80岁及以上2型糖尿病患者近端肾小管损伤的危险因素分析
|
摘要
目的探讨80岁及以上2型糖尿病患者近端肾小管损伤的危险因素。方法选取2014年1月～2016年7月于浙江省人民医院望江山院区住院的248例2型糖尿病患者(年龄≥80岁)作为研究对象,收集年龄、既往病史、用药史、糖尿病病程、血糖、生化、尿敏感肾功能等数据,测量血压、身高、体重。以本院检验科α1微球蛋白水平上限为切点将受检者分为α1微球蛋白≥12 mg/L和α1微球蛋白<12 mg/L两组,α1微球蛋白≥12 mg/L定义为肾小管受损。分析80岁及以上2型糖尿病患者近端肾小管损伤的危险因素。结果本研究人群中肾小管损伤的总数为63例,患病率为30.9%。以尿α1微球蛋白分组进行多元Logistic分析,结果显示,男性(OR=4.92,95%CI:1.84～13.14;P=0.0020)、空腹血糖(OR=1.22,95%CI:1.05～1.42;P=0.0090)、糖化血红蛋白(OR=1.78,95%CI:1.34～2.37;P<0.0001)是近端肾小管损伤的危险因素。结论男性、空腹血糖、糖化血红蛋白是80岁及以上2型糖尿病患者近端肾小管损伤的危险因素。
Objective To investigate the risk factors of proximal renal tubular injury in the patients with type 2 diabetes aged equal or greater than 80 years old.Methods A total of 248 patients with type 2 diabetes(age≥80 years old)who were admitted to the Wangjiangshan Branch of Zhejiang Provincial People's Hospital from January 2014 to July2016 were selected as study subjects.Data such as age,past medical history,medication history,duration of diabetes,blood glucose,biochemistry,and urinary sensitive renal function were collected,and blood pressure,height,and weight were measured.The subjects were divided into α1 microglobulin ≥12 mg/L group and α1 microglobulin <12 mg/L group in the upper limit of the α1 microglobulin level in the clinical laboratory of our hospital.α1 microglobulin ≥12 mg/L was defined as tubular damage.The risk factors of proximal renal tubular injury in the patients with type 2 diabetes aged equal or greater than 80 years old were analyzed.Results The total number patients with renal tubular injuries in the study population was 63 cases,and the prevalence was 30.9%.Multivariate Logistic analysis was carried out with urinary α1 microglobulin grouping.The results showed that male(OR=4.92,95%CI:1.84-13.14;P=0.002),fasting blood glucose(OR=1.22,95%CI:1.05-1.42;P=0.009) and glycated hemoglobin(OR=1.78,95%CI:1.34-2.37;P<0.0001) were risk factors for proximal renal tubular injury.Conclusion Male,fasting blood glucose and glycosylated hemoglobin are risk factors for proximal renal tubular injury in the patients with type 2 diabetes aged equal or greater than 80 years old.
Objective To investigate the risk factors of proximal renal tubular injury in the patients with type 2 diabetes aged equal or greater than 80 years old.Methods A total of 248 patients with type 2 diabetes(age≥80 years old)who were admitted to the Wangjiangshan Branch of Zhejiang Provincial People's Hospital from January 2014 to July2016 were selected as study subjects.Data such as age,past medical history,medication history,duration of diabetes,blood glucose,biochemistry,and urinary sensitive renal function were collected,and blood pressure,height,and weight were measured.The subjects were divided into α1 microglobulin ≥12 mg/L group and α1 microglobulin <12 mg/L group in the upper limit of the α1 microglobulin level in the clinical laboratory of our hospital.α1 microglobulin ≥12 mg/L was defined as tubular damage.The risk factors of proximal renal tubular injury in the patients with type 2 diabetes aged equal or greater than 80 years old were analyzed.Results The total number patients with renal tubular injuries in the study population was 63 cases,and the prevalence was 30.9%.Multivariate Logistic analysis was carried out with urinary α1 microglobulin grouping.The results showed that male(OR=4.92,95%CI:1.84-13.14;P=0.002),fasting blood glucose(OR=1.22,95%CI:1.05-1.42;P=0.009) and glycated hemoglobin(OR=1.78,95%CI:1.34-2.37;P<0.0001) were risk factors for proximal renal tubular injury.Conclusion Male,fasting blood glucose and glycosylated hemoglobin are risk factors for proximal renal tubular injury in the patients with type 2 diabetes aged equal or greater than 80 years old.
