老年2型糖尿病病人血清γ-谷氨酰转肽酶水平与肾小球滤过功能的相关性研究
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摘要
目的探讨老年2型糖尿病病人血清γ-谷氨酰转肽酶(GGT)与估计肾小球滤过率(eGFR)的相关性。方法选择eGFR≥60 m L/(min·1. 73m2)的老年2型糖尿病病人2127例(男1372例,女755例),测定GGT、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、尿酸(UA)、血清肌酐(SCr)、尿白蛋白/肌酐(ACR)、收缩压(SBP)、舒张压(DBP)、腰围(WC)等指标水平。男、女2组分别建立线性回归模型对GGT与eGFR进行相关性分析。结果男、女2组年龄、糖尿病病程、WC、DBP、SCr、UA、ACR、TG、TC、LDL-C、HDL-C、GGT水平差异均具有统计学意义(P<0. 05);(2)随着GGT四分位数的升高,男性组eGFR变化无统计学意义,而女性组eGFR降低(P<0. 05);男性组年龄、糖尿病病程、WC、BMI、DBP、UA、TG、TC、LDL-C升高(P<0. 05),女性组糖尿病病程、WC、BMI、Hb A1c、UA、ACR、TG、TC升高(P<0. 05);(3)线性回归分析显示,校正年龄、糖尿病病程、WC、BMI、SBP、DBP、TG、TC、LDL-C、HDL-C、Hb A1c、ACR后,女性组GGT与eGFR呈负相关(β=-0. 118,P=0. 022)。结论老年女性2型糖尿病病人血清GGT可能是导致eGFR水平下降的独立危险因素之一。
Objective To explore the association between serum gamma glutamyltransferase( GGT) and estimated glomerular filtration rate( eGFR) in the elderly patients with type 2 diabetes.Methods A total of 2127 patients with type 2 diabetes,with an eGFR≥60 m L/( min·1. 73 m2)( males1372 and females 755) were selected. The serum levels of GGT,triglyceride( TG),total cholesterol( TC),high-density lipoprotein cholesterol( HDL-C),low-density lipoprotein cholesterol( LDL-C),fasting plasma glucose( FPG),glycosylated hemoglobin( Hb A1 c),uric acid( UA),serum creatinine( SCr),urinary albumin/SCr( ACR),SBP,DBP and waist circumference( WC) were measured.Correlation between GGT and eGFR was analyzed by linear regression analysis in male and female,respectively. Results( 1) There were significant difference between male group and female group in age,diabetic duration,WC,DBP,SCr,UA,ACR,TG,TC,LDL-C,HDL-C and GGT( all P<0. 05).( 2) With the increase of serum GGT quartiles,eGFR showed no significant difference in males but decreased in females,while age,diabetic duration,WC,BMI,DBP,UA,TG,TC,LDL-C increased in males and diabetic duration,WC,BMI,HbA1 c,UA,ACR,TG,TC increased in females( all P<0. 05).( 3) In linear regression model,after adjusted by age,diabetic duration,WC,BMI,SBP,DBP,TG,TC,LDL-C,HDL-C,HbA1 c and ACR,there was a negative correlation between serum GGT and eGFR in females( β =-0. 118,P = 0. 022). Conlusions Serum GGT in geratic females with type 2 diabetes may be one of the independent risk factors that lead to a decline in eGFR.
