两种标准诊断的2型糖尿病肾病患者肾功能进展情况及其影响因素对比

摘要

目的 比较两种标准诊断的2型糖尿病肾病患者肾功能进展情况及其影响因素.方法 选取2型糖尿病患者283例,其中符合美国肾脏病基金会肾脏病预后质量倡议(NKF K/DOQI)标准的糖尿病肾病(DN)患者73例,符合中华医学会标准的DN患者85例.以估计肾小球滤过率(eGFR)、尿白蛋白肌酐比值(UACR)及糖尿病视网膜病变分期评价患者DN进展情况.随访1年后,比较两种标准诊断的DN患者肾功能进展情况.使用logistic回归模型分析两种标准诊断的DN患者肾功能进展的影响因素.结果 两种诊断标准的DN患者在eGFR、糖尿病视网膜病变分期、UACR进展方面比较,差异均无统计学意义(P＞0.05).对于中华医学会标准诊断的DN患者,糖尿病病程、糖化血红蛋白(HbA1c)及eGFR是肾功能进展性的影响因素(均P＜0.05);对于NKF K/DOQI标准诊断的DN患者,糖尿病病程、高血压、HbA1c、eGFR、糖尿病视网膜病变是肾功能进展性的影响因素(均P ＜0.05).结论 两种标准在反映DN的疾病进展方面相似;两种标准诊断的DN患者肾功能进展的影响因素也相似.%Objective To compare the progression of renal function and its influencing factors between the patients diagnosed as type 2 diabetic nephropathy by two standards.Methods Of 283 patients with type 2 diabetes enrolled,73 and 85 were diagnosed as diabetic nephropathy (DN) by the standard of National Kidney Foundation of Clinical Practice Guidelines(NKF K/DOQI) and the standard of Chinese Medical Association,respectively.Estimated glomerular filtration rate (eGFR),urinary albumin creatinine ratio (UACR) and diabetic retinopathy staging were used to assess the progression of DN.After one year of follow-up,the progression of renal function was compared between the DN patients diagnosed by the two standards.Logistic regression model was used to analyze the factors influencing the progression of renal function in the DN patients diagnosed by the two standards.Results There were no significant differences in the progression of eGFR,diabetic retinopathy staging or UACR between the DN patients diagnosed by the two standards (P ＞ 0.05).For the DN patients diagnosed by the standard of Chinese Medical Association,the diabetic course,hemoglobin A1C (HbAlc) level and eGRF were the factors influencing the progression of renal function(all P ＜ 0.05).For the DN patients diagnosed by the standard of NKF K/DOQI,the diabetic course,hypertension,HbA1C level,eGRF and diabetic retinopathy were the factors influencing the progression of renal function (all P ＜ 0.05).Conclusion The two standards obtain a similarity in the assessment of DN progression.And similar factors influencing the renal function progression are found between the DN patients diagnosed by the two standards.