白蛋白尿型慢性肾脏病与 2 型糖尿病患者糖尿病视网膜病变的真实世界关联：来自 No blind 研究的结果。

Relationship between albuminuric CKD and diabetic retinopathy in a real-world setting of type 2 diabetes: Findings from No blind study.

机构信息

Unit of Internal Medicine, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.

出版信息

Nutr Metab Cardiovasc Dis. 2019 Sep;29(9):923-930. doi: 10.1016/j.numecd.2019.05.065. Epub 2019 Jun 7.

DOI:10.1016/j.numecd.2019.05.065

PMID:31377186

Abstract

BACKGROUND AND AIMS

Recently, the albuminocentric view of diabetic kidney disease (DKD) in type 2 diabetes (T2DM) has been changing. Therefore, the relationship between diabetic retinopathy (DR) and chronic kidney disease (CKD) has to be addressed according to this new clinical presentation of DKD. The aim of this study was to evaluate, in a real-world setting, the correlation DR-DKD in T2DM.

METHODS AND RESULTS

A total of 2068 type 2 diabetic patients enrolled in a multicenter cross-sectional study were investigated. Albuminuric subjects were largely prevalent among subjects with DR (p = 0.019). In the whole study population, no difference in albumin excretion rate (AER) was observed between presence/absence of DR; instead, AER was significantly higher among patients with glomerular filtration rate (eGFR) < 60 mL/min/1.73 m (CKD) (p = 0.009), above all in those with CKD and AER ≥0.03 g/24 h (p = 0.005). Multivariate analysis confirmed that eGFR (O.R. 0.976; 95% C.I.: 0.960-1.028; p < 0.001) and AER (O.R. 1.249; 95% C.I. 1.001-1.619; p = 0.004) were independently associated with DR and HDL-cholesterol (O.R.: 1.042; 95% C.I.: 1.011-1.120; p = 0.014). Additionally, among patients with eGFR <60 mL/min/1.73 m and albuminuria, both eGFR and AER significantly varied between those with/without DR (p = 0.012 and p = 0.005, respectively), and this finding was observed among only albuminuric patients. Analogous results were obtained considering DR classification. AER was significantly higher among subjects with either proliferative DR (PDR) or severe nonproliferative DR (NPDR), with regard to mild NPDR (0.498 and 0.938 g/die vs. 0.101 g/die; p < 0.001, respectively). Similar results were obtained in the specular subgroups.

CONCLUSION

In T2DM with DKD, the AER seems to be related to the presence of DR. This association is confirmed above all in those with more severe DR.

摘要

背景和目的

最近，2 型糖尿病（T2DM）患者的糖尿病肾病（DKD）白蛋白中心观点发生了变化。因此，根据 DKD 的这种新的临床表现，必须解决糖尿病视网膜病变（DR）与慢性肾脏病（CKD）之间的关系。本研究旨在评估在真实环境中 T2DM 中 DR-DKD 的相关性。

方法和结果

共纳入了 2068 名参加多中心横断面研究的 2 型糖尿病患者。白蛋白尿患者在 DR 患者中占很大比例（p=0.019）。在整个研究人群中，DR 患者的白蛋白排泄率（AER）无差异；然而，eGFR（肾小球滤过率）<60 mL/min/1.73 m（CKD）的患者的 AER 显著升高（p=0.009），尤其是 eGFR 和 AER 均≥0.03 g/24 h 的 CKD 患者（p=0.005）。多变量分析证实，eGFR（O.R. 0.976；95%CI：0.960-1.028；p<0.001）和 AER（O.R. 1.249；95%CI：1.001-1.619；p=0.004）与 DR 和高密度脂蛋白胆固醇（O.R.：1.042；95%CI：1.011-1.120；p=0.014）独立相关。此外，在 eGFR<60 mL/min/1.73 m 和白蛋白尿的患者中，eGFR 和 AER 在有/无 DR 的患者之间差异有统计学意义（p=0.012 和 p=0.005），这种现象仅见于白蛋白尿患者。在考虑 DR 分类时，得到了类似的结果。与轻度 NPDR 相比，增殖性 DR（PDR）或严重非增殖性 DR（NPDR）患者的 AER 显著更高（0.498 和 0.938 g/die 与 0.101 g/die；p<0.001）。在镜像亚组中也得到了类似的结果。