估算肾小球滤过率和白蛋白尿：肥胖 2 型糖尿病患者心血管事件的真正预测因素？
Estimated glomerular filtration rate and albuminuria: true predictors of cardiovascular events in obese patients with type 2 diabetes?
机构信息
Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria.
出版信息
Wien Klin Wochenschr. 2013 Oct;125(19-20):629-33. doi: 10.1007/s00508-013-0422-3. Epub 2013 Sep 6.
BACKGROUND
The widely used MDRD formula underestimates kidney function in obese patients with diabetes mellitus. Therefore we aimed to evaluate the predictive value of estimated glomerular filtration rate (eGFR) for cardiovascular events in a typical cohort of patients with diabetes mellitus.
METHODS
A total of 988 patients were analyzed. Cox regression models including the variables HbA1c, age, duration of diabetes, eGFR and urinary albumin to creatinine ratio (UACR) were run. First the whole collective was analyzed, in a second step the cohort was split into four different groups according to body mass index (BMI) and eGFR (Group 1, 475 Pts: eGFR > 60 ml/min; BMI < 30 kg/m(2), Group 2, 274 Pts: eGFR > 60 ml/min;BMI > 30 kg/m(2), Group 3, 110 Pts,: eGFR < 60 ml/min; BMI > 30 kg/m(2) and Group 4, 129 Pts.: eGFR < 60 ml/min;BMI < 30 kg/m(2)). eGFR was calculated using MDRD, Cockroft-Gault, and CKD-EPI formula. The endpoint was defined as unplanned cardiovascular hospitalization.
RESULTS
Patients (571 male, 417 female) were 61 ± 22 years of age, mean duration of diabetes was 14.3 ± 12.3 years. After a median follow-up of 29 months 95 (9.6 %) patients reached the defined endpoint. The first model, including all patients showed that UACR (HR 1.001, p < 0.001) and eGFR (HR 0.957, p < 0.001) were significant predictors of the composite endpoint. In obese patients eGFR completely lost its predictive value for cardiovascular events. The prevalence of normoalbuminuria in patients with an eGFR below 60 ml/min was 59.4 %.
CONCLUSION
In obese patients eGFR is not predictive for cardiovascular events.
背景
广泛使用的 MDRD 公式低估了肥胖合并糖尿病患者的肾功能。因此，我们旨在评估肾小球滤过率估计值（eGFR）对糖尿病患者典型队列心血管事件的预测价值。
方法
共分析了 988 例患者。运行包含 HbA1c、年龄、糖尿病病程、eGFR 和尿白蛋白与肌酐比值（UACR）等变量的 Cox 回归模型。首先对整个集合进行分析，然后根据体重指数（BMI）和 eGFR 将队列分为四组（第 1 组，475 例：eGFR > 60 ml/min；BMI < 30 kg/m2；第 2 组，274 例：eGFR > 60 ml/min；BMI > 30 kg/m2；第 3 组，110 例：eGFR < 60 ml/min；BMI > 30 kg/m2；第 4 组，129 例：eGFR < 60 ml/min；BMI < 30 kg/m2）。使用 MDRD、Cockroft-Gault 和 CKD-EPI 公式计算 eGFR。终点定义为未计划的心血管住院。
结果
患者（571 例男性，417 例女性）年龄为 61 ± 22 岁，糖尿病病程平均为 14.3 ± 12.3 年。中位随访 29 个月后，95 例（9.6%）患者达到了定义的终点。第一个包含所有患者的模型显示，UACR（HR 1.001，p < 0.001）和 eGFR（HR 0.957，p < 0.001）是复合终点的显著预测因素。在肥胖患者中，eGFR 完全丧失了对心血管事件的预测价值。eGFR 低于 60 ml/min 的患者中，正常白蛋白尿的患病率为 59.4%。
结论
在肥胖患者中，eGFR 不能预测心血管事件。
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