Department of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Int Urol Nephrol. 2022 Aug;54(8):2005-2014. doi: 10.1007/s11255-021-03051-x. Epub 2022 Jan 19.
To investigate the prognostic value of metabolic syndrome (MetS) and its relationship with renal structure changes in patients with type 2 diabetes and associated diabetic nephropathy (DN).
411 Chinese patients with type 2 diabetes and biopsy-confirmed DN were enrolled in this retrospective study. MetS was defined according to the modified criteria of the 2005 International Diabetes Federation. Baseline demographics and clinical information at the time of renal biopsy were extracted from the hospital's electronic medical records system. Renal pathological findings were assessed according to Renal Pathology Society system. Univariate and multivariate logistic regression analyses were performed to define the pathological covariates associated with MetS. A competing risk model, with death as the competing risk, was used to estimate the sub-distribution hazard ratio (SHR) of MetS for end-stage kidney disease (ESKD).
224 (55%) patients had MetS. Patients with MetS had poor renal function and more severe interstitial fibrosis tubular atrophy scores (IFTA) than those without MetS. Multivariate logistic regression analysis revealed that IFTA was significantly associated with MetS (odds ratio per score increase 1.45, 95% confidence interval [CI] 1.02-2.05). Of the patients with DN at risk, 40% of patients progressed to ESKD. After adjusting for renal function and pathological parameters, the presence of MetS was an independent predictor for progression to ESKD (SHR 1.93, 95% CI 1.34-2.79). The SHRs for progression to ESKD also increased as the number of MetS components increased. Additionally, adding the IFTA scores improved the prognostic power of a model that only contained MetS and clinical covariates for predicting future ESKD.
MetS is an independent prognostic predictor of ESKD in patients with T2D and DN, while adding the IFTA scores increased the prognostic value of MetS for renal outcome.
探讨代谢综合征（MetS）在 2 型糖尿病伴糖尿病肾病（DN）患者中的预后价值及其与肾脏结构变化的关系。
本回顾性研究纳入了 411 名经肾活检证实为 2 型糖尿病伴 DN 的中国患者。MetS 根据 2005 年国际糖尿病联合会的修正标准定义。从医院的电子病历系统中提取肾活检时的基线人口统计学和临床信息。根据肾脏病理学会系统评估肾脏病理发现。采用单变量和多变量逻辑回归分析确定与 MetS 相关的病理协变量。采用以死亡为竞争风险的竞争风险模型估计 MetS 对终末期肾病（ESKD）的亚分布危险比（SHR）。
224 名（55%）患者患有 MetS。与无 MetS 患者相比，MetS 患者的肾功能较差，间质纤维化和肾小管萎缩评分（IFTA）更严重。多变量逻辑回归分析显示，IFTA 与 MetS 显著相关（每增加 1 分的比值比为 1.45，95%置信区间[CI]为 1.02-2.05）。在有 DN 风险的患者中，40%的患者进展为 ESKD。在调整肾功能和病理参数后，MetS 的存在是进展为 ESKD 的独立预测因子（SHR 为 1.93，95%CI 为 1.34-2.79）。随着 MetS 成分数量的增加，进展为 ESKD 的 SHR 也随之增加。此外，添加 IFTA 评分可提高仅包含 MetS 和临床协变量的模型预测未来 ESKD 的预后能力。
MetS 是 2 型糖尿病伴 DN 患者 ESKD 的独立预后预测因子，而添加 IFTA 评分可提高 MetS 对肾脏结局的预后价值。