Objective To explore the association between serum gamma glutamyltransferase( GGT) and estimated glomerular filtration rate( eGFR) in the elderly patients with type 2 diabetes.Methods A total of 2127 patients with type 2 diabetes,with an eGFR≥60 m L/( min·1. 73 m2)( males1372 and females 755) were selected. The serum levels of GGT,triglyceride( TG),total cholesterol( TC),high-density lipoprotein cholesterol( HDL-C),low-density lipoprotein cholesterol( LDL-C),fasting plasma glucose( FPG),glycosylated hemoglobin( Hb A1 c),uric acid( UA),serum creatinine( SCr),urinary albumin/SCr( ACR),SBP,DBP and waist circumference( WC) were measured.Correlation between GGT and eGFR was analyzed by linear regression analysis in male and female,respectively. Results( 1) There were significant difference between male group and female group in age,diabetic duration,WC,DBP,SCr,UA,ACR,TG,TC,LDL-C,HDL-C and GGT( all P<0. 05).( 2) With the increase of serum GGT quartiles,eGFR showed no significant difference in males but decreased in females,while age,diabetic duration,WC,BMI,DBP,UA,TG,TC,LDL-C increased in males and diabetic duration,WC,BMI,HbA1 c,UA,ACR,TG,TC increased in females( all P<0. 05).( 3) In linear regression model,after adjusted by age,diabetic duration,WC,BMI,SBP,DBP,TG,TC,LDL-C,HDL-C,HbA1 c and ACR,there was a negative correlation between serum GGT and eGFR in females( β =-0. 118,P = 0. 022). Conlusions Serum GGT in geratic females with type 2 diabetes may be one of the independent risk factors that lead to a decline in eGFR.
引文
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[11]俞匀,卞茸文,顾刘宝,等.不同性别2型糖尿病患者血清γ-谷氨酰转肽酶水平与代谢综合征的相关性研究[J].实用老年医学,2011,25(1):26-29.
[12]Inada A,Inada O,Fujii NL,et al.Adjusting the 17β-estradiol-to-androgen ratio ameliorates diabetic nephropathy[J].JAm Soc Nephrol,2016,27(10):3035-3050.
[2]柯箫韵,翟海龙,黄飞.黄石社区2型糖尿病肾病患病率调查及其相关因素研究[J].中国全科医学,2013,16(12):1373-1375.
[3]Targher G.Elevated serum gamma-glutamyltransferase activity is associated with increased risk of mortality,incident type 2 diabetes,cardiovascular events,chronic kidney disease and cancer-a narrative review[J].Clin Chem Lab Med,2010,48(2):147-157.
[4]Liu CF,Gu YT,Wang HY,et al.Gamma-glutamyltransferase level and risk of hypertension:a systematic review and meta-analysis[J].PLoS One,2012,7(11):e48878.
[5]Levey AS,Stevens LA,Schmid CH,et al.A new equation to estimate glomerular filtration rate[J].Ann Intern Med,2009,150(9):604-612.
[6]杨叶青,刘波,徐广平,等.氧化应激相关指标在慢性肾脏病诊断中的价值[J].预防医学,2017,29(4):338-341.
[7]Ble爫C,Coculescu BI,Manole G,et al.Gamma-glutamyltransferase,possible novel biomarker in colon diverticulosis:a case-control study[J].J Enzyme Inhib Med Chem,2018,33(1):428-432.
[8]Targher G,Kendrick J,Smits G,et al.Relationship between serum gamma-glutamyltransferase and chronic kidney disease in the United States adult population.Findings from the National Health and Nutrition Examination Survey 2001-2006[J].Nutr Metab Cardiovasc Dis,2010,20(8):583-590.
[9]Nagel G,Zitt E,Peter R,et al.Body mass index and metabolic factors predict glomerular filtration rate and albuminuria over 20 years in a high-risk population[J].BMC Nephrology,2013,14(1):177.
[10]甄月巧,董瑞鸿,吴毓敏,等.血清谷氨酰转肽酶与2型糖尿病慢性肾脏疾病关系的研究[J].中国糖尿病杂志,2015,23(8):714-716.
[11]俞匀,卞茸文,顾刘宝,等.不同性别2型糖尿病患者血清γ-谷氨酰转肽酶水平与代谢综合征的相关性研究[J].实用老年医学,2011,25(1):26-29.
[12]Inada A,Inada O,Fujii NL,et al.Adjusting the 17β-estradiol-to-androgen ratio ameliorates diabetic nephropathy[J].JAm Soc Nephrol,2016,27(10):3035-3050.