Okada Hiroshi, Hasegawa Goji, Tanaka Muhei, Osaka Takafumi, Shiotsu Yayoi, Narumiya Hiromichi, Inoue Mamoru, Nakano Koji, Nakamura Naoto, Fukui Michiaki
Department of Metabolism, Nephrology and Immunology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto, 602-8026, Japan.
Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
PLoS One. 2015 May 29;10(5):e0129192. doi: 10.1371/journal.pone.0129192. eCollection 2015.
Anemia, which might contribute to pathogenesis of kidney dysfunction, is a common finding in patients with type 2 diabetes. The aim of this study was to investigate if hemoglobin concentration is associated with the degree of change in urinary albumin-creatinine ratio or the development of albuminuria in patients with type 2 diabetes.
We measured hemoglobin concentration in 470 (296 men and 174 women) consecutive type 2 diabetic patients without albuminuria. We performed a follow-up study to assess the progression or development of albuminuria, the interval of which was 3.0 years. Then we evaluated relationships between hemoglobin concentration and albuminuria, using multivariate linear regression analyses and logistic regression analyses.
Eighty four patients developed albuminuria during follow-up duration. In multivariate analyses, hemoglobin concentration was negatively associated with a change in urinary albumin-creatinine ratio in men (ß = -0.259, P = 0.0002) and women (ß = -0.194, P = 0.030). Moreover, multivariate adjusted odds ratio associated with 1 g/L in hemoglobin for the development of albuminuria was 0.93 (95% confidence interval; 0.89-0.96) in men and 0.94 (95% confidence interval; 0.88-0.99) in women, respectively. And, multivariate analyses revealed that adjusted odds ratios for the development of albuminuria were 4.78 (95% confidence interval; 1.65-13.91) in men and 4.62 (95% confidence interval; 1.34-16.68) in women with anemia (hemoglobin < 130 g/L for men and < 120 g/L for women), which were higher than those without anemia.
Low hemoglobin concentration could be a predictor for the progression and development of albuminuria in patients with type 2 diabetes.
贫血在2型糖尿病患者中很常见，可能与肾功能不全的发病机制有关。本研究旨在探讨血红蛋白浓度是否与2型糖尿病患者尿白蛋白肌酐比值的变化程度或蛋白尿的发生有关。
我们测量了470例（296例男性和174例女性）无蛋白尿的连续2型糖尿病患者的血红蛋白浓度。我们进行了一项随访研究，以评估蛋白尿的进展或发生情况，随访间隔为3.0年。然后，我们使用多变量线性回归分析和逻辑回归分析评估血红蛋白浓度与蛋白尿之间的关系。
84例患者在随访期间出现蛋白尿。在多变量分析中，血红蛋白浓度与男性（β = -0.259，P = 0.0002）和女性（β = -0.194，P = 0.030）尿白蛋白肌酐比值的变化呈负相关。此外，男性血红蛋白每增加1 g/L发生蛋白尿的多变量调整比值比为0.93（95%置信区间；0.89 - 0.96），女性为0.94（95%置信区间；0.88 - 0.99）。并且，多变量分析显示，贫血（男性血红蛋白<130 g/L，女性血红蛋白<120 g/L）男性发生蛋白尿的调整比值比为4.78（95%置信区间；1.65 - 13.91），女性为4.62（95%置信区间；1.34 - 16.68），高于无贫血者。
低血红蛋白浓度可能是2型糖尿病患者蛋白尿进展和发生的预测指标。
