2 型糖尿病患者的代谢表型与终末期肾病风险。
Metabolic phenotypes and risk of end-stage kidney disease in patients with type 2 diabetes.
机构信息
Department of General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Nephrology, Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
出版信息
Front Endocrinol (Lausanne). 2023 May 10;14:1103251. doi: 10.3389/fendo.2023.1103251. eCollection 2023.
BACKGROUND
Obesity often initiates or coexists with metabolic abnormalities. This study aimed to investigate the pathological characteristics and the independent or mutual relations of obesity and metabolic abnormalities with end-stage kidney disease (ESKD) in patients with type 2 diabetes (T2D) and associated diabetic kidney disease (DKD).
METHODS
A total of 495 Chinese patients with T2D and biopsy-confirmed DKD between 2003 and 2020 were enrolled in this retrospective study. The metabolic phenotypes were based on the body weight index (BMI)-based categories (obesity, BMI ≥ 25.0 kg/m) and metabolic status (metabolically unhealthy status, ≥ 1 criterion National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) excluding waist circumference and hyperglycemia) and were categorized into four types: metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy non-obesity (MUNO), and metabolically unhealthy obesity (MUO). The pathological findings were defined by the Renal Pathology Society classification. Cox proportional hazards models were used to estimate hazard ratios (HRs) for ESKD.
RESULTS
There are 56 (11.3%) MHNO patients, 28 (5.7%) MHO patients, 176 (35.6%) MUNO patients, and 235 (47.5%) MUO patients. The high prevalence of the Kimmelstiel-Wilson nodule and severe mesangial expansion were associated with obesity, whereas severe IFTA was related to metabolically unhealthy status. In the multivariate analysis, the adjusted HR (aHR) was 2.09 [95% confidence interval (CI) 0.99-4.88] in the MHO group, 2.16 (95% CI 1.20-3.88) in the MUNO group, and 2.31 (95% CI 1.27-4.20) in the MUO group compared with the MHNO group. Furthermore, the presence of obesity was insignificantly associated with ESKD compared with non-obese patients (aHR 1.22, 95% CI 0.88-1.68), while the metabolically unhealthy status was significantly associated with ESKD compared to the metabolically healthy status in the multivariate analysis (aHR 1.69, 95% CI 1.10-2.60).
CONCLUSION
Obesity itself was insignificantly associated with ESKD; however, adding a metabolically unhealthy status to obesity increased the risk for progression to ESKD in T2D and biopsy-proven DKD.
背景
肥胖通常会引发或伴随代谢异常。本研究旨在探讨肥胖和代谢异常与 2 型糖尿病（T2D）和相关糖尿病肾病（DKD）患者终末期肾病（ESKD）之间的病理特征，以及它们之间的独立或相互关系。
方法
本回顾性研究共纳入 2003 年至 2020 年间 495 名经活检证实患有 T2D 和 DKD 的中国患者。代谢表型基于体重指数（BMI）分类（肥胖，BMI≥25.0kg/m）和代谢状态（代谢不健康状态，至少有 1 项国家胆固醇教育计划成人治疗专家组 III（NCEP/ATP III）标准，不包括腰围和高血糖），并分为以下 4 种类型：代谢健康非肥胖（MHNO）、代谢健康肥胖（MHO）、代谢不健康非肥胖（MUNO）和代谢不健康肥胖（MUO）。病理发现由肾脏病理学会分类定义。Cox 比例风险模型用于估计 ESKD 的风险比（HR）。
结果
MHNO 患者 56 例（11.3%），MHO 患者 28 例（5.7%），MUNO 患者 176 例（35.6%），MUO 患者 235 例（47.5%）。Kimmelstiel-Wilson 结节和严重系膜扩张的高患病率与肥胖有关，而严重间质纤维化和肾小管萎缩（IFTA）与代谢不健康状态有关。多变量分析显示，与 MHNO 组相比，MHO 组的调整后 HR（aHR）为 2.09（95%置信区间（CI）0.99-4.88），MUNO 组为 2.16（95%CI 1.20-3.88），MUO 组为 2.31（95%CI 1.27-4.20）。此外，与非肥胖患者相比，肥胖患者发生 ESKD 的风险无显著差异（aHR 1.22，95%CI 0.88-1.68），而在多变量分析中，代谢不健康状态与 ESKD 显著相关（aHR 1.69，95%CI 1.10-2.60）。
结论
肥胖本身与 ESKD 无显著相关性；然而，将代谢不健康状态与肥胖结合起来，会增加 T2D 和经活检证实的 DKD 患者进展为 ESKD 的风险。
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