引文
[1] Pofi R,Di MF,Gigante A,et al. Diabetic Nephropathy:Focus on Current and Future Therapeutic Strategies[J].Current Drug Metabolism,2016,17(5):479-502.
[2] Alpers CE,Hudkins KL. Pathology identifies glomerular treatment targets in diabetic nephropathy[J]. Kidney Res Clin Pract,2018,37(2):106-111.
[3] Bonventre JV. Can we target tubular damage to prevent renal function decline in diabetes?[J]. Semin Nephrol,2012,32(5):452-462.
[4] Terami T,Wada J,Inoue K,et al. Urinary angiotensinogen is a marker for tubular injuries in patients with type2 diabetes[J]. International Journal of Nephrology&Renovascular Disease,2013,6(default):233-240.
[5]欧阳涓,姜傥.肾脏的损伤性诊断[J].中华检验医学杂志,2005,28(8):877-879.
[6] Shaw JE,Zimmet PZ,Mccarty D,et al. Type 2 diabetes worldwide according to the new classification and criteria[J].Diabetes Care,2000,23(2):B5-B10.
[7] Martinovic AB,Zdravkovic A. A mass survey of diabetes mellitus in a population of 300,000 in 14 provinces and municipalities in China[J]. Zhonghua Nei Ke Za Zhi,1981,20(11):678-683.
[8] Pan XR,Yang WY,Li GW,et al. Prevalence of diabetes and its risk factors in China,1994. National Diabetes Prevention and Control Cooperative Group[J]. Diabetes Care,1997,20(11):1664-1669.
[9] Gu D,Reynolds K,Duan X,et al. Prevalence of diabetes and impaired fasting glucose in the Chinese adult population:International Collaborative Study of Cardiovascular Disease in Asia(InterASIA)[J]. Diabetologia,2012,55(10):2861-2862.
[10] Yang W,Lu J,Weng J,et al. Prevalence of diabetes among men and women in China[J]. New England Journal of Medicine,2010,362(12):1090-1101.
[11] Xu Y,Wang L,He J,et al. Prevalence and control of diabetes in Chinese adults[J]. Jama the Journal of the American Medical Association,2013,310(9):948-958.
[12]任惠珠,杨菊红,单春艳,等. 2型糖尿病患者肾小管功能受损与动态血压节律的关系[J].中国糖尿病杂志,2016,8(8):478-482.
[13] Seppi T,Prajczer S,D觟rler MM,et al. Sex Differences in Renal Proximal Tubular Cell Homeostasis[J]. Journal of the American Society of Nephrology,2016,27(10):3051-3062.
[14] Turin TC,Tonelli M,Manns BJ,et al. Lifetime risk of ESRD[J]. Journal of the American Society of Nephrology Jasn,2012,23(9):1569-1578.
[15]姜旭,张茜,刘蕊,等. 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[J].中国糖尿病杂志,2017,25(4):334-338.
[16] Jelinsky SA,Harris HA,Brown EL,et al. Global transcription profiling of estrogen activity:estrogen receptor alpha regulates gene expression in the kidney[J]. Endocrinology,2003,144(2):701-710.
[17] Nordquist L,Brown R,Fasching A,et al. Proinsulin Cpeptide reduces diabetes-induced glomerular hyperfiltration via efferent arteriole dilation and inhibition of tubular sodium reabsorption[J]. Am J Physiol Renal Physiol,2009,297(5):1265-1272.
[18] Qi W,Chen X,Zhang Y,et al. High glucose induces macrophage inflammatory protein-3αin renal proximal tubule cells via a transforming growth factor-β1 dependent mechanism[J]. Nephrology,Dialysis,Transplantation,2007,22(11):3147-3153.
[19] Miyauchi K,Takiyama Y,Honjyo J,et al. Upregulated IL-18 expression in type 2 diabetic subjects with nephropathy:TGF-beta1 enhanced IL-18 expression in human renal proximal tubular epithelial cells[J]. Diabetes Research and Clinical Practice,2009,83(2):190-199.
[20] Zhang X,Zhao Y,Chu Q,et al. Zinc modulates high glucose-induced apoptosis by suppressing oxidative stress in renal tubular epithelial cells[J]. Biological Trace Element Research,2014,158(2):259-267.
