估算肾小球滤过率和蛋白尿在预测无心血管疾病 2 型糖尿病患者心血管风险中的价值。
Value of Estimated Glomerular Filtration Rate and Albuminuria in Predicting Cardiovascular Risk in Patients with Type 2 Diabetes without Cardiovascular Disease.
机构信息
Professor in Medicine, Department of Medicine, Faculty of Medicine, University of Ruhuna, PO Box 70, Galle, Sri Lanka.
Senior Lecturer in Pharmacology, Department of Pharmacology, Faculty of Medicine, University of Ruhuna, PO Box 70, Galle, Sri Lanka.
出版信息
Biomed Res Int. 2018 Dec 26;2018:8178043. doi: 10.1155/2018/8178043. eCollection 2018.
INTRODUCTION
Onset of nephropathy in patients with type 2 diabetes (T2DM) increases the cardiovascular disease (CVD) risk. Association of the parameters of diabetic nephropathy such as albuminuria and estimated Glomerular filtration rate (eGFR) with predicted CVD risk has not been studied in Sri Lankan patients with T2DM.
METHODS
In a cross-sectional study of patients who underwent single visit screening at a diabetes center in Sri Lanka, we obtained demographic and biochemical data. Those with urine albumin excretion over 30 mg/g creatinine were considered as having albuminuria, and eGFR was calculated using modified diet in renal disease (MDRD) formula. Ten-year coronary heart disease risk (CHDR) in all patients was calculated using United Kingdom Prospective Diabetes Study risk engine, and those with CHDR > 10% were considered as having high risk. Spearman correlation was used to study the association between eGFR and CHDR, and logistic regression analysis was carried out to study the association of albuminuria and eGFR with high (>10%) CHDR.
RESULTS
Of the patients with diabetes studied (n=2434), 64% (1563) were males. Mean (SD) age and duration of diabetes were 52 (11) and 9 (3) years, respectively. Normoalbuminuria, microalbuminuria, and macroalbuminuria were observed in 16.4%, 14.8%, and 68.7% of patients, respectively. Three hundred ninety-four (16.2%) patients had eGFR < 60 ml/min. Moderate correlation was observed between eGFR and predicted CHDR [r = (-0.4), P<0.01] and between eGFR and fatal CHDR (FCHDR) [r = (-0.5), P<0.01]. Independent t-test showed that patients with eGFR < 60 ml/min were older and had longer diabetes duration and lesser BMI compared to those who had eGFR > 60 ml/min (P < 0.01). On logistic regression, nephropathy according to eGFR became a strong predictor for high CHDR (OR; 3.497, 95% CI 2.08 to 5.87), and nephropathy according to albuminuria and both albuminuria and eGFR was not significant predictor of CHDR.
CONCLUSIONS
Predicted CHDR shows a moderate and significant association with eGFR in patients with T2DM without symptomatic CVD. eGFR is a stronger predictor than albuminuria in predicting high CHDR in patients with T2DM. Intensification of CVD prevention measures should be done more confidently among patients with T2DM and reduced eGFR than in those with albuminuria alone.
简介
2 型糖尿病（T2DM）患者肾病的发作会增加心血管疾病（CVD）的风险。在斯里兰卡的 T2DM 患者中，尚未研究糖尿病肾病的参数（如蛋白尿和估计肾小球滤过率[eGFR]）与预测 CVD 风险之间的关系。
方法
在斯里兰卡一家糖尿病中心进行的一项横断面研究中，我们获得了人口统计学和生化数据。尿白蛋白排泄量超过 30mg/g 肌酐的患者被认为存在蛋白尿，并且使用改良肾脏病饮食（MDRD）公式计算 eGFR。使用英国前瞻性糖尿病研究风险引擎计算所有患者的 10 年冠心病风险（CHDR），CHDR>10%的患者被认为具有高风险。使用 Spearman 相关分析研究 eGFR 与 CHDR 之间的关系，使用 logistic 回归分析研究蛋白尿和 eGFR 与高（>10%）CHDR 的关系。
结果
在所研究的糖尿病患者中（n=2434），64%（1563）为男性。平均（标准差）年龄和糖尿病病程分别为 52（11）岁和 9（3）年。分别有 16.4%、14.8%和 68.7%的患者出现正常白蛋白尿、微量白蛋白尿和大量白蛋白尿。394（16.2%）名患者的 eGFR<60ml/min。eGFR 与预测 CHDR 之间存在中度相关性[r=（-0.4），P<0.01]，与致命 CHDR（FCHDR）之间存在中度相关性[r=（-0.5），P<0.01]。独立 t 检验显示，与 eGFR>60ml/min 的患者相比，eGFR<60ml/min 的患者年龄更大、糖尿病病程更长、BMI 更小（P<0.01）。在 logistic 回归中，根据 eGFR 诊断的肾病是高 CHDR 的强预测因子（OR；3.497，95%CI 2.08 至 5.87），而根据白蛋白尿和白蛋白尿及 eGFR 诊断的肾病不是 CHDR 的显著预测因子。
结论
在没有症状性 CVD 的 T2DM 患者中，预测 CHDR 与 eGFR 之间存在中度且显著的关联。在预测 T2DM 患者的高 CHDR 方面，eGFR 是比白蛋白尿更强的预测因子。与仅存在白蛋白尿的患者相比，应更有信心地在 T2DM 合并 eGFR 降低的患者中加强 CVD 预防措施。
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