2型糖尿病患者的肾小球滤过率、心肾终点指标及全因死亡率
Glomerular filtration rate, cardiorenal end points, and all-cause mortality in type 2 diabetic patients.
作者信息
So Wing Yee, Kong Alice P S, Ma Ronald C W, Ozaki Risa, Szeto Cheuk Chun, Chan Norman N, Ng Vanessa, Ho Chung Shun, Lam Christopher W K, Chow Chun Chung, Cockram Clive S, Chan Juliana C N, Tong Peter C Y
机构信息
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR.
出版信息
Diabetes Care. 2006 Sep;29(9):2046-52. doi: 10.2337/dc06-0248.
OBJECTIVE
Chronic kidney disease (CKD) predicts cardiovascular disease (CVD) in the general population. We investigated the effects of stages of renal function using the estimated glomerular filtration rate (eGFR) on all-cause mortality and cardiovascular end points in a prospective cohort of Chinese type 2 diabetic patients.
RESEARCH DESIGN AND METHODS
Between 1995 and 2000, 4,421 patients without macrovascular disease or end-stage renal disease were recruited. Renal function was assessed by eGFR, as calculated by the abbreviated Modification of Diet in Renal Disease Study Group formula. Clinical end points included all-cause mortality, cardiovascular end point (cardiovascular death, new admissions due to angina, myocardial infarction, stroke, revascularization, or heart failure), and renal end point (reduction in eGFR by >50%, progression of eGFR to stage 5, or dialysis or renal death).
RESULTS
After a median follow-up period of 39.4 months (interquartile range 20.3-55), all-cause mortality rate increased from 1.2% (95% CI 0.8-1.7) to 18.3% (9.1-27.5) (P for trend <0.001) as renal function deteriorated from stage 1 (eGFR > or =90 ml/min per 1.73 m(2)) to stage 4 (15-29 ml/min per 1.73 m(2)). The respective rate of new cardiovascular end points also increased from 2.6% (2.0-3.3) to 25.3% (15.0-35.7) (P for trend <0.001). After adjustment for covariates (age, sex, albuminuria, use of renin-angiotensin-aldosterone system [RAAS] inhibitors, lipids, blood pressure, and glycemic control), hazard ratios across different stages of eGFR (> or =90, 60-89, 30-59, and 15-29 ml/min per 1.73 m(2)) for all-cause mortality were 1.00, 1.27, 2.34, and 9.82 (P for trend <0.001), for cardiovascular end points were 1.00, 1.04, 1.05, and 3.23 (P for trend <0.001), and for renal end points were 1.00, 1.36, 3.34, and 27.3 (P for trend <0.001), respectively.
CONCLUSIONS
Chinese type 2 diabetic patients with reduced eGFR were at high risk of developing cardiovascular end points and all-cause mortality, independent of albuminuria and metabolic control.
目的
慢性肾脏病（CKD）可预测普通人群的心血管疾病（CVD）。我们在一个中国2型糖尿病患者前瞻性队列中，研究了使用估计肾小球滤过率（eGFR）评估的肾功能分期对全因死亡率和心血管终点事件的影响。
研究设计与方法
1995年至2000年期间，招募了4421例无大血管疾病或终末期肾病的患者。肾功能通过eGFR进行评估，eGFR由肾脏病饮食改良研究组简化公式计算得出。临床终点包括全因死亡率、心血管终点事件（心血管死亡、因心绞痛、心肌梗死、中风、血运重建或心力衰竭而新入院）以及肾脏终点事件（eGFR降低>50%、eGFR进展至5期、透析或肾脏死亡）。
结果
在中位随访期39.4个月（四分位间距20.3 - 55）后，随着肾功能从1期（eGFR≥90 ml/min/1.73 m²）恶化至4期（15 - 29 ml/min/1.73 m²），全因死亡率从1.2%（95%CI 0.8 - 1.7）增至18.3%（9.1 - 27.5）（趋势P<0.001）。新发生心血管终点事件的相应发生率也从2.6%（2.0 - 3.3）增至25.3%（15.0 - 35.7）（趋势P<0.001）。在校正协变量（年龄、性别、蛋白尿、肾素 - 血管紧张素 - 醛固酮系统[RAAS]抑制剂的使用、血脂、血压和血糖控制）后，eGFR不同分期（≥90、60 - 89、30 - 59和15 - 29 ml/min/1.73 m²）的全因死亡率风险比分别为1.00、1.27、2.34和9.82（趋势P<0.001），心血管终点事件风险比分别为1.00、1.04、1.05和3.23（趋势P<0.001），肾脏终点事件风险比分别为1.00、1.36、3.34和27.3（趋势P<0.001）。
结论
eGFR降低的中国2型糖尿病患者发生心血管终点事件和全因死亡的风险较高，且独立于蛋白尿和代谢控制情况。
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