[中年及老年人群中2型糖尿病和糖调节受损与慢性肾脏病的相关性]
[Correlation of type 2 diabetes and impaired glucose regulation with chronic kidney disease in middle-aged and elderly individuals].
作者信息
Wang Qiangmei, Zhen Jieyu, Guan Conghui, Zhao Nan, Liu Jinjin, Li Hongli, Fu Songbo, Tang Xulei, Han Yanping, Su Shan, Zhang Di, Liu Lijuan, Zhen Donghu
机构信息
First College of Clinical Medicine, Lanzhou University, Gansu Provincial People's Hospital, Lanzhou 730000, China.
Department of Endocrinology, First Hospital of Lanzhou University, Gansu Provincial People's Hospital, Lanzhou 730000, China.
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Oct 30;40(10):1457-1464. doi: 10.12122/j.issn.1673-4254.2020.10.11.
OBJECTIVE
To explore the correlation of different glucose metabolism statues with chronic kidney disease (CKD) in middle-aged and elderly individuals in Lanzhou.
METHODS
Based on the baseline data of REACTION Study in Lanzhou area, we randomly sampled 10 038 residents aged 40-75 years in 3 communities in Lanzhou, who were classified into normal glucose tolerance (NGT), impaired glucose regulation (IGR) and diabetes groups. The estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) were used to assess the renal function and albuminuria, respectively. Binary logistic regression was performed to analyze the contribution of the risk factors to CKD. Polynominal regression was used to determine the trends of eGFR with the increment of ACR.
RESULTS
Among all the participants, the prevalences of albuminuria, CKD and renal insufficiency (RI) were 26.2%, 27.4% and 2.5%, respectively. The prevalence of albuminuria, CKD and RI were significantly higher in the diabetes group than in IGR and NGT groups ( < 0.05). In IGR group, age, hypertension, and hypertriglyceridemia were positively correlated with the risk of RI (OR: 1.113, 1.904, and 2.608, respectively; < 0.05). In diabetes group, age, coronary heart disease, obesity, hypertriglyceridemia, and elevated LDL-C level were positively correlated with the risk of RI (OR: 1.069, 2.535, 3.359, 1.827, and 2.690, respectively; < 0.05). Logistic regression analysis showed that diabetes mellitus significantly increased the risk of albuminuria (OR: 1.543, =0.000) and RI (OR: 1.446, =0.005). Logistic regression analysis and multivariate regression analysis showed that although the deterioration trends of eGFR were similar in diabetes group and IGR group, IGR was not a significant risk factor for albuminuria or RI (OR:1.057, =0.355; OR: 0.918, =0.614).
CONCLUSIONS
Diabetes mellitus is a significant risk factor for albuminuria and RI, while IGR is not. Screening for albuminuria and eGFR is highly recommended for individuals with diabetes, hypertension, and obesity, especially in women and the elderly population.
目的
探讨兰州地区中老年人群不同糖代谢状态与慢性肾脏病（CKD）的相关性。
方法
基于兰州地区REACTION研究的基线数据，我们在兰州市3个社区随机抽取了10038名年龄在40 - 75岁的居民，将其分为正常糖耐量（NGT）、糖调节受损（IGR）和糖尿病组。分别采用估算肾小球滤过率（eGFR）和尿白蛋白肌酐比值（ACR）评估肾功能和蛋白尿情况。进行二元logistic回归分析以分析危险因素对CKD的影响。采用多项式回归确定eGFR随ACR升高的变化趋势。
结果
在所有参与者中，蛋白尿、CKD和肾功能不全（RI）的患病率分别为26.2%、27.4%和2.5%。糖尿病组的蛋白尿、CKD和RI患病率显著高于IGR组和NGT组（<0.05）。在IGR组中，年龄、高血压和高甘油三酯血症与RI风险呈正相关（OR分别为1.113、1.904和2.608；<0.05）。在糖尿病组中，年龄、冠心病、肥胖、高甘油三酯血症和低密度脂蛋白胆固醇（LDL-C）水平升高与RI风险呈正相关（OR分别为1.069、2.535、3.359、1.827和2.690；<0.05）。Logistic回归分析显示，糖尿病显著增加蛋白尿风险（OR：1.543，P = 0.000）和RI风险（OR：1.446，P = 0.005）。Logistic回归分析和多因素回归分析显示，虽然糖尿病组和IGR组的eGFR恶化趋势相似，但IGR不是蛋白尿或RI的显著危险因素（OR：1.057，P = 0.355；OR：0.918，P = 0.614）。
结论
糖尿病是蛋白尿和RI的显著危险因素，而IGR不是。强烈建议对糖尿病、高血压和肥胖患者，尤其是女性和老年人群进行蛋白尿和eGFR筛查。
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