血清肌酐及胱抑素 C 水平正常的2型糖尿病患者肾小球滤过率水平的变化

摘要

目的：探讨血清肌酐（Scr）、血清胱抑素 C（Cys-C）水平正常的 T2DM 患者 eGFR 水平的变化。方法选取2014年1月至2015年9月于我院住院的 T2DM 患者166例，根据 Scr 及 Cys-C 水平，将研究对象分为 Scr 及 Cys-C 正常组109例，Scr 正常、Cys-C 升高组（Cys-C 升高组）40例，Scr 及Cys-C 均升高组（Scr 及 Cys-C 升高组）17例。Scr 及 Cys-C 正常组根据 eGFR 水平分为 eGFR≥90 ml／（min·1．73 m2）亚组和 eGFR＜90 ml／（min·1．73 m2）亚组。记录各组临床基本资料、实验室数据。采用99mTc-DTPA 肾动态显像法测定 eGFR。结果 Scr 及 Cys-C 正常组 eGFR 为（82．68±13．45）ml／（min·1．73 m2），Cys-C 升高组 eGFR 为（67．93±14．01）ml／（min·1．73 m2），Scr 及 Cys-C 升高组 eGFR 为（50．54±15．10）ml／（min·1．73 m2），各组比较，差异均有统计学意义（P＜0．05）。Scr 及 Cys-C正常组26．6％的患者 eGFR≥90 ml／（min·1．73 m2），72．5％的患者 eGFR 60～89 ml／（min·1．73 m2），0．9％的患者 eGFR 30～59 ml／（min·1．73 m2）。经3个月随访观察，Scr 及 Cys-C 正常组中4．6％处于T2DM 合并慢性肾脏病（CKD）1期，34．9％处于 T2DM 合并 CKD 2期，0．9％处于 T2DM 合并 CKD 3期。多因素非条件 Logistic 回归分析结果显示，女性、高龄、高 TC、低左室射血分数（LVEF）是 eGFR 下降的危险因素（P ＜0．05）。结论本研究中，Scr 及 Cys C 水平均正常的 T2DM 患者，73．4％出现了eGFR 轻到中度下降，40．4％进入 CKD 期，女性、高龄、高 TC、低 LVEF 是 T2DM 患者 eGFR 下降高危因素，应加强对其 eGFR 水平的监测。%Objective To investigate the changesof glomerular filtration rate(eGFR)in type 2 diabetic patients with normal serum creatinine(Scr)and serum cystatin C(Cys-C). Methods A total of 166 patients with type 2 diabetes mellitus admitted into our hospital from January 2014 to September 2015 were enrolled in this study and divided into three groups according to the level of Scr and Cys-C:T2DM patients with normal Scr and Cys-C (normal group,n =109),T2DM patients with normal Scr and high level of Cys-C (high Cys-C group,n=40),and T2DM patients with high levels of Scr and Cys-C (high Scr Cys-C group,n=17). Normal group were further divided into two subgroups according to the level of eGFR:eGFR≥90 ml/(min·1.73 m2 )subgroup and eGFR<90 ml/(min·1.73 m2 )subgroup.Clinical characteristics and laboratory datawere collected in all subjects. eGFR were measured by 99mTc-DTPA nephro-dynamic imaging. Results The average value of eGFR were significantly different in normal group(82.68±13.45)ml/(min·1.73 m2 ),high Cys-C group(67.93 ±14.01)ml/(min·1.73 m2 )and high Scr,Cys-C group (50.54±15.10)ml/(min·1.73 m2 ). In normal group,the proportion of patients with eGFR equal or greater than 90 ml/(min·1.73 m2 )was 26.6%,patients with eGFR ranged from 60 to 89 ml/(min·1.73 m2 )was 72.5%,patients with eGFR ranged from 30 to 59 ml/(min·1.73 m2 )was 0.9%. After follow-up for three months,in normal group,the proportion of patients with CKD stage1 was 4.6%,patients with CKD stage 2 was 34.9%,and patients with CKD stage 3 was 0.9%.Multivariate logistic regressionanalysis in normal group showed that female,older age,higher TC,lower LVEF were risk factors for eGFR decline (P <0.05). Conclusion In T2DM patients with normal Scr and Cys-C, 73.4% of them had mild to moderate eGFR decline,and 40.4%entered CKD stage in this study.eGFR should be evaluated especially in T2DM patients with risk factors including female,older age,higher TC and lower LVEF.