中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
14期
967-971
,共5页
黄虹%李红%郑芬萍%卢薇娜%董雪红%阮昱
黃虹%李紅%鄭芬萍%盧薇娜%董雪紅%阮昱
황홍%리홍%정분평%로미나%동설홍%원욱
糖尿病,2型%老年人%肾小球滤过率
糖尿病,2型%老年人%腎小毬濾過率
당뇨병,2형%노년인%신소구려과솔
Diabetes mellitus,2 type%Eged%Glomerular filtration rate
目的 探讨老年与非老年2型糖尿病(T2DM)患者肾脏损害的特点及影响因素.方法 回顾性分析中华医学会糖尿病学分会对住院糖尿病患者慢性并发症调查的临床资料,筛选出符合要求T2DM患者共1351例,根据24 h尿白蛋白排泄率(AER)水平分为正常白蛋白尿组(AER<30 mg/24 h)、微量白蛋白尿组(30≤AER<300 ms/24 h)和大量白蛋白尿组(AER≥300 ms/24 h);采用改良的MDRD公式计算肾小球滤过率(eGFR),对老年(≥60岁)与非老年T2DM患者的肾脏损害特点,及其影响因素进行比较分析.结果 (1)T2DM正常白蛋白尿组和微量白蛋白尿组伴eGFR下降的比例在老年组明显高于非老年组(26.7%比15.8%,P<0.01;30.5%比21.3%,P<0.05);(2)正常白蛋白尿伴eGFR下降的T2DM患者中,老年患者糖尿病平均病程(7.7年比3.8年)、收缩压[(146±24)mm Hg比(134±23)mm Hg]、舒张压[(84±13)mm Hg比(80±11)mm Hg]、合并高血压(37.8%比21.1%)、发生糖尿病视网膜病变(34.1%比23.9%)、发生心、脑血管病变(31.6%比11.3%及24.4%比9.9%)均明显高于非老年(P<0.05或0.01);(3)多因素回归分析显示糖尿病病程(OR=1.046,P=0.013)和收缩压(OR=1.014,P=0.002)是影响老年T2DM正常白蛋白尿组eGFR下降的主要危险因素;收缩压(OR=1.042,P=0.000)和餐后2 h血糖(OR=1.048,P=0.002)则是影响非老年T2DM正常白蛋白尿组eGFR下降的主要危险因素.结论 老年T2DM患者较非老年T2DM患者更易出现以eGFR下降为早期表现的肾脏损害;收缩压是老年和非老年T2DM患者正常白蛋白尿期eGFR下降的主要危险因素,控制血压可能延缓肾功能损害.
目的 探討老年與非老年2型糖尿病(T2DM)患者腎髒損害的特點及影響因素.方法 迴顧性分析中華醫學會糖尿病學分會對住院糖尿病患者慢性併髮癥調查的臨床資料,篩選齣符閤要求T2DM患者共1351例,根據24 h尿白蛋白排洩率(AER)水平分為正常白蛋白尿組(AER<30 mg/24 h)、微量白蛋白尿組(30≤AER<300 ms/24 h)和大量白蛋白尿組(AER≥300 ms/24 h);採用改良的MDRD公式計算腎小毬濾過率(eGFR),對老年(≥60歲)與非老年T2DM患者的腎髒損害特點,及其影響因素進行比較分析.結果 (1)T2DM正常白蛋白尿組和微量白蛋白尿組伴eGFR下降的比例在老年組明顯高于非老年組(26.7%比15.8%,P<0.01;30.5%比21.3%,P<0.05);(2)正常白蛋白尿伴eGFR下降的T2DM患者中,老年患者糖尿病平均病程(7.7年比3.8年)、收縮壓[(146±24)mm Hg比(134±23)mm Hg]、舒張壓[(84±13)mm Hg比(80±11)mm Hg]、閤併高血壓(37.8%比21.1%)、髮生糖尿病視網膜病變(34.1%比23.9%)、髮生心、腦血管病變(31.6%比11.3%及24.4%比9.9%)均明顯高于非老年(P<0.05或0.01);(3)多因素迴歸分析顯示糖尿病病程(OR=1.046,P=0.013)和收縮壓(OR=1.014,P=0.002)是影響老年T2DM正常白蛋白尿組eGFR下降的主要危險因素;收縮壓(OR=1.042,P=0.000)和餐後2 h血糖(OR=1.048,P=0.002)則是影響非老年T2DM正常白蛋白尿組eGFR下降的主要危險因素.結論 老年T2DM患者較非老年T2DM患者更易齣現以eGFR下降為早期錶現的腎髒損害;收縮壓是老年和非老年T2DM患者正常白蛋白尿期eGFR下降的主要危險因素,控製血壓可能延緩腎功能損害.
