2型糖尿病患者伴慢性肾脏病和外周动脉疾病对全因死亡和心血管疾病死亡的影响
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摘要
目的评价2型糖尿病(type 2 diabetes mellitus,T2DM)患者伴慢性肾脏病(chronic kidney disease,CKD)和外周动脉疾病(peripheral arterial disease,PAD)对全因和心血管疾病(cardiovascular disease,CVD)死亡的影响。方法 2004年7月—2005年1月,收集北京和上海地区8所医院的T2DM患者1 559例。根据是否患有CKD或PAD,将研究对象分为不同的CKD/PAD组,对其进行5年的随访研究。使用生存分析比较各组的生存率,使用COX比例风险模型比较各组的全因和CVD死亡相对危险度(relative risk,RR)。结果经过5年随访,共获得1 343例T2DM患者的完整随访资料。随访期间,共发生全因死亡370例(27. 55%),其中CVD死亡185例(13. 78%)。与非PAD非CKD组相比较,CKD合并PAD组的全因和CVD死亡率最高,其RR值分别为3. 12(95%CI:2. 30～4. 24)和3. 47(95%CI:2. 29～5. 24)。结论 T2DM患者同时伴CKD和PAD具有较高的全因和CVD死亡风险。
Objective To evaluate the effect of chronic kidney disease(CKD) and peripheral arterial disease(PAD) on all-cause and CVD mortality in patients with type 2 diabetes mellitus(T2DM).Methods A total of 1 559 T2DM patients were recruited from eight hospitals in Beijing and Shanghai from July 2004 to January 2005.Patients were categorized into different CKD/PAD groups,according to their CKD and PAD status.Survival rates among different CKD/PAD groups were compared after a5-year followup.Cox regression model was used to compare relative risk(RR) of death from all-cause and CVD.Results In total,1 343 T2DM patients completed the 5-year follow-up.The number of allcause and CVD deaths was 370(27.55%) and 185(13.78%),respectively.Compared with the group of no CKD and PAD,patients in the CKD and PAD group had the higher all-cause and CVD mortality(RR: 3.12,95%CI: 2.30-4.24; RR: 3.47,95%CI: 2.29-5.24).Conclusion T2DM patients with combined CKD and PAD have a high risk of all-cause and CVD mortality.
Objective To evaluate the effect of chronic kidney disease(CKD) and peripheral arterial disease(PAD) on all-cause and CVD mortality in patients with type 2 diabetes mellitus(T2DM).Methods A total of 1 559 T2DM patients were recruited from eight hospitals in Beijing and Shanghai from July 2004 to January 2005.Patients were categorized into different CKD/PAD groups,according to their CKD and PAD status.Survival rates among different CKD/PAD groups were compared after a5-year followup.Cox regression model was used to compare relative risk(RR) of death from all-cause and CVD.Results In total,1 343 T2DM patients completed the 5-year follow-up.The number of allcause and CVD deaths was 370(27.55%) and 185(13.78%),respectively.Compared with the group of no CKD and PAD,patients in the CKD and PAD group had the higher all-cause and CVD mortality(RR: 3.12,95%CI: 2.30-4.24; RR: 3.47,95%CI: 2.29-5.24).Conclusion T2DM patients with combined CKD and PAD have a high risk of all-cause and CVD mortality.
引文
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[21]WATTANAKIT K,FOLSOM A R,SELVIN E,et al.Kidney function and risk of peripheral arterial disease:results from the Atherosclerosis Risk in Communities(ARIC)Study[J].J Am Soc Nephrol,2007,18(2):629-636.
[22]ITAYA H,SHIBA M,JOKI N,et al.Combined assessment of chronic kidney disease and subclinical peripheral artery disease used to predict future cardiac events[J].Nephrology,2010,15(2):230-235.
[23]FOSTER M C,GHUMAN N,HWANG S J,et al.Low ankle-brachial index and the development of rapid estimated GFR decline and CKD[J].Am J Kidney Dis,2013,61(2):204-210.
[24]于淼,彭艾,余晨,等.2型糖尿病肾病患者生存质量多重线性逐步回归分析[J].同济大学学报(医学版),2017,38(5):108-112.
[2]STAUFFER M E,FAN T.Prevalence of anemia in chronic kidney disease in the United States[J].PLoSONE,2014,9(1):e84943.
[3]ZHANG L,WANG F,WANG L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.
[4]SELVIN E,ERLINGER T P.Prevalence of and risk factors for peripheral arterial disease in the United States:results from the National Health and Nutrition Examination Survey,1999-2000[J].Circulation,2004,110(6):738-743.
