评估糖化白蛋白作为糖尿病和非糖尿病人群肾功能不全有用指标的研究

Assessment of Glycated Albumin as a Useful Indicator for Renal Dysfunction in Diabetic and Nondiabetic Population.

作者信息

Duan Nan, Zhu Sai-Nan, Li Hai-Xia, Jiao Li-Li, Yang Hong-Yun, Guo Qi

出版信息

Clin Lab. 2017 Jul 1;63(7):1129-1137. doi: 10.7754/Clin.Lab.2017.161224.

DOI:10.7754/Clin.Lab.2017.161224

PMID:28792709

Abstract

BACKGROUND

Glycated albumin (GA) reflects serum glucose of the preceding 2 - 3 weeks and plays an important role in diabetes mellitus (DM). This study aimed at investigating whether GA can assess renal dysfunction in population.

METHODS

3818 individuals attending physical examination were enrolled in this cross-sectional study and divided into five groups: healthy controls, impaired fasting glucose, DM without renal complications, DM with albuminuria, and nondiabetic chronic kidney disease patients. All analyses were conducted using the subjects with both fasting venous blood and morning urine samples.

RESULTS

Among all groups, mean GA, hemoglobin A1c, fasting plasma glucose, and serum creatinine were the highest and estimated glomerular filtration rate (eGFR) was the lowest in DM with albuminuria group. When eGFR was 90 - 105 mL/minute/1.73 m2 or mildly decreased to 60 - 90 mL/minute/1.73 m2, GA increased significantly with elevating albumin-to-creatinine ratio (ACR) from 0 - 10 mg/g to 10 - 30 mg/g to > 30 mg/g (p < 0.001 and p < 0.001). GA increased further when eGFR decreased moderately to severely as a result of renal function continuing to deteriorate (eGFR ≤ 60 mL/minute/1.73 m2).When ACR ≤ 30 mg/g and eGFR ≤ 60 mL/minute/ 1.73 m2, more than 50% subjects were DM patients and had significantly higher GA levels than other subjects with eGFR > 105 mL/minute/1.73 m2. After adjusting demographics, every 5% rise of GA levels showed a 1.778fold increased risk in all subjects (adjusted odds ratio [OR], 1.778; 95% confidence interval [CI], 1.373 - 2.302; p < 0.001) and 1.737-fold risk in DM subjects (adjusted OR, 1.737; 95% CI, 1.221 - 2.471; p = 0.002) for occurrence of ACR > 30mg/g in contrast to ACR ≤ 30 mg/g. Compared to eGFR > 90 mL/minute/1.73 m2, 5% rise of GA levels showed a 1.482-fold risk for eGFR 60 - 90 mL/minute/1.73 m2 (adjusted OR, 1.482; 95% CI, 1.112 - 1.975; p = 0.007) and a 1.996-fold risk for eGFR ≤ 60 mL/minute/1.73 m2 (adjusted OR, 1.996; 95% CI, 1.366 - 2.916; p < 0.001).

CONCLUSIONS

Increased GA serves as a risk marker for renal dysfunction. GA combined with eGFR and ACR can reflect renal function changes in population.

摘要

背景

糖化白蛋白（GA）反映前2 - 3周的血清葡萄糖水平，在糖尿病（DM）中起重要作用。本研究旨在调查GA是否可用于评估人群中的肾功能障碍。

方法

3818名参加体检的个体纳入本横断面研究，分为五组：健康对照、空腹血糖受损、无肾脏并发症的DM、有蛋白尿的DM以及非糖尿病慢性肾脏病患者。所有分析均使用同时采集空腹静脉血和晨尿样本的受试者进行。

结果

在所有组中，有蛋白尿的DM组的平均GA、糖化血红蛋白、空腹血糖和血清肌酐最高，估计肾小球滤过率（eGFR）最低。当eGFR为90 - 105 mL/分钟/1.73 m²或轻度降至60 - 90 mL/分钟/1.73 m²时，随着白蛋白与肌酐比值（ACR）从0 - 10 mg/g升高至10 - 30 mg/g再升高至> 30 mg/g，GA显著升高（p < 0.001和p < 0.001）。当由于肾功能持续恶化导致eGFR中度至重度降低（eGFR≤60 mL/分钟/1.73 m²）时，GA进一步升高。当ACR≤30 mg/g且eGFR≤60 mL/分钟/1.73 m²时，超过50%的受试者为DM患者，其GA水平显著高于eGFR> 105 mL/分钟/1.73 m²的其他受试者。调整人口统计学因素后，GA水平每升高5%，所有受试者发生ACR> 30mg/g（与ACR≤30 mg/g相比）的风险增加1.778倍（调整后的优势比[OR]，1.778；95%置信区间[CI]，1.373 - 2.302；p < 0.001），DM受试者的风险增加1.737倍（调整后的OR，1.737；95% CI, 1.221 - 2.471；p = 0.002）。与eGFR> 90 mL/分钟/1.73 m²相比，GA水平升高5%时，eGFR为60 - 90 mL/分钟/1.73 m²的风险增加1.482倍（调整后的OR，1.482；95% CI，1.112 - 1.975；p = 0.007），eGFR≤60 mL/分钟/1.73 m²的风险增加1.996倍（调整后的OR，1.996；95% CI，1.366 - 2.916；p < 0.001）。