文章摘要

2型糖尿病患者肾小球滤过率与外周血管病变的相关性

作者: 1张梦夏, 1叶启宝, 1刘尚全
1 安徽医科大学第三附属医院,合肥市第一人民医院内分泌科,合肥 230000
通讯: 刘尚全 Email: 52100325@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.08.009

摘要

目的:探讨2型糖尿病(Type 2 diabetes mellitus,T2DM)患者肾小球滤过率与外周血管病变之间的关系。方法:回顾性分析符合纳入标准的2010年1月至2016年12月于安徽医科大学第三附属医院内分泌科住院的T2DM患者1 248例,收集患者一般资料与临床生化指标,应用肾脏疾病饮食改良(modification of diet in renal disease,MDRD)简化公式估算肾小球滤过率(glomerular filtration rate,GFR),应用颈部和双下肢血管超声联合诊断外周血管病变。分析GFR与外周血管病变之间的相关性。根据GFR水平将患者5组:GFR≥90 mL/min/1.73 m2,75~<90 mL/min/1.73 m2,60~<75 mL/min/1.73 m2,30~<60 mL/min/1.73 m2,<30 mL/min/1.73 m2。比较各组患者外周血管病变受累程度及双下肢血管病变类型的不同。结果:外周血管病变与GFR呈负相关(r=−0.263,P<0.01),GFR是发生外周血管的危险因素(B=−0.12,P<0.05)。随着GFR水平的下降,颈部和双下肢血管两处均有病变的发生率逐渐上升(χ2=87.972,P<0.05)。以GFR≥90 mL/min/1.73 22组作为参照组,随着GFR水平的降低,双下肢血管斑块[OR (95%CI)分别为1,1.703 (1.077~2.692),2.003 (1.051~3.817),2.471 (1.062~5.751),11.102 (1.336~93.274),P<0.05]、狭窄[OR (95%CI)分别为1,3.734 (1.72~8.109),4.368 (1.632~11.546),5.773 (1.857~17.980),25.802 (1.73~384.785),P<0.05]、闭塞[OR (95%CI)分别为1,2.584 (1.197~5.579),3.932 (1.554~9.946),4.313 (1.415~12.875),22.195 (1.680−293.261),P<0.05]的患病风险增大。结论:GFR是T2DM患者外周血管病变的危险因素,且T2DM患者外周血管病变的严重程度与肾脏损伤的进展有同步趋势。
关键词: 2型糖尿病;外周血管病变;肾小球滤过率;相关性

Correlation between glomerular filtration rate and peripheral vascular lesions in type 2 diabetes patients

Authors: 1ZHNAG Mengxia, 1YE Qibao, 1LIU Shangquan
1 Department of Endocrinology, Third Affiliated Hospital of Anhui Medical University, Hefei First People’s Hospital, Hefei 230000, China

CorrespondingAuthor: LIU Shangquan Email: 52100325@qq.com

DOI: 10.3978/j.issn.2095-6959.2020.08.009

Abstract

Objective: To investigate the relationship between glomerular filtration rate and peripheral vascular lesions in Type 2 diabetes mellitus (T2DM) patients. Methods: A retrospective analysis of 1 248 patients with T2DM hospitalized in the Department of Endocrinology, Third Affiliated Hospital of Anhui Medical University from January 2010 to December 2016 was carried out. General data and clinical biochemical indicators were collected. The glomerular filtration rate (GFR) was estimated by simplified formula of Modification of Diet in Renal Disease (MDRD). Neck and lower limbs were used. Diagnosis of peripheral vascular diseases by vascular ultrasound. The correlation between GFR and peripheral vascular lesions was analyzed. According to the level of GFR, the patients were divided into five groups: GFR ≥90 mL/min/1.73 m2, 75–<90 mL/min/1.73 m2, 60–<75 mL/min/1.73 m2, 30–<60 mL/min/1.73 m2, and <30 mL/min/1.73 m2. To compare the degree of involvement of peripheral vascular diseases and the different types of vascular diseases of both lower limbs in each group. Results: There was a negative correlation between GFR and peripheral vascular disease (r=−0.263, P<0.01). GFR was a risk factor for peripheral vascular disease (B=−0.12, P<0.05). With the decrease of GFR level, the incidence of vascular lesions in both neck and lower limbs increased gradually (χ2=87.972, P<0.05), and the difference was statistically significant. With GFR ≥90 mL/min/1.73 m2 group as the control group, with the decrease of GFR levels. The risk of vascular plaque[OR (95% CI) was 1, 1.703 (1.077–2.692), 2.003 (1.051–3.817), 2.471 (1.062–5.751), 11.102 (1.336–93.274), P<0.05], stenosis[OR (95% CI) were 1, 3.734 (1.72–8.109), 4.368 (1.632−11.546), 5.773 (1.857−17.980), 25.802 (1.73–384.785), P<0.05], and occlusion[OR (95% CI) were 1, 2.584 (1.197–5.579), 3.932 (1.554–9.946), 4.313 (1.415−12.875), 22.195 (1.680−293.261), P<0.05] in both lower extremities is increasing. Conclusion: GFR is an increasing risk factor for peripheral vascular lesions in patients with T2DM, and the severity of the peripheral vascular lesions in patients with T2DM is synchronized with the progression of renal injury.
Keywords: Type 2 diabetes mellitus; peripheral vascular disease; glomerular filtration rate; correlation