[21]许娟,亓文波.糖尿病肾病的肾小管损伤研究进展[J].国际内分泌代谢杂志,2008,28(2):123-125.
[2] Alpers CE,Hudkins KL. Pathology identifies glomerular treatment targets in diabetic nephropathy[J]. Kidney Res Clin Pract,2018,37(2):106-111.
[3] Bonventre JV. Can we target tubular damage to prevent renal function decline in diabetes?[J]. Semin Nephrol,2012,32(5):452-462.
[4] Terami T,Wada J,Inoue K,et al. Urinary angiotensinogen is a marker for tubular injuries in patients with type2 diabetes[J]. International Journal of Nephrology&Renovascular Disease,2013,6(default):233-240.
[5]欧阳涓,姜傥.肾脏的损伤性诊断[J].中华检验医学杂志,2005,28(8):877-879.
[6] Shaw JE,Zimmet PZ,Mccarty D,et al. Type 2 diabetes worldwide according to the new classification and criteria[J].Diabetes Care,2000,23(2):B5-B10.
[7] Martinovic AB,Zdravkovic A. A mass survey of diabetes mellitus in a population of 300,000 in 14 provinces and municipalities in China[J]. Zhonghua Nei Ke Za Zhi,1981,20(11):678-683.
[8] Pan XR,Yang WY,Li GW,et al. Prevalence of diabetes and its risk factors in China,1994. National Diabetes Prevention and Control Cooperative Group[J]. Diabetes Care,1997,20(11):1664-1669.
[9] Gu D,Reynolds K,Duan X,et al. Prevalence of diabetes and impaired fasting glucose in the Chinese adult population:International Collaborative Study of Cardiovascular Disease in Asia(InterASIA)[J]. Diabetologia,2012,55(10):2861-2862.
[10] Yang W,Lu J,Weng J,et al. Prevalence of diabetes among men and women in China[J]. New England Journal of Medicine,2010,362(12):1090-1101.
[11] Xu Y,Wang L,He J,et al. Prevalence and control of diabetes in Chinese adults[J]. Jama the Journal of the American Medical Association,2013,310(9):948-958.
[12]任惠珠,杨菊红,单春艳,等. 2型糖尿病患者肾小管功能受损与动态血压节律的关系[J].中国糖尿病杂志,2016,8(8):478-482.
[13] Seppi T,Prajczer S,D觟rler MM,et al. Sex Differences in Renal Proximal Tubular Cell Homeostasis[J]. Journal of the American Society of Nephrology,2016,27(10):3051-3062.
[14] Turin TC,Tonelli M,Manns BJ,et al. Lifetime risk of ESRD[J]. Journal of the American Society of Nephrology Jasn,2012,23(9):1569-1578.
[15]姜旭,张茜,刘蕊,等. 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[J].中国糖尿病杂志,2017,25(4):334-338.
[16] Jelinsky SA,Harris HA,Brown EL,et al. Global transcription profiling of estrogen activity:estrogen receptor alpha regulates gene expression in the kidney[J]. Endocrinology,2003,144(2):701-710.
[17] Nordquist L,Brown R,Fasching A,et al. Proinsulin Cpeptide reduces diabetes-induced glomerular hyperfiltration via efferent arteriole dilation and inhibition of tubular sodium reabsorption[J]. Am J Physiol Renal Physiol,2009,297(5):1265-1272.
[18] Qi W,Chen X,Zhang Y,et al. High glucose induces macrophage inflammatory protein-3αin renal proximal tubule cells via a transforming growth factor-β1 dependent mechanism[J]. Nephrology,Dialysis,Transplantation,2007,22(11):3147-3153.
[19] Miyauchi K,Takiyama Y,Honjyo J,et al. Upregulated IL-18 expression in type 2 diabetic subjects with nephropathy:TGF-beta1 enhanced IL-18 expression in human renal proximal tubular epithelial cells[J]. Diabetes Research and Clinical Practice,2009,83(2):190-199.
[20] Zhang X,Zhao Y,Chu Q,et al. Zinc modulates high glucose-induced apoptosis by suppressing oxidative stress in renal tubular epithelial cells[J]. Biological Trace Element Research,2014,158(2):259-267.
[21]许娟,亓文波.糖尿病肾病的肾小管损伤研究进展[J].国际内分泌代谢杂志,2008,28(2):123-125.