红细胞生成素对贫血的反应及其与无晚期肾衰竭的 2 型糖尿病患者自主神经病变的关系。

Erythropoietin response to anemia and its association with autonomic neuropathy in type 2 diabetic patients without advanced renal failure.

机构信息

Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.

出版信息

J Diabetes Complications. 2010 Mar-Apr;24(2):90-5. doi: 10.1016/j.jdiacomp.2009.02.002. Epub 2009 Mar 19.

DOI:10.1016/j.jdiacomp.2009.02.002

PMID:19303331

Abstract

AIM

We aim to investigate erythropoietin (EPO) response to anemia and its association with autonomic neuropathy in type 2 diabetic patients without advanced renal failure.

METHODS

A cross-sectional study was conducted on 211 type 2 diabetes mellitus patients without advanced renal failure [estimated glomerular filtration rate (eGFR) >40 ml/min/1.73 m(2)]. The response of EPO to anemia of type 2 diabetic patients without advanced renal failure was compared with those of nondiabetic control subjects. Autonomic nerve function was assessed using three cardiovascular tests (deep breathing, the Valsalva maneuver, and lying-to-standing). The results of each test were scored as 0 if normal, 1 if borderline, and 2 if abnormal. Autonomic neuropathy was diagnosed when a total score of the tests was 2 or more.

RESULTS

Fifty-eight patients were anemic; compared with nonanemic patients, they had a longer duration of diabetes (16.69+/-10.11 vs. 10.67+/-8.41 years, P<.001), lower eGFR (66.43+/-16.30 vs. 81.74+/-19.49 ml/min/1.73 m(2), P<.001), and higher cardiovascular autonomic neuropathy score (3.17+/-1.95 vs. 1.79+/-1.72, P<.001). Serum EPO level was weakly correlated with hemoglobin (Hb) level (r=-.085, P<.001). However, the slopes of regression lines between EPO and Hb levels differed significantly between type 2 diabetic patients and nondiabetic control subjects (-0.0085 vs. -0.255, P=.008). Multiple linear regression analysis revealed that cardiovascular autonomic neuropathy score was independently related to Hb (P<.001) or EPO level (P=.052).

CONCLUSIONS

Autonomic neuropathy is associated with a blunted EPO response to anemia in type 2 diabetic patients without advanced renal failure.

摘要

目的

本研究旨在探讨无晚期肾衰竭的 2 型糖尿病患者贫血时促红细胞生成素（EPO）的反应及其与自主神经病变的关系。

方法

本研究为横断面研究，共纳入 211 例无晚期肾衰竭的 2 型糖尿病患者[估算肾小球滤过率（eGFR）>40 ml/min/1.73 m2]。比较无晚期肾衰竭的 2 型糖尿病患者与非糖尿病对照患者 EPO 对贫血的反应。使用三项心血管测试（深呼吸、瓦尔萨尔瓦动作和卧位到站立位）评估自主神经功能。如果测试结果正常，则每个测试的结果得分为 0；如果接近正常，则得分为 1；如果异常，则得分为 2。如果测试总得分≥2，则诊断为自主神经病变。

结果

58 例患者贫血；与非贫血患者相比，贫血患者糖尿病病程较长（16.69+/-10.11 岁 vs. 10.67+/-8.41 岁，P<.001），eGFR 较低（66.43+/-16.30 毫升/分钟/1.73 m2 vs. 81.74+/-19.49 毫升/分钟/1.73 m2，P<.001），心血管自主神经病变评分较高（3.17+/-1.95 分 vs. 1.79+/-1.72 分，P<.001）。血清 EPO 水平与血红蛋白（Hb）水平呈弱相关（r=-.085，P<.001）。然而，EPO 与 Hb 水平之间的回归线斜率在 2 型糖尿病患者和非糖尿病对照组之间存在显著差异（-0.0085 对 -0.255，P=.008）。多元线性回归分析显示，心血管自主神经病变评分与 Hb（P<.001）或 EPO 水平（P=.052）独立相关。