摘要
目的 探讨老年2型糖尿病(T2DM)合并高尿酸血症患者早期肾损害发生情况及影响因素,并构建预测模型.方法 纳入老年T2DM合并高尿酸血症患者200例,根据是否发生早期肾损害将其分为早期肾损害组(96例)和非早期肾损害组(104例),收集其一般临床资料及实验室检查结果并进行组间比较.采用多因素logistic回归分析评估老年T2DM合并高尿酸血症患者发生早期肾损害的危险因素,并构建预测模型;采用受试者工作特征(ROC)曲线评价该模型的预测价值.结果 早期肾损害组患者年龄、糖尿病病程、糖化血红蛋白(HbA1c)、甘油三酯(TG)、血尿酸(SUA)、C反应蛋白(CRP)、同型半胱氨酸(Hcy)及24 h尿微量白蛋白水平均高于非早期肾损害组(P＜0.05).多因素logistic回归分析结果显示,年龄、糖尿病病程、BMI、HbA1c、TG、SUA、CRP、Hcy及24 h尿微量白蛋白均是老年T2DM合并高尿酸血症患者发生早期肾损害的独立危险因素(P＜0.05).构建logistic回归预测模型,验证结果显示模型建立具有统计学意义、构建有效、拟合效果较好.ROC曲线分析结果显示,该logistic回归预测模型对老年T2DM合并高尿酸血症患者早期肾损害有较好的预测价值[ROC曲线下面积(AUC)为0.920],当Log(P)=3.77时,预测敏感度为76.04％,特异度为90.38％.结论 老年T2DM合并高尿酸血症患者早期肾损害发生率高达48％,其影响因素涉及年龄、糖尿病病程、BMI、HbA1c、TG、SUA、CRP、Hcy及24 h尿微量白蛋白,临床需根据上述因素重视对重点人群的筛查,加强对该群体早期肾功能损害的防治工作.
Abstract
Objective To investigate the occurrence and influencing factors of early renal damage in elderly type 2 diabetes mellitus(T2DM)patients with hyperuricemia,and to construct a prediction model for it.Methods A total of 200 elderly T2DM patients with hyperuricemia were included,according to whether early kidney damage occurred,the patients were divided into early kidney damage group(96 cases)and non-early kidney damage group(104 cases).General clinical data and laboratory results were collected and compared between groups.Multivariate logistic regression analysis was used to evaluate the risk factors for early kidney damage in elderly T2DM patients with hyperuricemia,and a predictive model was constructed.The predictive value of the model was evaluated by receiver operating characteristic(ROC)curve.Results Age,diabetes course,levels of glycated hemoglobin(HbA1c),triacylglycerol(TG),serum uric acid(SUA),C-reactive protein(CRP),homocysteine(Hcy)and 24 h urinary microalbumin in early renal damage group were higher than those in non-early renal damage group(P＜0.05).Multivariate logistic regression analysis showed that age,diabetes course,BMI,HbA1c,TG,SUA,CRP,Hey and 24 h urinary microalbumin were independent risk factors for early renal damage in elderly T2DM patients with hyperuricemia(P＜0.05).Logistic regression prediction model was constructed,and the verification results showed that the model was statistically significant,effective and had good fitting effect.ROC curve analysis results showed that the logistic regression prediction model had good predictive value for early kidney damage in elderly T2DM patients with hyperuricemia[area under ROC curve(AUC)was 0.920],when Log(P)=3.77,the prediction sensitivity was 76.04％and the specificity was 90.38％.Conclusion The incidence of early renal injury in elderly T2DM patients with hyperuricemia is as high as 48％,and the influencing factors include age,diabetes duration,BMI,HbA1c,TG,SUA,CRP,Hcy and 24 h urinary microalbumin.Screen and pay attention to key patients,and strengthen the prevention and treatment of early renal damage in this group.
基金项目
秦皇岛市科学技术研究与发展计划(202004A097)
维普
万方数据