목적 탐토노년여비노년2형당뇨병(T2DM)환자신장손해적특점급영향인소.방법 회고성분석중화의학회당뇨병학분회대주원당뇨병환자만성병발증조사적림상자료,사선출부합요구T2DM환자공1351례,근거24 h뇨백단백배설솔(AER)수평분위정상백단백뇨조(AER<30 mg/24 h)、미량백단백뇨조(30≤AER<300 ms/24 h)화대량백단백뇨조(AER≥300 ms/24 h);채용개량적MDRD공식계산신소구려과솔(eGFR),대노년(≥60세)여비노년T2DM환자적신장손해특점,급기영향인소진행비교분석.결과 (1)T2DM정상백단백뇨조화미량백단백뇨조반eGFR하강적비례재노년조명현고우비노년조(26.7%비15.8%,P<0.01;30.5%비21.3%,P<0.05);(2)정상백단백뇨반eGFR하강적T2DM환자중,노년환자당뇨병평균병정(7.7년비3.8년)、수축압[(146±24)mm Hg비(134±23)mm Hg]、서장압[(84±13)mm Hg비(80±11)mm Hg]、합병고혈압(37.8%비21.1%)、발생당뇨병시망막병변(34.1%비23.9%)、발생심、뇌혈관병변(31.6%비11.3%급24.4%비9.9%)균명현고우비노년(P<0.05혹0.01);(3)다인소회귀분석현시당뇨병병정(OR=1.046,P=0.013)화수축압(OR=1.014,P=0.002)시영향노년T2DM정상백단백뇨조eGFR하강적주요위험인소;수축압(OR=1.042,P=0.000)화찬후2 h혈당(OR=1.048,P=0.002)칙시영향비노년T2DM정상백단백뇨조eGFR하강적주요위험인소.결론 노년T2DM환자교비노년T2DM환자경역출현이eGFR하강위조기표현적신장손해;수축압시노년화비노년T2DM환자정상백단백뇨기eGFR하강적주요위험인소,공제혈압가능연완신공능손해.
Objective To investigate the clinical features and risk factors of renal damage in the elderly and non-elderly patients with type 2 diabetes mellitus. Methods The data were collected from a survey of 10-year retrospective study of chronic complications of hospitalized type 2 diabetics organized by Chinese Diabetes Society. A total of 1351 patients of type 2 diabetes were selected and divided into an elderly group( ≥ 60 year)and a non-elderly group( <60 year). The patients were also divided into three groups according to urinary albumin excretion rate (AER): normoalbuminuria group ( AER <30 mg/24 h), microalbuminuria group (30≤ AER <300 mg/24 h) and macroalbuminuria group (AER ≥ 300 mg/24 h). eGFR was estimated by the equation from the MDRD study. Clinical and laboratory parameters of all patients were analyzed. Results ( 1 ) The proportions of renal insufficiency in both normoalbuminuria and microalbuminuria groups of type 2 diabetes in the elderly patients were significantly higher than those in the non-elderly patients (26.7% vs 15.8%, P<0.01; 30.5% vs 21. 3% , P<0.05 respectively); (2)in type 2 diabetic patients with renal insufficiency and normoalbuminuria, the diabetes duration (7. 7 vs 3. 8 years) , systolic blood pressure [ (146 ±24) mm Hg vs (134 ± 23) mm Hg] , diastolic blood pressure [ (84 ± 13) mm Hg vs ( 80 ± 11 ) mm Hg], proportion of hypertension (37. 8% vs 21. 1% ) , diabetic retinopathy(34. 1% vs 23.9%), cardiovascular diseases (31. 6% vs 11.3%)and cerebrovascular disease (24.4% vs 9.9% ) were significantly higher in the elderly group than in the non-elderly group (P <0. 05 or 0.01) ; (3 ) multiple logistic regression analysis revealed that the duration of diabetes ( OR = 1.046, P = 0.013) and systolic blood pressure ( OR = 1.014, P =0.002) were independently associated with renal insufficiency in the elderly type 2 diabetic patients with normoalbuminuria, whereas systolic blood pressure (OR = 1.042, P= 0.000) and 2-hour postprandial blood glucose ( OR = 1.048, P = 0. 002 ) were independent risk factors for renal insufficiency of non-elderly patients. Conclusion The elderly type 2 diabetic patients are likely to suffer renal insufficiency initially from a lower glomerular filtration rate than the non-elderly patients. Systolic blood pressure is the main risk factor in both elderly and non-elderly type 2 diabetes with normoalbuminuria and a decreased renal function. Controlling blood pressure may delay the decline of renal function.
