糖化血红蛋白升高而非空腹血糖升高与非糖尿病个体的慢性肾脏病风险相关。

Elevated haemoglobin A1c but not fasting plasma glucose conveys risk of chronic kidney disease in non-diabetic individuals.

机构信息

Diabetes Center, Aizawa Hospital, Matsumoto, Japan.

Health Center, Aizawa Hospital, Matsumoto, Japan.

出版信息

Diabetes Res Clin Pract. 2018 Dec;146:233-239. doi: 10.1016/j.diabres.2018.10.026. Epub 2018 Nov 2.

DOI:10.1016/j.diabres.2018.10.026

PMID:30391503

Abstract

AIMS

To compare impact of elevated HbA1c and fasting plasma glucose (FPG) on incident chronic kidney disease (CKD) in a non-diabetic cohort.

METHODS

Data from diabetes- and CKD-free 25,109 health examinees were retrospectively analysed with a mean observation period of 5.3 years. Prediabetes was diagnosed by the ADA and WHO criteria, and CKD by estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m and/or dipstick proteinuria. Cox proportional hazards model was applied with sex, age, insulin sensitivity, systolic blood pressure, eGFR and serum alanine aminotransferase level as covariates.

RESULTS

For incident CKD (n = 2483), high HbA1c but not FPG was an independent risk: adjusted hazard ratio (AHR, 95%CI) for HbA1c 1% and FPG 1 mmol/L, 1.91 (1.70-2.16) and 0.85 (0.60-1.20), respectively. Prediabetes by the ADA and WHO criteria were both risk for CKD with AHR (95%CI), 1.21 (1.12-1.32) and 1.31 (1.16-1.48), respectively. Prediabetes diagnosed by 'elevated HbA1c irrespective of FPG', either by the ADA and the WHO definition, was a risk with AHR (95%CI), 1.48 (1.36-1.61) and 1.51 (1.31-1.74), respectively. In contrast, prediabetes diagnosed by 'raised FPG irrespective of HbA1c' was not a CKD risk.

CONCLUSIONS

Elevated HbA1c, but not FPG, identified CKD risk in non-diabetic individuals.

摘要

目的

比较糖化血红蛋白（HbA1c）和空腹血糖（FPG）升高对非糖尿病患者发生慢性肾脏病（CKD）的影响。

方法

回顾性分析了 25109 例无糖尿病和 CKD 的健康体检者的数据，平均观察时间为 5.3 年。采用美国糖尿病协会（ADA）和世界卫生组织（WHO）标准诊断糖尿病前期，采用估算肾小球滤过率（eGFR）<60ml/min/1.73m2和/或尿蛋白试纸法诊断 CKD。应用 Cox 比例风险模型，以性别、年龄、胰岛素敏感性、收缩压、eGFR 和血清丙氨酸氨基转移酶水平为协变量。

结果

对于新发 CKD（n=2483），高 HbA1c 但不是 FPG 是独立的危险因素：HbA1c 升高 1%和 FPG 升高 1mmol/L 的校正风险比（AHR，95%CI）分别为 1.91（1.70-2.16）和 0.85（0.60-1.20）。ADA 和 WHO 标准诊断的糖尿病前期均与 CKD 相关，AHR（95%CI）分别为 1.21（1.12-1.32）和 1.31（1.16-1.48）。通过 ADA 和 WHO 定义的“无论 FPG 如何，只要 HbA1c 升高”来诊断的糖尿病前期是 CKD 的危险因素，AHR（95%CI）分别为 1.48（1.36-1.61）和 1.51（1.31-1.74）。相反，通过“升高的 FPG 而不考虑 HbA1c”来诊断的糖尿病前期不是 CKD 的危险因素。