空腹血糖与肾小球滤过率的相关性研究
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摘要
目的:在大样本体检人群的基础上探讨空腹血糖浓度与肾小球滤过率(GFR)的关系。方法:选取2011至2016年某医院体检中心接受体检的18～80岁的人群,检测血压并测定血清肌酐、胱抑素C、尿素氮、空腹血糖、血脂、尿酸等指标,采用CKD-EPI公式估算GFR,并分析血糖与GFR的关系。结果:年龄增加、肥胖及胱抑素C、尿素氮、尿酸、高密度脂蛋白及低密度脂蛋白异常为GFR异常的危险因素,血糖则为保护因素;进一步采用平滑曲线分析显示,老年组血糖浓度残差与GFR之间平滑曲线呈"U"型,GFR>70 ml/(min·1.73 m~2)时,血糖浓度随GFR的上升而升高,而GFR≤70 ml/(min·1.73 m~2)时,血糖浓度随着GFR的降低而升高。结论:血糖与GFR存在"U"型曲线关系。
Objective:To investigate the relationship between fasting blood glucose concentration and glomerular filtration rate (GFR). Methods:A total of 37 206 people from a hospital physical examination center,aged 18-80 years old,from 2011 to 2016,were selected as objects. The levels of serum creatinine,cystatin C,urea nitrogen,fasting blood glucose,blood lipids and uric acid were detected,and the blood pressure was examined. GFR was calculated according to the CKD-EPI formula. The relationship between blood glucose concentration and GFR was analyzed. Results:Elder,obesity and abnormal cystatin C,urea nitrogen,uric acid,high-density lipoprotein,and low-density lipoprotein were risk factors for abnormal GFR,and the blood glucose was protective factor. The smooth curve of the blood glucose concentration residuals and GFR in the elderly group showed a "U" type,and when GFR was >70 ml/(min·1.73 m~2),the blood glucose concentration increased with the increase of GFR,but when GFR was ≤ 70 ml/(min·1.73 m~2),the blood glucose concentration increased with the decrease of GFR. Conclusion:There is a "U" curve relationship between blood glucose and GFR.
Objective:To investigate the relationship between fasting blood glucose concentration and glomerular filtration rate (GFR). Methods:A total of 37 206 people from a hospital physical examination center,aged 18-80 years old,from 2011 to 2016,were selected as objects. The levels of serum creatinine,cystatin C,urea nitrogen,fasting blood glucose,blood lipids and uric acid were detected,and the blood pressure was examined. GFR was calculated according to the CKD-EPI formula. The relationship between blood glucose concentration and GFR was analyzed. Results:Elder,obesity and abnormal cystatin C,urea nitrogen,uric acid,high-density lipoprotein,and low-density lipoprotein were risk factors for abnormal GFR,and the blood glucose was protective factor. The smooth curve of the blood glucose concentration residuals and GFR in the elderly group showed a "U" type,and when GFR was >70 ml/(min·1.73 m~2),the blood glucose concentration increased with the increase of GFR,but when GFR was ≤ 70 ml/(min·1.73 m~2),the blood glucose concentration increased with the decrease of GFR. Conclusion:There is a "U" curve relationship between blood glucose and GFR.
引文
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[14]杨杉杉.老年糖尿病血尿酸与肾功能的关系[J].辽宁实用糖尿病杂志,2000,2(2):35-36.
[15]Hsu CY,McCulloch CE,Iribarren C,et al.Body mass index and risk for end-stage renal disease[J].Ann Intern Med,2006,144(1):21-28.
[16]Chen W,Chen W,Wang H,et al.Prevalence and risk factors associated with chronic kidney disease in an adult population from southern China[J].Nephrol Dial Transplant,2009,24(4):1205-1212.
[17]Noborisaka Y.Smoking and chronic kidney disease in healthy populations[J].Nephrourol Mon,2013,5(1):655-667.
[18]Shankar A,Klein R,Klein BE.The association among smoking,heavy drinking,and chronic kidney disease[J].Am JEpidemiol,2006,164(3):263-271.
[19]汪月娟.中国成人高血压患者空腹血糖状态与肾小球高滤过的关联性分析及高滤过对肾病进展风险影响的队列研究[D].广州:南方医科大学,2015.
[20]Brands MW,Bell TD,Rodriquez NA,et al.Chronic glucose infusion causes sustained increases in tubular sodium reabsorption and renal blood flow in dogs[J].Am J Physiol Regul Integr Comp Physiol,2009,296(2):R265-R271.
[21]Brenner BM,Lawler EV,Mackenzie HS.The hyperfiltration theory:a paradigm shift in nephrology[J].Kidney Int,1996,49(6):1774-1777.
[22]Palatini P,Mormino P,Dorigatti F,et al.Glomerular hyperfiltration predicts the development of microalbuminuria in stage 1hypertension:the HARVEST[J].Kidney Int,2006,70(3):578-584.
