通过Tc-DTPA动态肾显像和估算方程评估的血糖控制指标与肾功能之间的关联。
Association between glycemic control indicators with renal function assessed by Tc-DTPA dynamic renal scintigraphy and estimating equations.
作者信息
Su Hang, Ni Jiaying, Peng Danfeng, He Xingxing, Lu Wei, Zhu Wei, Wang Yufei, Ma Xiaojing, Lu Jingyi, Zhou Jian
机构信息
Department of Gerontology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
出版信息
Endocrine. 2025 Jun 4. doi: 10.1007/s12020-025-04268-x.
PURPOSE
Our study aimed to analyze the impact of renal function, assessed by various methods of evaluating glomerular filtration rate (GFR), on glycated hemoglobin A1c (HbA1c), glycated albumin (GA), and 1,5-anhydroglucitol (1,5-AG).
METHODS
This cross-sectional study analyzed 5113 type 2 diabetes patients. GFR was evaluated using both Tc-DTPA dynamic renal scintigraphy (mGFR) and various estimating equations, including eGFRcr, eGFRcys, eGFRcr-cys, and eGFRc_MDRD.
RESULTS
Overall, the median or mean values of HbA1c, GA, serum 1,5-AG, and mGFR were 8.3 (7.2-9.8)%, 21.0 (17.5-25.9)%, 3.4 (1.8-7.1) μg/mL, and 88.3 ± 24.1 mL/min/1.73 m, respectively. Multiple linear regression demonstrated that HbA1c and GA were not correlated with mGFR (both P > 0.05), but showed weak associations in all equations besides eGFRcys (β = 0.002-0.008, all P < 0.001). Serum 1,5-AG correlated mildly with all GFR measures (β = -0.016 to -0.048, all P < 0.001). When FPG and 2hPG were used as references for "actual" glucose level, significant and moderate associations were observed between HbA1c and GA with FPG (r = 0.324-0.649, all P < 0.001) and 2hPG (r = 0.341-0.592, all P < 0.001) across all CKD categories. Serum 1,5-AG maintained negative correlations with FPG and 2hPG (r = -0.239 to -0.463, all P < 0.001) in GFR ≥ 30 mL/min/1.73 m, but not in GFR < 30 mL/min/1.73 m. Results were consistent across all assessments using both mGFR and eGFR derived from the four equations.
CONCLUSION
In subjects with mild-to-moderate renal insufficiency, HbA1c, GA, and serum 1,5-AG are reliable indicators of glucose control.
目的
我们的研究旨在分析通过多种评估肾小球滤过率（GFR）的方法评估的肾功能对糖化血红蛋白A1c（HbA1c）、糖化白蛋白（GA）和1,5-脱水葡萄糖醇（1,5-AG）的影响。
方法
这项横断面研究分析了5113例2型糖尿病患者。使用Tc-DTPA动态肾闪烁显像（mGFR）和各种估算方程评估GFR，包括eGFRcr、eGFRcys、eGFRcr-cys和eGFRc_MDRD。
结果
总体而言，HbA1c、GA、血清1,5-AG和mGFR的中位数或平均值分别为8.3（7.2-9.8）%、21.0（17.5-25.9）%、3.4（1.8-7.1）μg/mL和88.3±24.1 mL/min/1.73 m²。多元线性回归表明，HbA1c和GA与mGFR无关（P均>0.05），但在eGFRcys以外的所有方程中均显示出弱关联（β=0.002-0.008，P均<0.001）。血清1,5-AG与所有GFR测量值均呈轻度相关（β=-0.016至-0.048，P均<0.001）。当空腹血糖（FPG）和餐后2小时血糖（2hPG）用作“实际”血糖水平的参考时，在所有慢性肾脏病（CKD）类别中，HbA1c和GA与FPG（r=0.324-0.649，P均<0.001）和2hPG（r=0.341-0.592，P均<0.001）之间观察到显著且中等程度的关联。在GFR≥30 mL/min/1.73 m²时，血清1,5-AG与FPG和2hPG保持负相关（r=-0.239至-0.463，P均<0.001），但在GFR<30 mL/min/1.73 m²时则不然。使用mGFR和由四个方程得出的eGFR进行的所有评估结果均一致。
结论
在轻度至中度肾功能不全的受试者中，HbA1c、GA和血清1,5-AG是血糖控制的可靠指标。
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