摘要
目的探讨2型糖尿病患者肾小球滤过率(GFR)的动态改变及相关临床因素的关系。方法1994～2008年进行过两次核素测定GFR的2型糖尿病住院患者309例,初次测定的GFR为基线值,根据末次测定GFR时的糖尿病病程分为3组;Ⅰ组:病程≤10年,76例,年龄(56.9±13.0)岁;Ⅱ组:病程>10～20年,139例,年龄(65.1±9.1)岁;Ⅲ组:病程>20年,94例,年龄(71.0±9.8)岁。各组之间末次GFR及同期测定的相关临床因素进行比较,计算GFR年下降率。结果随着年龄与糖尿病病程的增加,Ⅲ组的基线GFR、末次GFR均明显低于Ⅰ组、Ⅱ组,基线GFRⅠ组、Ⅱ组、Ⅲ组分别为(73.5±26.8)ml/min、(71.6±22.0)ml/min、(63.0±21.3)ml/min;末次GFRⅠ组、Ⅱ组、Ⅲ组分别为(67.5±27.7)ml/min、(61.6±24.8)ml/min、(47.0±23.4)ml/min(P<0.01)。Ⅰ组、Ⅱ组、Ⅲ组的GFR年下降率分别为(3.6±10.4)ml/min,(2.7±7.8)ml/min,(4.6±7.4)ml/min(P>0.05)。合并高血压的糖尿病患者较未合并高血压的糖尿病的基线GFR、末次GFR均明显降低,未合并高血压的糖尿病基线GFRⅠ组、Ⅱ组、Ⅲ组分别为(87.9±18.5)ml/min、(80.2±19.1)ml/min、(79.3±19.0)ml/min;末次GFRⅠ组、Ⅱ组、Ⅲ组分别为(85.0±22.5)ml/min、(75.0±18.7)ml/min、(68.6±17.0)ml/min。合并高血压的糖尿病基线GFRⅠ组、Ⅱ组、Ⅲ组分别为(66.0±18.0)ml/min、(68.1±22.2)ml/min、(59.2±20.1)ml/min;末次GFRⅠ组、Ⅱ组、Ⅲ组分别为(58.4±25.9)ml/min、(56.2±25.0)ml/min、(41.9±21.8)ml/min(P<0.01)。结论年龄、病程是糖尿病肾病重要的独立危险因素,病程在20年以上的糖尿病患者GFR下降更为显著。合并高血压糖尿病患者的GFR以更快的速率下降。
Objective To observe dynamic change and influencing factors of glomerular filtration rate（GFR） in type 2 diabetes. Methods 309 type 2 diabetic patients in 1994 -- 2008 were divided into three groups according to diabetes duration of last GFR： group Ⅰ （diabetes duration ≤10 years, n = 76） ; group Ⅱ （diabetes duration 〉 l0 - 20 years, n = 139）;group Ⅲ （diabetes duration 〉20 years, n= 94）. Last GFR and clinical characteristics were compared; baseline GFR,last GFR and the rate of GFR decline in type 2 diabetes with hypertension were compared,too. The rate of GFR decline was calculated. Results With age and diabetes duration increasing,baseline GFR and last GFR of group Ⅲ were more evidently decreased than those of group Ⅰ and group Ⅱ , baseline GFR： group Ⅰ was （73.5 ± 26.8） ml/ min,group Ⅱ was （71.6±22.0） ml/min,group Ⅲ was （63.0±21.3） ml/min,last GFR：group Ⅰ was （67.5±27.7） ml/min,group Ⅱ was （61.6±24.8） ml/min,group Ⅲ was （47.0±23.4） ml/min （ P 〈0.01） . The average yearly rate of GFR decline of group Ⅰ was （3.6±10.4） ml/min,group Ⅱ was （2.7±7.8） ml/min,group Ⅲ was （4.6± 7.4） ml/min （ P 〉0.05）. Compared with baseline GFR and last GFR,type 2 diabetes patients with hypertension were more evidently decreased than type 2 diabetes ones without hypertension. In groups of type＇ 2 diabetes without hypertension,baseline GFR：group Ⅰ was （87.9±18.5） ml/min,group 11 was （80.2± 19.1） ml/min,group Ⅲ was （79.3±19.0） ml/min,last GFR：group Ⅰ was （85.0±22.5） ml/min,group Ⅱ was （75.0±18.7） ml/min,group Ⅲ was （68.6±17.0） ml/min. In groups of type 2 diabetes with hypertension,baseline GFR：group Ⅰ was （66.0±18.0） ml/min,group Ⅱ was （68. 1±22.2） ml/min,group Ⅲ was （59.2±20.1） ml/min, last GFR：group Ⅰ was （58.4±25.9） ml/min,group Ⅱ was （56.2±25.0） ml/min,group Ⅲ was （41.9±21.8） ml/min （ P 〈0.01）,but the yearly rate of GFR decline was rio significant difference between with the patients hypertension or without hypertension （P〉0.05）. Conclusion Age and diabetes duration are important dangerous factors to diabetic nephropathy, GFR is more significantly decreased in diabetes duration 〉 20 years. GFR is more significantly decreased for type 2 diabetes with hypertension.
出处
《临床荟萃》
CAS
2009年第4期300-303,共4页
Clinical Focus
关键词
糖尿病肾病
肾小球滤过率
危险因素
diabetic nephropathy
glomerular filtration rate,risk factors
