血糖水平对2型糖尿病患者肾小球滤过率及其评估方程的影响

摘要

目的 探讨不同血糖水平对2型糖尿病患者肾小球滤过率(GFR)及其评估方程的影响方法 选择经同位素99mTc-DTPA测定GFR的2型糖尿病患者495例,HbA1c与99mTc-DTPA测定GFR及CG方程、MDRD方程和MCQ方程GFR估计值之间进行相关性分析;以HbA1c=8%为临界值,比较两组间各评估方程的精确性和准确性.结果:经同位素测定的GFR为(70.11±20.54)ml·min(-1)·(1.73 m2)(-1),HbA1c与同位素测定GFR及CG方程、MDRD方程和MCQ方程GFR估计值呈正相关(γ值分别为0.196、0.201、0.289和0.181,P<0.01).无论血糖水平如何,CG方程的准确性都明显高于其他两个方程.结论 近期高血糖增加同位素测定GFR和方程估算GFR的水平.虽然这些评估方程存在一些不足之处,但由于目前尚缺乏专门针对糖尿病人群的评估方程,在临床实际工作中采用CG方程来评估2型糖尿病患者的GFR不失为一个简便实用的方法.%Objective To discuss the influence of different blood glucose levels on glomerular filtration rate (GFR) and on its estimation equations in type 2 diabetes. Methods 495 type 2 diabetic patients undergoing GFR measurement using 99m Tc-DTPA were enrolled in this study. The correlations were performed between glycosylated hemoglobin (HbA1c) and 99m Tc-DTPA measured GFR and its estimations by CG, MDRD and MCQ equations. The precision and accuracy were compared among these three estimating equations under the threshold of HbA1c 8 ％. Results When GFR measured using 99m Tc-DTPA was (70. 11 ± 20. 54 ) ml· min-1 · ( 1.73 m2 )-1, HbA1c was positively correlated with isotopically measured GFR and its estimations by CG, MDRD and MCQ equations (r=0. 196, 0. 201,0. 289 and 0.181, P＜0. 01). CG equation was more accurate than the other equations regardless of blood glucose level. Conclusions Acute hyperglycemia increases isotopically measured GFR and its estimations. These equations all have some disadvantages in estimating GFR, but in clinical work it is more convenient and practical to use CG equation to estimate GFR in Chinese type 2 diabetes.