首页|蛋白尿与估算肾小球滤过率联合对糖尿病患者新发心血管疾病的影响

蛋白尿与估算肾小球滤过率联合对糖尿病患者新发心血管疾病的影响

The combined effect of albuminuria and eGFR on cardiovascular disease in population with diabetes mellitus

扫码查看
目的 观察估算肾小球滤过率(estimated glomerular filtration rate,eGFR)和尿微量白蛋白与肌酐比值(urine al-bumin-to-creatinine ratio,uACR)评估肾功能的一致性,探讨二者联合对糖尿病患者新发心脑血管疾病(cardia-cerebro-vascular disease,CVD)(包括心力衰竭、心肌梗死、脑卒中)的影响.方法 选择参加开滦第5次或第6次健康体检且进行尿微量白蛋白及尿肌酐、血肌酐检测的 8 791 例 2 型糖尿病(type 2 diabetes mellitus,T2DM)患者为研究对象.依据基线uACR和eGFR水平分组:正常组(uACR<3 mg/mmol且eGFR≥90 mL·min-1·1.73 m-2)、单纯eGFR下降组(uACR<3 mg/mmol 且 eGFR<90 mL·min-1·1.73 m-2)、单纯 uACR 升高组(uACR≥3 mg/mmol 且 eGFR≥90 mL·min-1·1.73 m-2)和uACR升高合并eGFR下降组(uACR≥3 mg/mmol且eGFR<90 mL·min-1·1.73 m-2).观察eGFR和uACR评估的肾功能是否一致.采用多因素Cox回归模型分析uACR和eGFR联合分组对CVD发病风险的影响.结果 (1)研究对象基线年龄为(60.97±9.99)岁,男性占79.05%,中位uACR为1.68(0.81,4.60)mg/mmol,平均eGFR为(92.14±16.52)mL·min-1·1.73 m-2,uACR升高与eGFR下降不一致者占43.59%.(2)中位随访时间为 3.83 年,共发生 CVD 事件 694 例(7.89%),4 组总 CVD 事件的发病密度分别为 12.96/1 000 人年、19.04/1 000 人年、25.65/1 000 人年和46.87/1 000 人年.(3)与正常组相比,单纯eGFR下降组、单纯uACR升高组和uACR升高合并eGFR下降组新发总CVD事件的风险分别升高 1.06(95%CI 0.73~1.55)倍、1.99(95%CI 1.41~2.80)倍和 3.00(95%CI 2.12~4.25)倍.结论 eGFR下降和uACR升高所评估的肾功能不一致现象较为常见,二者对CVD发病的影响存在联合作用.
Objective To investigate whether the renal function assessed by estimated glomerular filtration rate(eGFR)and urinealbumin-to-creatinine rate(uACR)is consistent and explore the effect of the combination of the two on new-onset Cardia-cerebrovascular disease(CVD)in population with type 2 diabetes mellitus(T2DM).Methods We included 8 791 participants with T2DM but no CVD who were assessed with uACR and eGFR between 2014 and 2016.The participants were divided into four groups based on their baseline uACR and eGFR:normal(uACR<3 mg/mmol and eGFR≥90 mL·min-1·1.73 m-2),simple eGFR decreaed(uACR<3 mg/mmol and eGFR<90 mL·min-1·1.73 m-2),simple uACR increased(uACR≥3 mg/mmol and eGFR≥90 mL·min-1·1.73 m-2),uACR increased and eGFR decreaed(uACR≥3 mg/mmol and eGFR<90 mL·min-1·1.73 m-2).The relationship between uACR and eGFR and new-onset CVD was studied using Cox proportional hazard models.Results There were 79.05%males in all participants with an average age of 60.97 years old.Their median uACR was 1.68(0.81,4.60)mg/mmol and mean of eGFR was(92.14±16.52)mL·min-1·1.73 m-2),increased uACR and decreased eGFR were inconsistent in 43.59%.694 new-onset CVD cases(7.89%)were recorded after a median follow-up of 3.83 years.The incidence of CVD in all four groups was 12.96/1 000 preson-years,19.04/1 000 preson-years,25.65/1 000 preson-years and 46.87/1 000 preson-years,respectively.When compared with normal,multivariable-adjustted hazard ratios of CVD were 1.06(95%CI 0.73~1.55),1.99(95%CI 1.41~2.80)and 3.00(95%CI 2.12~4.25)in simple eGFR decreaed group,simple uACR increased group,uACR increased and eGFR decreaed group,re-spectively.Conclusion Inconsistencies in renal function assessed by decreased eGFR and increased uACR are common,there is a joint effect of the two methods on the prediction of new CVD.

cardiovascular diseaseurine albumin-to-creatinine ratioestimated glomerular filtration ratetype 2 diabetes

陶杰、张欣欣、李跃军、张明、桑大森

展开 >

保定市第一中心医院心内科,河北 保定 071002

心血管疾病 尿微量白蛋白与尿肌酐比值 估算肾小球滤过率 2型糖尿病

保定市科学技术研究与发展计划项目

2241ZF249

2024

医学研究与教育
河北大学

医学研究与教育

影响因子:0.675
ISSN:1674-490X
年,卷(期):2024.41(3)
  • 2