Chen Xiangjun, Qin Yao, Hu Jinbo, Shen Yan, Mao Yun, Xie Lianghua, Li Jia, Wang Jie, Yang Shumin, Li Qifu, He John Cijiang, Wang Zhihong
Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing 400016, PR China.
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing 400016, PR China.
Diabetes Metab. 2024 Nov;50(6):101583. doi: 10.1016/j.diabet.2024.101583. Epub 2024 Oct 9.
Perirenal fat (PRF) is an independent predictor for chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) patients. Previous studies speculated that PRF may promote renal dysfunction through affecting renal hemodynamics. To verify this hypothesis, we studied the relationship between PRF and renal hemodynamics in T2DM.
91 T2DM patients were included. PRF thickness (PRFT) was measured by magnetic resonance imaging. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined by renal dynamic imaging. Renal vascular resistance (RVR), glomerular hydrostatic pressure (P), afferent (R) and efferent (R) arteriolar resistance were calculated by Gomez equations. Multiple linear regression was used to determine the relationship between PRFT and renal hemodynamics. Mediation analysis was conducted to estimate the mediation effects of renal hemodynamics on the relationship between PRF and CKD.
All patients were divided into three groups according to the tertiles of PRFT. Compared with patients in tertile 1, GFR and ERPF were significantly decreased in patients in tertile 3, while RVR and R were significantly increased. PRFT was negatively correlated with GFR, ERPF and P, and positively correlated with RVR and R after adjustment for sex, age, visceral adipose tissue and treatments with ACE inhibitors/angiotensin receptor blockers and sodium-glucose cotransporter protein-2 inhibitors. Moreover, RVR and R mediated the effect of PRF on GFR, with a mediated proportion of 29.1 % and 41.4 % respectively.
In T2DM patients, PRF was negatively correlated with GFR, and positively correlated with R. R mediated the relationship between PRF and CKD.
肾周脂肪（PRF）是2型糖尿病（T2DM）患者慢性肾脏病（CKD）的独立预测指标。既往研究推测，PRF可能通过影响肾血流动力学促进肾功能不全。为验证这一假说，我们研究了T2DM患者中PRF与肾血流动力学之间的关系。
纳入91例T2DM患者。通过磁共振成像测量PRF厚度（PRFT）。通过肾动态显像测定肾小球滤过率（GFR）和有效肾血浆流量（ERPF）。采用Gomez方程计算肾血管阻力（RVR）、肾小球静水压（P）、入球（R）和出球（R）小动脉阻力。采用多元线性回归确定PRFT与肾血流动力学之间的关系。进行中介分析以评估肾血流动力学对PRF与CKD关系的中介作用。
根据PRFT的三分位数将所有患者分为三组。与三分位数1的患者相比，三分位数3的患者GFR和ERPF显著降低，而RVR和R显著升高。在校正性别、年龄、内脏脂肪组织以及使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和钠-葡萄糖协同转运蛋白2抑制剂治疗后，PRFT与GFR、ERPF和P呈负相关，与RVR和R呈正相关。此外，RVR和R介导了PRF对GFR的影响，介导比例分别为29.1%和41.4%。
在T2DM患者中，PRF与GFR呈负相关，与R呈正相关。R介导了PRF与CKD之间的关系。
