Zhang Fan, Han Yan, Zheng Guojun, Li Wenjian
Department of Endocrinology, Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People's Republic of China.
Department of Clinical Nutrition, Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People's Republic of China.
Diabetes Metab Syndr Obes. 2024 Feb 26;17:943-957. doi: 10.2147/DMSO.S451628. eCollection 2024.
This research aims to examine and scrutinize gender variations in the incidence of diabetic nephropathy (DN) and the trajectory of renal function in type 2 diabetes mellitus (T2DM) patients.
We conducted a retrospective cohort study that enrolled 1549 patients diagnosed with T2DM from May 2015 to July 2023. We separately compared the clinical characteristics of male and female participants with and without DN. We utilized the Kaplan-Meier method to examine the cumulative incidence of DN among T2DM patients of varying genders. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using univariable and multivariable Cox proportional hazards regression analysis to evaluate the correlation between various factors and the risk of DN incidence. Multiple linear regression was utilized to investigate the relationship between ΔeGFR% and each factor. Logistic regression with cubic spline function and smooth curve fitting was employed to analyze the nonlinear link between ΔeGFR% and the risk of DN among participants of different genders.
The prevalence of DN was higher in female participants (17.31%) than in male participants (12.62%), with a significant cumulative risk ratio (1.33 [1.02-1.73], = 0.034). Multiple linear regression analysis revealed that creatinine, female gender, blood urea nitrogen, alkaline phosphatase, and total cholesterol had a significant impact on ΔeGFR% in T2DM patients, with standardized β coefficients of -0.325, -0.219, -0.164, -0.084, and 0.071, respectively. The restricted cubic spline analysis demonstrated a strong negative association between ΔeGFR% and the risk of developing DN ( < 0.001).
Both male and female patients with T2DM had a higher prevalence of DN over the 5-year follow-up period. However, women had a greater risk of developing DN and a faster decline in renal function compared to men.
本研究旨在调查和审视2型糖尿病（T2DM）患者糖尿病肾病（DN）发病率及肾功能轨迹的性别差异。
我们进行了一项回顾性队列研究，纳入了2015年5月至2023年7月期间诊断为T2DM的1549例患者。我们分别比较了有和没有DN的男性和女性参与者的临床特征。我们使用Kaplan-Meier方法检查不同性别的T2DM患者中DN的累积发病率。使用单变量和多变量Cox比例风险回归分析计算风险比（HR）和95%置信区间（CI），以评估各种因素与DN发病风险之间的相关性。使用多元线性回归研究ΔeGFR%与各因素之间的关系。采用具有三次样条函数和光滑曲线拟合的逻辑回归分析不同性别参与者中ΔeGFR%与DN风险之间的非线性联系。
女性参与者中DN的患病率（17.31%）高于男性参与者（12.62%），累积风险比显著（1.33[1.02 - 1.73]，P = 0.034）。多元线性回归分析显示，肌酐、女性性别、血尿素氮、碱性磷酸酶和总胆固醇对T2DM患者的ΔeGFR%有显著影响，标准化β系数分别为 - 0.325、 - 0.219、 - 0.164、 - 0.084和0.071。受限三次样条分析显示ΔeGFR%与发生DN的风险之间存在强烈的负相关（P < 0.001）。
在5年随访期内，T2DM男性和女性患者的DN患病率均较高。然而，与男性相比，女性发生DN的风险更高，肾功能下降更快。
