社区2型糖尿病患者肾小球滤过率与尿白蛋白水平变化的随访研究

摘要

背景估算肾小球滤过率(eGFR)和尿蛋白排泄率(UAER)是肾脏功能和肾损害的指标,2型糖尿病患者两者变化是否一致尚不完全清楚。目的随访2型糖尿病患者eGFR与UAER水平5年的变化情况,并分析其相关因素。方法选择2013年3月-2018年12月参加北京市社区糖尿病研究项目的北京市朝阳区团结湖社区2型糖尿病患者作为研究对象,对其进行5年随访,并且每年随访1次。随访指标包括糖尿病病程、体质指数(BMI)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)、收缩压(SBP)、舒张压(DBP)、eGFR及UAER。eGFR进展定义为e GFR下降且慢性肾脏病(CKD)分期增加;UAER进展定义为新出现的蛋白尿或由微量白蛋白尿发展为大量蛋白尿。结果2013-2018年每年完成随访且UAER和eGFR等资料齐全的患者共66例。基线、随访第5年患者DBP、UAER、eGFR水平比较,差异均有统计学意义(P<0.05)。根据随访第5年eGFR和UAER变化,66例患者中出现eGFR进展37例(56.1%)、UAER进展10例(15.2%)。37例(56.1%)患者eGFR和UAER进展平行,29例(43.9%)患者UAER和e GFR进展不平行。UAER和eGFR进展平行组、UAER和eGFR进展不平行组BMI、年龄、TG、TC、HDL-C、LDL-C、HbA1c、SBP、DBP比较,差异均无统计学意义(P>0.05);UAER和eGFR进展平行组糖尿病病程长于UAER和eGFR进展不平行组(P<0.05)。结论对社区2型糖尿病患者随访5年发现,随糖尿病病程延长eGFR逐渐下降,UAER逐渐升高。43.9%的患者UAER进展和eGFR进展不平行,提示在临床中观察糖尿病患者的肾脏损害,建议同时进行e GFR和UAER检查,尤其是糖尿病病程10年以下的患者。Background Estimated glomerular filtration rate(eGFR)and urinary albumin excretion rates(UAER)are indicators of kidney function and kidney damage.It is still not completely clear whether the changes of these two indicators in type 2 diabetes patients are consistent.Objective To follow up the changes of eGFR and UAER levels in patients with type 2 diabetes for 5 years,and to analyze the related factors.Methods Patients with type 2 diabetes in Tuanjiehu Community,Chaoyang District,who were involved in the Beijing Community Diabetes Study from March 2013 to December 2018,were selected,and they were followed up annually for 5 years.The follow-up indicators include duration of diabetes,body mass index(BMI),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),glycosylated hemoglobin(HbA1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),eGFR and UAER.The eGFR progression was defined as decreased eGFR combined with developed chronic kidney disease(CKD)stage,and UAER progression was defined as newly present proteinuria or progression from microalbuminuria to macroalbuminuria.Results A total of 66 patients were followed up annually from 2013 to 2018 with completed data of UAER and eGFR.The results showed that the differences in DBP,UAER and eGFR levels of patients at baseline and 5 years of follow-up were statistically significant(P<0.05).According to the changes of eGFR and UAER at the 5th year of follow-up,37 cases(56.1%)of 66 patients had eGFR progression and 10 cases(15.2%)had UAER progression.The changes of eGFR and UAER were consistent in 37 patients(56.1%),while the progression of UAER and eGFR was not parallel in 29 patients(43.9%).There were no significant differences in BMI,age,TG,TC,HDL-C,LDL-C,HbA1c,SBP,and DBP between the UAER and eGFR progression parallel group and UAER and eGFR progression non-parallel group(P>0.05).The duration of diabetes in UAER and eGFR progression parallel group was longer than that in UAER and eG

作者路长安王健罗金兵夏立军郝士伟赵瑞泉王猛宋飞张明宝杨光燃LU Changan;WANG Jian;LUO Jinbing;XIA Lijun;HAO Shiwei;ZHAO Ruiquan;WANG Meng;SONG Fei;ZHANG Mingbao;YANG Guangran(Department of General Practice,Tuanjiehu Community Health Service Center,Chaoyang District,Beijing 100026,China;Department of Endocrinology,Beijing Tongren Hospital,Capital Medical University,Beijing100730,China)

机构地区北京市朝阳区团结湖社区卫生服务中心全科首都医科大学附属北京同仁医院内分泌科

出处《中国全科医学》 CAS 北大核心 2021年第18期2275-2280,共6页Chinese General Practice

基金首都卫生发展科技专项(2016-1-2057,2016-2-2054) 首都临床特色应用研究项目(Z151100004015021)。

关键词糖尿病 2型肾小球滤过率尿蛋白排泄率社区随访研究Diabetes mellitus,type 2 Glomerular filtration rate Urinary albumin excretion rate Community Follow-up studies

分类号R587.1 [医药卫生—内分泌]