2型糖尿病患者近端肾小管损伤及肾功能下降的影响因素分析

摘要

目的 探讨T2DM患者近端肾小管损伤及肾功能下降的情况,分析二者相关影响因素.方法 选取T2DM患者237例,检测患者尿α1-微球蛋白(α1-MG)、尿肌酐(Ucr)及血胱抑素C(Cys-C)浓度,分析T2DM患者中近端肾小管损伤及肾功能下降的比例及二者影响因素的OR.结果 237例T2DM患者中,α1-MG/Ucr比值(α1CR)升高者占67.93%,eGFR降低者占35.02%,仅α1CR升高、但eGFR相对正常者占37.55%.二元Logistic多因素回归分析显示,近端肾小管损伤和肾功能下降的影响因素各不相同,其中性别(OR=2.136,P=0.047)、糖尿病病程(OR=1.058,P=0.020)及UAlb/Ucr比值(UACR)(OR=1.008,P=0.007)是引起近端肾小管损伤的危险因素;而α1CR(OR=1.035,P<0.001)是导致肾功能下降的危险因素.结论 T2DM患者近端肾小管损伤发生率高于肾功能下降发生率,且部分患者仅存在近端肾小管的损伤而无肾功能的异常.导致近端肾小管损伤和肾功能下降的危险因素各不相同,UACR仅是近端肾小管损伤的危险因素而不是肾功能下降的危险因素;近端肾小管损伤是肾功能下降的危险因素.%Objective To investigate the prevalence of proximal tubular injury and renal function decline in hospitalized patients with type 2 diabetes (T2DM) and analyze their risk factors.Method A total of 237 hospitalized patients with T2DM were enrolled.Urine α1-microglobulin (α1-MG),urine creatinine and serum cystatin C (Cys-C) were measured in the first morning sample.We calculated the prevalence of renal damage and analyzed their risk factors.Result Overall,the percent of participants with increased α1CR (α1-MG to creatinine ratio) was 67.93%,with decreased eGFR(estimate glomerular filtration rate) was 35.02%,with nomal eGFR but increased α1CR was 37.55%.The risk factors of renal damage had different influences to proximal tubules and renal function.Gender (OR=2.136,P=0.047),dabetic duration (OR=1.058,P=0.020) and (albumin to creatinine ratio,ACR)(OR=1.008,P=0.007) were the risk factors of proximal tubular injury.α1CR(OR=1.035,P<0.001) was risk factors of renal function decline.Conclusion The prevalence of proximal tubules injury is much higher than the prevalence of renal function decline in T2DM patients.It's worth noting that some patients only present with proximal tubules injury but without renal function decline.In addition,the risk factors have different influences on proximal tubules and renal function.ACR is not a risk factor associated with renal function decline,but it is a risk factor for proximal tubules injury.Proximal tubules injury is a risk factor associated with renal function decline.