分析老年 2 型糖尿病患者肾功能异常的影响因素。
Analysis on influencing factors of abnormal renal function in elderly patients with type 2 diabetes mellitus.
机构信息
Department of Nephrology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Department of Ophthalmology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
出版信息
Minerva Endocrinol. 2020 Mar;45(1):12-17. doi: 10.23736/S0391-1977.18.02832-8. Epub 2018 Apr 12.
BACKGROUND
To investigate the related influencing factors of abnormal renal function in elderly in patients with type 2 diabetes mellitus (T2DM) and their clinical significance.
METHODS
The clinical data of elderly T2DM patients hospitalized in Beijing Luhe Hospital from January 2013 to June 2016 were retrospectively analyzed. According to their glomerular filtration rate (GFR) levels, these patients were divided into GFR≥90 mL/min/1.73 m2 group (group A), GFR =60-90 mL/min/1.73 m2 group (group B), and GFR <60 mL/min/1.73 m2 group (group C, i.e., abnormal renal function group). Clinical and laboratory indicators were compared among each group.
RESULTS
A total of 614 elderly T2DM patients were collected and divided into group A (N.=186), group B (N.=280) and group C (N.=148, 24.10%). Among them, patients clinically diagnosed with diabetic nephropathy (DN) accounted for 13.68%, and those complicated with high blood pressure (HBP) accounted for 61.40%. In Group C, DN accounted for only 29.73%. In elderly T2DM patients, HBP course, systolic blood pressure (SBP), diastolic blood pressure (DBP), 2h postprandial blood glucose (2hPBG), serum total cholesterol (TC) and blood uric acid (BUA) were independent influencing factors associated with abnormal renal function, among which HBP had a more significant impact on abnormal renal function. With the increase of blood pressure (BP) level, the extension in the course of DM, the increase in urinary albumin/creatinine (Alb/Cr) and the decrease in GFR, the incidence rate of abnormal renal function was increased.
CONCLUSIONS
HBP course, SBP, DBP, 2hPBG, TC and BUA are independent risk factors for abnormal renal function in elderly patients with T2DM. Well-controlled BP and blood glucose are protective factors, and a comprehensive treatment targeting to the above influencing factors has important clinical significance in preventing and delaying the occurrence and development of abnormal renal function.
背景
探讨老年 2 型糖尿病（T2DM）患者肾功能异常的相关影响因素及其临床意义。
方法
回顾性分析 2013 年 1 月至 2016 年 6 月北京潞河医院老年 T2DM 住院患者的临床资料。根据肾小球滤过率（GFR）水平将患者分为 GFR≥90ml/min/1.73m2 组（A 组）、GFR=60-90ml/min/1.73m2 组（B 组）和 GFR<60ml/min/1.73m2 组（C 组，即肾功能异常组）。比较各组临床和实验室指标。
结果
共纳入老年 T2DM 患者 614 例，分为 A 组（186 例）、B 组（280 例）和 C 组（148 例，24.10%）。其中，临床诊断为糖尿病肾病（DN）的患者占 13.68%，合并高血压（HBP）的患者占 61.40%。C 组中仅 29.73%的患者合并 DN。在老年 T2DM 患者中，HBP 病程、收缩压（SBP）、舒张压（DBP）、餐后 2h 血糖（2hPBG）、血清总胆固醇（TC）和血尿酸（BUA）是肾功能异常的独立影响因素，其中 HBP 对肾功能异常的影响更为显著。随着血压（BP）水平的升高、DM 病程的延长、尿白蛋白/肌酐（Alb/Cr）的增加和 GFR 的降低，肾功能异常的发生率增加。
结论
HBP 病程、SBP、DBP、2hPBG、TC 和 BUA 是老年 T2DM 患者肾功能异常的独立危险因素。良好控制 BP 和血糖是保护因素，针对上述影响因素进行综合治疗对预防和延缓肾功能异常的发生发展具有重要的临床意义。
Zotero 插件