[5]LI J,LUO Y,XU Y,et al.Risk factors of peripheral arterial disease and relationship betw een low ankle-brachial index and mortality from all-cause and cardiovascular disease in Chinese patients w ith type 2 diabetes[J].Cir J,2007,71(3):377-381.
[6]O’HARE A M,GLIDDEN D V,FOX C S,et al.High prevalence of peripheral arterial disease in persons w ith renal insufficiency:results from the National Health and Nutrition Examination Survey 1999-2000[J].Circulation,2004,109(3):320-323.
[7]De VINUESA S G,ORTEGA M,MARTINEA P,et al.Subclinical peripheral arterial disease in patients w ith chronic kidney disease:prevalence and related risk factors[J].Kidney Int Suppl,2005(93):S44-47.
[8]SARMENTO C,PEREIRA T,MALDONADO J,et al.Peripheral artery disease and kidney function in hypertensive patients[J].Arq Bras Cardiol,2013,100(4):362-367.
[9]GO A S,CHERTOW G M,FAN D,et al.Chronic kidney disease and the risks of death,cardiovascular events,and hospitalization[J].N Engl J M ed,2004,351(13):1296-1305.
[10]FOWKES F G,MURRAY G D,BUTCHER I,et al.Ankle brachial index combined w ith Framingham Risk Score to predict cardiovascular events and mortality:a meta-analysis[J].JAM A,2008,300(2):197-208.
[11]LIEW Y P,BARTHOLOMEW J R,DEMIRJIAN S,et al.Combined effect of chronic kidney disease and peripheral arterial disease on all-cause mortality in a high-risk population[J].Clin J Am Soc Nephrol,2008,3(4):1084-1089.
[12]JIN X,MA J H,SHEN Y,et al.An analysis of the relationship betw een ankle-brachial index and estimated glomerular filtration rate in type 2 diabetes[J].Angiology,2013,64(3):237-241.
[13]XU D C,LI J,ZOU L L,et al.Sensitivity and specificity of the ankle-brachial index to diagnose peripheral artery disease:a structured review[J].Vasc M ed,2010,15(5):361-369.
[14]HIRSCH A T,HASKAL Z J,HERTZER N R,et al.ACC/AHA 2005 guidelines for the management of patients w ith peripheral arterial disease[J].J Am Coll Cardiol,2006,47(6):1239-312.
[15]KIDNEY DISEASE IMPROVING GLOBAL OUT-COM ES CKD WORK GROUP.KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease[J].Kidney Int Suppl,2013,3:1-150.
[16]LEVEY A S,STEVENS L A,SCHIMID C H,et al.A new equation to estimate glomerular filtration rate[J].Ann Intern Med,2009,150(9):604-612.
[17]MATSUSHITA K,MAHMOODI B K,WOODWARDM,et al.Comparison of risk prediction using the CKD-EPI equation and the M DRD study equation for estimated glomerular filtration rate[J].JAM A,2012,307(18):1941-1951.
[18]CHEN S C,CHANG J M,LIU W C,et al.Brachialankle pulse w ave velocity and rate of renal function decline and mortality in chronic kidney disease[J].Clin JAm Soc Nephrol,2011,6(4):724-732.
[19]FORD M L,TOMLINSON L A,CHAPMAN T P,et al.Aortic stiffness is independently associated with rate of renal function decline in chronic kidney disease stages3 and 4[J].Hypertension,2010,55(5):1110-1115.
[20]TAAL M W,SIGRIST M K,FAKIS A,et al.Markers of arterial stiffness are risk factors for progression to endstage renal disease among patients with chronic kidney disease stages 4 and 5[J].Nephron Clin Pract,2007,107(4):c177-c181.
[21]WATTANAKIT K,FOLSOM A R,SELVIN E,et al.Kidney function and risk of peripheral arterial disease:results from the Atherosclerosis Risk in Communities(ARIC)Study[J].J Am Soc Nephrol,2007,18(2):629-636.
[22]ITAYA H,SHIBA M,JOKI N,et al.Combined assessment of chronic kidney disease and subclinical peripheral artery disease used to predict future cardiac events[J].Nephrology,2010,15(2):230-235.
[23]FOSTER M C,GHUMAN N,HWANG S J,et al.Low ankle-brachial index and the development of rapid estimated GFR decline and CKD[J].Am J Kidney Dis,2013,61(2):204-210.
[24]于淼,彭艾,余晨,等.2型糖尿病肾病患者生存质量多重线性逐步回归分析[J].同济大学学报(医学版),2017,38(5):108-112.