Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China,
Kidney Blood Press Res. 2020;45(3):378-390. doi: 10.1159/000505919. Epub 2020 Mar 25.
Despite the high mortality of cardiovascular disease (CVD) in diabetic patients with renal injury, few studies have compared cardiovascular characteristics and outcomes between patients with diabetic nephropathy (DN) and non-diabetic renal disease (NDRD).
A total of 326 type 2 diabetes mellitus patients with renal biopsy were assigned to DN and NDRD groups. Echocardiography and Doppler ultrasound were performed to evaluate left ventricular hypertrophy (LVH) and peripheral atherosclerosis disease (PAD). Renal and cardiovascular survival rates were compared between the DN and NDRD groups by Kaplan-Meier analysis. Risk factors for renal and cardiovascular events in DN patients were identified by a Cox proportional hazards model.
In total, 179 patients entered the DN group (54.9%) and 147 made up the NDRD group (45.1%). The presence of diabetic retinopathy, family history of diabetes, and dependence on insulin therapy were associated with the presence of DN. DN patients had more CVD with more severe LVH and PAD. Poorer renal (log-rank χ2 = 26.534, p < 0.001) and cardiovascular (log-rank χ2 = 16.257, p < 0.001) prognoses were seen in the DN group. DR (HR 1.539, 95% CI 1.332-1.842), eGFR (HR 0.943, 95% CI 0.919-0.961), and 24-h proteinuria (HR 1.211, 95% CI 1.132-1.387) were identified as risk factors for renal endpoints. Age (HR 1.672, 95% CI 1.487-1.821), HbA1C (HR 1.398, 95% CI 1.197-1.876), and 24-h proteinuria (HR 1.453, 95% CI 1.289-1.672) were associated with cardiovascular endpoints.
Patients with DN had more severe CVD along with poorer renal and cardiovascular prognoses than those with NDRD.
尽管心血管疾病（CVD）在合并肾损伤的糖尿病患者中的死亡率较高，但很少有研究比较糖尿病肾病（DN）和非糖尿病肾疾病（NDRD）患者的心血管特征和结局。
共纳入 326 例接受肾活检的 2 型糖尿病患者，分为 DN 组和 NDRD 组。行超声心动图和多普勒超声检查评估左心室肥厚（LVH）和外周动脉粥样硬化疾病（PAD）。通过 Kaplan-Meier 分析比较 DN 组和 NDRD 组的肾脏和心血管生存率。采用 Cox 比例风险模型确定 DN 患者肾脏和心血管事件的危险因素。
共 179 例患者纳入 DN 组（54.9%），147 例纳入 NDRD 组（45.1%）。存在糖尿病视网膜病变、糖尿病家族史和依赖胰岛素治疗与 DN 的存在相关。DN 患者更易发生 CVD，且 LVH 和 PAD 更严重。DN 组患者的肾脏（log-rank χ2 = 26.534，p < 0.001）和心血管（log-rank χ2 = 16.257，p < 0.001）预后更差。DR（HR 1.539，95%CI 1.332-1.842）、eGFR（HR 0.943，95%CI 0.919-0.961）和 24 小时蛋白尿（HR 1.211，95%CI 1.132-1.387）被确定为肾脏终点的危险因素。年龄（HR 1.672，95%CI 1.487-1.821）、HbA1C（HR 1.398，95%CI 1.197-1.876）和 24 小时蛋白尿（HR 1.453，95%CI 1.289-1.672）与心血管终点相关。
与 NDRD 患者相比，DN 患者合并更严重的 CVD，且肾脏和心血管预后更差。
Zotero 插件