Palazhy Sabitha, Viswanathan Vijay
M.V. Hospital for Diabetes & Prof. M. Viswanathan Diabetes Research Centre, Chennai, India.
Diabetes Metab J. 2017 Apr;41(2):128-134. doi: 10.4093/dmj.2017.41.2.128.
Diabetic nephropathy is a major complication of diabetes and an established risk factor for cardiovascular events. Lipid abnormalities occur in patients with diabetic nephropathy, which further increase their risk for cardiovascular events. We compared the degree of dyslipidemia among type 2 diabetes mellitus (T2DM) subjects with and without nephropathy and analyzed the factors associated with nephropathy among them.
In this retrospective study, T2DM patients with overt nephropathy were enrolled in the study group (n=89) and without nephropathy were enrolled in the control group (n=92). Both groups were matched for age and duration of diabetes. Data on total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), urea and creatinine were collected from the case sheets. TG/HDL-C ratio, a surrogate marker for small, dense, LDL particles (sdLDL) and estimated glomerular filtration rate (eGFR) were calculated using equations. Multivariate analysis was done to determine the factors associated with eGFR.
Dyslipidemia was present among 56.52% of control subjects and 75.28% of nephropathy subjects (P=0.012). The percentage of subjects with atherogenic dyslipidemia (high TG+low HDL-C+sdLDL) was 14.13 among controls and 14.61 among nephropathy subjects. Though serum creatinine was not significantly different, mean eGFR value was significantly lower among nephropathy patients (P=0.002). Upon multivariate analysis, it was found that TC (P=0.007) and HDL-C (P=0.06) were associated with eGFR among our study subjects.
Our results show that dyslipidemia was highly prevalent among subjects with nephropathy. Regular screening for dyslipidemia may be beneficial in controlling the risk for adverse events among diabetic nephropathy patients.
糖尿病肾病是糖尿病的主要并发症,也是心血管事件的既定危险因素。糖尿病肾病患者会出现脂质异常,这进一步增加了他们发生心血管事件的风险。我们比较了有和没有肾病的2型糖尿病(T2DM)患者的血脂异常程度,并分析了其中与肾病相关的因素。
在这项回顾性研究中,显性肾病的T2DM患者被纳入研究组(n = 89),无肾病的患者被纳入对照组(n = 92)。两组在年龄和糖尿病病程方面进行了匹配。从病历中收集总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿素和肌酐的数据。使用公式计算TG/HDL-C比值,这是小而密的低密度脂蛋白颗粒(sdLDL)的替代标志物以及估计肾小球滤过率(eGFR)。进行多变量分析以确定与eGFR相关的因素。
对照组中56.52%的受试者和肾病组中75.28%的受试者存在血脂异常(P = 0.012)。具有致动脉粥样硬化性血脂异常(高TG + 低HDL-C + sdLDL)的受试者百分比在对照组中为14.13,在肾病组中为14.61。虽然血清肌酐没有显著差异,但肾病患者的平均eGFR值显著较低(P = 0.002)。经过多变量分析,发现TC(P = 0.007)和HDL-C(P = 0.06)与我们研究对象中的eGFR相关。
我们的结果表明,血脂异常在肾病患者中非常普遍。定期筛查血脂异常可能有助于控制糖尿病肾病患者发生不良事件的风险。