN)、血肌酐(Scr)、血尿酸(SUA)、血红蛋白及糖化血红蛋白(Hb A1c)比较,差异均无统计学意义(P>0.05);与非DKD组患者比较,DKD组患者糖尿病病程较长,收缩压、空腹血糖升高,LVPW厚度、IVS厚度增加,HDL降低(P<0.05)。多因素Logistic回归分析结果提示,IVS厚度[OR=4.577,95%CI(2.280,9.188)]、LVPW厚度[OR=3.805,95%CI(1.917,7.553)]是DKD发生的独立影响因素(P<0.05)。Log-rank检验结果显示,高血压组(n=47)IVS增厚者、LVPW增厚者DKD发生率分别高于IVS正常者、LVPW正常者(P<0.05);非高血压组(n=131)IVS增厚者、LVPW增厚者DKD发生率分别高于IVS正常者、LVPW正常者(P<0.05)。相关性分析结果显示,IVS、LVPW厚度与24 h尿蛋白呈正相关(P<0.001),与GFR呈负相关(P<0.001)。ROC曲线结果显示,IVS增厚预测2型糖尿病患者进展为DKD的ROC曲线下面积为0.824,其临界值为12.5
Background 20%to 40%of patients with diabetes clinically develop diabetic kidney disease(DKD).The main clinical manifestations of DKD are trace proteinuria and negative changes in renal function.The glomerular filtration rate(GFR)is an indicator of kidney function.In diabetic patients,the relationship of renal function with interventricular septal thickness(IVST)has been confirmed,but its relationship with left ventricular wall thickness(LVWT)is not clear.Objective To investigate the development of DKD in patients with type 2 diabetes mellitus.Methods A retrospective analysis was performed on the clinical and laboratory data of patients with type 2 diabetes mellitus who received treatment in 2008 and 120-month follow-up(as of December 31,2018)from Chengdu Fifth People's Hospital.Those with significantly increased albuminuria〔defined as 24-hour urinary albumin excretion>500 mg/d and GFR<50 ml/min〕and those without during the study period were assigned to DKD group,and non-DKD group,respectively.Kaplan-Meier method was used for survival analysis.Log-rank test was used to compare the survival status.Multivariate Logistic regression analysis was used to analysis the influencing factors associated with DKD.ROC analysis was conducted to estimate the value of IVST and LVWT in predicting the development of DKD.Results A total of 178 were included and 48 of them(26.9%)developed DKD.Compared with those without DKD,those with DKD showed similar sex ratio,mean age,BMI,total cholesterol,LDL,BUN,Scr,sUA,hemoglobin,and HbA1c(P>0.05),but had longer mean duration of diabetes,higher mean systolic blood pressure,fasting blood glucose,LVWT and IVST,and mean lower HDL(P<0.05).The result of multivariate Logistic regression analysis suggested that IVST〔OR=4.577,95%CI(2.280,9.188)〕,and LVWT〔OR=3.805,95%CI(1.917,7.553)〕were independently associated with the occurrence of DKD(P<0.05).Log-rank test results showed that increased IVST was associated with higher incidence of DKD either in those with hypertension(n=47)or in those w
作者
李昌艳
刘娟
顾芳
唐明敏
胡晶晶
欧三桃
LI Changyan;LIU Juan;GU Fang;TANG Mingmin;HU Jingjing;OU Santao(Department of Nephropathy,the Affiliated Hospital of Southwest Medical University/Nephropathy Clinical Medical Research Center of Sichuan Province,Luzhou 646000,China;Department of Nephropathy,Chengdu Fifth People's Hospital,Chengdu 611130,China)
出处
《中国全科医学》
CAS
北大核心
2020年第26期3291-3296,共6页
Chinese General Practice
基金
泸州市人民政府-四川医科大学科技战略合作项目(2015LZCYD-S04)。
关键词
2型糖尿病
糖尿病肾病
室间隔厚度
左室内壁厚度
影响因素分析
Diabetes mellitus
type 2
Diabetic kidney disease
Interventrieular septum thickness
Left wall thickness
Root cause analysis
