Lu Wei-Na, Li Hong, Zheng Fen-Ping, Huang Hong, Ruan Yu
Department of Endocrinology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China.
Zhonghua Nei Ke Za Zhi. 2010 Jan;49(1):24-7.
To investigate the prevalence of renal insufficiency and its associated factors in type 2 diabetes mellitus with normoalbuminuria using estimated glomerular filtration rate (eGFR).
We retrospectively analyzed 10-year data of chronic complications in type 2 diabetics in-patient from the Chinese Diabetes Society. eGFR was estimated using the equation from Modification of Diet in Renal Disease (MDRD) study. The clinical characteristics as well as associated factors for low eGFR were analyzed among the normoalbuminuric type 2 diabetic patients.
A total of 1351 type 2 diabetic patients were included, 755 patients with normoalbuminuria, 466 patients with microalbuminuria and 130 patients with macroalbuminuria respectively. Among the patients, 310 (22.9%) had low eGFR (GFR < 60 mlxmin(-1) x 1.73 m(-2)), 19.7% (149/755) in the patients with normoalbuminuria, 21.9% (102/466) in microalbuminuria and 45.4% (59/130) in macroalbuminuria. Patients with normoalbuminuria and low eGFR suffered more chronic complications than those with normoalbuminuria and normal eGFR, mainly retinopathy, cerebrovascular diseases and sensory neuropathy. Stepwise logistic regression analysis revealed that age (OR = 1.042, P < 0.001), diabetic duration (OR = 1.038, P = 0.045), systolic blood pressure (OR = 1.017, P < 0.001) were independently associated with renal impairment among the patients with normoalbuminuria. Body mass index (OR = 0.868, P < 0.001) and HbA1c (OR = 0.898, P = 0.021) were also related with renal insufficiency.
A considerable proportion in type 2 diabetic patients without albuminuria may exist renal impairment, and eGFR estimation could benefit the evaluation of renal function in such patients.
采用估算肾小球滤过率（eGFR）研究正常白蛋白尿的2型糖尿病患者肾功能不全的患病率及其相关因素。
我们回顾性分析了中国糖尿病学会2型糖尿病住院患者10年的慢性并发症数据。使用肾脏病饮食改良（MDRD）研究的公式估算eGFR。分析正常白蛋白尿的2型糖尿病患者的临床特征以及低eGFR的相关因素。
共纳入1351例2型糖尿病患者，分别有755例正常白蛋白尿患者、466例微量白蛋白尿患者和130例大量白蛋白尿患者。在这些患者中，310例（22.9%）eGFR较低（肾小球滤过率<60 ml·min⁻¹·1.73 m⁻²），正常白蛋白尿患者中为19.7%（149/755），微量白蛋白尿患者中为21.9%（102/466），大量白蛋白尿患者中为45.4%（59/130）。正常白蛋白尿且eGFR较低的患者比正常白蛋白尿且eGFR正常的患者患慢性并发症更多，主要是视网膜病变、脑血管疾病和感觉神经病变。逐步逻辑回归分析显示，年龄（OR = 1.042，P < 0.001）、糖尿病病程（OR = 1.038，P = 0.045）、收缩压（OR = 1.017，P < 0.001）在正常白蛋白尿患者中与肾功能损害独立相关。体重指数（OR = 0.868，P < 0.001）和糖化血红蛋白（OR = 0.898，P = 0.021）也与肾功能不全有关。
相当一部分无蛋白尿的2型糖尿病患者可能存在肾功能损害，eGFR估算有助于评估此类患者的肾功能。
