Huang Hong, Li Hong, Zheng Fen-ping, Lu Wei-na, Dong Xue-hong, Ruan Yu
Department of Endocrinology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China.
Zhonghua Yi Xue Za Zhi. 2010 Apr 13;90(14):967-71.
To investigate the clinical features and risk factors of renal damage in the elderly and non-elderly patients with type 2 diabetes mellitus.
The data were collected from a survey of 10-year retrospective study of chronic complications of hospitalized type 2 diabetics organized by Chinese Diabetes Society. A total of 1351 patients of type 2 diabetes were selected and divided into an elderly group (>or=60 year) and a non-elderly group (<60 year). The patients were also divided into three groups according to urinary albumin excretion rate (AER): normoalbuminuria group (AER<30 mg/24 h), microalbuminuria group (30<or=AER<300 mg/24 h) and macroalbuminuria group (AER>or=300 mg/24 h). eGFR was estimated by the equation from the MDRD study. Clinical and laboratory parameters of all patients were analyzed.
(1) The proportions of renal insufficiency in both normoalbuminuria and microalbuminuria groups of type 2 diabetes in the elderly patients were significantly higher than those in the non-elderly patients (26.7% vs 15.8%, P<0.01; 30.5% vs 21.3%, P<0.05 respectively); (2) in type 2 diabetic patients with renal insufficiency and normoalbuminuria, the diabetes duration (7.7 vs 3.8 years), systolic blood pressure [(146+/-24) mm Hg vs (134+/-23) mm Hg], diastolic blood pressure [(84+/-13) mm Hg vs (80+/-11) mm Hg], proportion of hypertension (37.8% vs 21.1%), diabetic retinopathy (34.1% vs 23.9%), cardiovascular diseases (31.6% vs 11.3%) and cerebrovascular disease (24.4% vs 9.9%) were significantly higher in the elderly group than in the non-elderly group (P<0.05 or 0.01); (3) multiple logistic regression analysis revealed that the duration of diabetes (OR=1.046, P=0.013) and systolic blood pressure (OR=1.014, P=0.002) were independently associated with renal insufficiency in the elderly type 2 diabetic patients with normoalbuminuria, whereas systolic blood pressure (OR=1.042, P=0.000) and 2-hour postprandial blood glucose (OR=1.048, P=0.002) were independent risk factors for renal insufficiency of non-elderly patients.
The elderly type 2 diabetic patients are likely to suffer renal insufficiency initially from a lower glomerular filtration rate than the non-elderly patients. Systolic blood pressure is the main risk factor in both elderly and non-elderly type 2 diabetes with normoalbuminuria and a decreased renal function. Controlling blood pressure may delay the decline of renal function.
探讨老年和非老年2型糖尿病患者肾损害的临床特征及危险因素。
数据来自中国糖尿病学会组织的一项对住院2型糖尿病患者慢性并发症的10年回顾性研究调查。共选取1351例2型糖尿病患者，分为老年组（≥60岁）和非老年组（<60岁）。患者还根据尿白蛋白排泄率（AER）分为三组：正常白蛋白尿组（AER<30mg/24h）、微量白蛋白尿组（30≤AER<300mg/24h）和大量白蛋白尿组（AER≥300mg/24h）。采用MDRD研究公式估算eGFR。分析所有患者的临床和实验室参数。
（1）老年2型糖尿病患者正常白蛋白尿组和微量白蛋白尿组的肾功能不全比例均显著高于非老年患者（分别为26.7%对15.8%，P<0.01；30.5%对21.3%，P<0.05）；（2）在2型糖尿病肾功能不全且为正常白蛋白尿的患者中，老年组的糖尿病病程（7.7年对3.8年）、收缩压[（146±24）mmHg对（134±23）mmHg]、舒张压[（84±13）mmHg对（80±11）mmHg]、高血压比例（37.8%对21.1%）、糖尿病视网膜病变（34.1%对23.9%）、心血管疾病（31.6%对11.3%）和脑血管疾病（24.4%对9.9%）均显著高于非老年组（P<0.05或0.01）；（3）多因素logistic回归分析显示，糖尿病病程（OR=1.046，P=0.013）和收缩压（OR=1.014，P=0.002）是老年2型糖尿病正常白蛋白尿患者肾功能不全的独立相关因素，而收缩压（OR=1.042，P=0.000）和餐后2小时血糖（OR=1.048，P=0.002）是非老年患者肾功能不全的独立危险因素。
老年2型糖尿病患者比非老年患者更易最初因较低的肾小球滤过率而出现肾功能不全。收缩压是老年和非老年2型糖尿病正常白蛋白尿且肾功能下降患者的主要危险因素。控制血压可能延缓肾功能下降。