[23]Premaratne E,Macisaac RJ,Tsalamandris C,et al.Renal hyperfiltration in type 2 diabetes:effect of age-related decline in glomerular filtration rate[J].Diabetologia,2005,48(12):2486-2493.
[24]Hoy WE,Douglas-Denton RN,Hughson MD,et al.A stereological study of glomerular number and volume:preliminary findings in a multiracial study of kidneys at autopsy[J].Kidney Int Suppl,2003(83):S31-S37.2018-04-23
[2]Hou FF.Cardiovascular risk in Chinese patients with chronic kidney diseases:where do we stand?[J].Chin Med J(Engl),2005,118(11):883-886.
[3]Fried LF,Shlipak MG,Crump C,et al.Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals[J].J Am Coll Cardiol,2003,41(8):1364-1372.
[4]Fox CS,Matsushita K,Woodward M,et al.Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes:a meta-analysis[J].Lancet,2012,380(9854):1662-1673.
[5]余海峰,赵梅霖,聂艳芳,等.高尿酸合并高血压对肾功能影响的分析[J].中华全科医师杂志,2014,13(12):986-989.
[6]Rodenbach KE,Schneider MF,Furth SL,et al.Hyperuricemia and progression of CKD in children and adolescents:the chronic kidney disease in children(CKiD)cohort study[J].Am J Kidney Dis,2015,66(6):984-992.
[7]Pyram R,Kansara A,Banerji MA,et al.Chronic kidney disease and diabetes[J].Maturitas,2012,71(2):94-103.
[8]Plantinga LC,Crews DC,Coresh J,et al.Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes[J].Clin J Am Soc Nephrol,2010,5(4):673-682.
[9]Redon J,Morales-Olivas F,Galgo A,et al.Urinary albumin excretion and glomerular filtration rate across the spectrum of glucose abnormalities in essential hypertension[J].J Am Soc Nephrol,2006,17(12 Suppl 3):S236-S245.
[10]White SL,Cass A,Atkins RC,et al.Chronic kidney disease in the general population[J].Adv Chronic Kidney Dis,2005,12(1):5-13.
[11]Fox CS,Larson MGS,Leip EP,et al.Predictors of new-onset kidney disease in a community-based population[J].JAMA.2004,291(7):844-850.
[12]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.
[13]Levey AS,Eckardt KU,Tsukamoto Y,et al.Definition and classification of chronic kidney disease:a position statement from Kidney Disease:Improving Globsl Outcomes(KDIGO)[J].Kidney Int,2005,67(6):2089-2100.
[14]杨杉杉.老年糖尿病血尿酸与肾功能的关系[J].辽宁实用糖尿病杂志,2000,2(2):35-36.
[15]Hsu CY,McCulloch CE,Iribarren C,et al.Body mass index and risk for end-stage renal disease[J].Ann Intern Med,2006,144(1):21-28.
[16]Chen W,Chen W,Wang H,et al.Prevalence and risk factors associated with chronic kidney disease in an adult population from southern China[J].Nephrol Dial Transplant,2009,24(4):1205-1212.
[17]Noborisaka Y.Smoking and chronic kidney disease in healthy populations[J].Nephrourol Mon,2013,5(1):655-667.
[18]Shankar A,Klein R,Klein BE.The association among smoking,heavy drinking,and chronic kidney disease[J].Am JEpidemiol,2006,164(3):263-271.
[19]汪月娟.中国成人高血压患者空腹血糖状态与肾小球高滤过的关联性分析及高滤过对肾病进展风险影响的队列研究[D].广州:南方医科大学,2015.
[20]Brands MW,Bell TD,Rodriquez NA,et al.Chronic glucose infusion causes sustained increases in tubular sodium reabsorption and renal blood flow in dogs[J].Am J Physiol Regul Integr Comp Physiol,2009,296(2):R265-R271.
[21]Brenner BM,Lawler EV,Mackenzie HS.The hyperfiltration theory:a paradigm shift in nephrology[J].Kidney Int,1996,49(6):1774-1777.
[22]Palatini P,Mormino P,Dorigatti F,et al.Glomerular hyperfiltration predicts the development of microalbuminuria in stage 1hypertension:the HARVEST[J].Kidney Int,2006,70(3):578-584.
[23]Premaratne E,Macisaac RJ,Tsalamandris C,et al.Renal hyperfiltration in type 2 diabetes:effect of age-related decline in glomerular filtration rate[J].Diabetologia,2005,48(12):2486-2493.
[24]Hoy WE,Douglas-Denton RN,Hughson MD,et al.A stereological study of glomerular number and volume:preliminary findings in a multiracial study of kidneys at autopsy[J].Kidney Int Suppl,2003(83):S31-S37.2018-04-23