Hsieh Yi-Ting, Kuo Jeng-Fu, Su Shih-Li, Chen Jung-Fu, Chen Hung-Chun, Hsieh Ming-Chia
From the Department of Ophthalmology, National Taiwan University Hospital, Taipei (Y-TH); The Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua (J-FK, S-LS, M-CH); The Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung (J-FC); The Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital; Faculty of Medicine College of Medicine; Faculty of Renal Care College of Medicine, Kaohsiung Medical University, Kaohsiung (H-CC); and The Graduate Institute of Integrated Medicine, China Medical University, Taichung (M-CH).
Medicine (Baltimore). 2016 Jan;95(2):e2200. doi: 10.1097/MD.0000000000002200.
No study has evaluated whether subnormal estimated glomerular filtration rate (eGFR) (between 61 and 90 mL/min) and high normal albumin-creatinine ratio (ACR) (<30 mg/g) are associated with cardiovascular (CV) events and mortality in type 2 diabetic (T2DM) patients with normoalbuminuria.We observed a longitudinal cohort study of 1291 T2DM patients with normoalbuminuria who were receiving intensified multifactorial treatment from 2004 to 2008. Cox regression models were used to evaluate eGFR and ACR as the risk factors of major CV events (nonfatal myocardial infarction and stroke) and mortality.During the 4-year period, 56 patients died and 159 patients developed major CV events. We found eGFR, but not ACR, to be associated with major CV events. Compared to those with eGFR higher than 90 mL/min, patients with subnormal eGFR (HR: 3.133, 1.402-7.002, P = 0.005) were at greater risk of incident major CV events. Extremely low eGFR (<30 mL/min) was associated with mortality only in patients under 65 years old.Subnormal eGFR was a strong predictor of major CV events in diabetic patients with normoalbuminuria. Normoalbuminuric diabetic patients with subnormal eGFR may need intensive CV risk factor intervention to prevent and treat CV events.
尚无研究评估估算肾小球滤过率(eGFR)低于正常水平(61至90毫升/分钟)且白蛋白-肌酐比值(ACR)处于高正常范围(<30毫克/克)是否与正常白蛋白尿的2型糖尿病(T2DM)患者的心血管(CV)事件及死亡率相关。我们对1291例接受强化多因素治疗的正常白蛋白尿T2DM患者进行了一项2004年至2008年的纵向队列研究。采用Cox回归模型评估eGFR和ACR作为主要CV事件(非致命性心肌梗死和中风)及死亡率的危险因素。在4年期间,56例患者死亡,159例患者发生主要CV事件。我们发现与主要CV事件相关的是eGFR,而非ACR。与eGFR高于90毫升/分钟的患者相比,eGFR低于正常水平的患者发生主要CV事件的风险更高(风险比:3.133,1.402 - 7.002,P = 0.005)。极低的eGFR(<30毫升/分钟)仅在65岁以下患者中与死亡率相关。eGFR低于正常水平是正常白蛋白尿糖尿病患者发生主要CV事件的有力预测指标。eGFR低于正常水平的正常白蛋白尿糖尿病患者可能需要强化心血管危险因素干预以预防和治疗CV事件。