摘要
目的探讨老年2型糖尿病合并高血压患者肠道微生物分布与估算肾小球滤过率(eGFR)的关系。方法选取老年2型糖尿病合并高血压患者225例为研究对象,以改良的肾脏病膳食改良试验(MDRD)方程计算患者入院时的eGFR,分为eGFR降低组[<60ml(/min 1.73m2)]63例和eGFR正常组[≥60ml(/min 1.73m2)]162例。分析并比较两组患者一般临床资料和生化检查、肠道微生物计数结果,并采用logistic回归方程分析肠道微生物与eGFR降低的关系。结果与eGFR正常组比较,eGFR降低组收缩压、空腹血糖、餐后2h血糖、糖化血红蛋白、甘油三酯、尿酸、血肌酐、血尿素氮、白细胞计数、C反应蛋白水平均较高(均P<0.05);乳酸杆菌、双歧杆菌、拟杆菌计数均显著偏低(均P<0.05);肠杆菌、酵母菌计数显著偏多(均P<0.05);肠球菌计数略低,但两组比较差异无统计学意义(P>0.05)。多元logistic回归方程分析显示肠杆菌、酵母菌是老年2型糖尿病合并高血压患者eGFR降低的危险因素(OR=1.456、1.278,均P<0.05);乳酸杆菌、双歧杆菌、拟杆菌是老年2型糖尿病合并高血压患者eGFR的保护性因素(OR=0.472、0.510、0.673,均P<0.05)。结论2型糖尿病合并高血压患者肾功能损害发生率较高,且与肠道菌群失调密切相关(益生菌减少,致病菌增加),在治疗中应当密切关注此类患者的肠道菌群失调情况,及早干预以降低肾脏损害发生的风险。
Objective To investigate the relationship between intestinal microbial distribution and estimated glomerular filtration rate(eGFR)in elderly patients with type 2 diabetes mellitus(T2DM)and hypertension.Methods Two hundred and twenty-five elderly T2DM patients with hypertension were recruited in the study.The eGFR was calculated by modified dietary improvement test(MDRD)equation.According to eGFR,the patients were divided into eGFR reduction[<60 ml/(min 1.73 m2)]group(n=63)and eGFR normal[>60 ml/(min 1.73 m2)]group(n=162).Clinical data and biochemical test findings were collected,and the intestinal microorganism counts of the two groups were detected.Logistic regression was used to analyze the relationship between intestinal microorganisms and the decrease of eGFR.Results Compared with the normal eGFR group,the systolic blood pressure(SBP),fasting blood glucose(FPG),2-h postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1C),triglyceride(TG),uric acid(UA),creatinine(Cr),blood urea nitrogen(BUN),white blood cell count(WBC),and C-reactive protein(CRP)levels in the eGFR reduction group were higher(all P<0.05).The counts of lactobacillus,bifidobacterium and bacteroides in the eGFR reduction group were significantly lower than those in the eGFR normal group(all P<0.05);the counts of enterobacteria and yeasts in the eGFR reduction group were significantly higher than those in the eGFR normal group(all P<0.05);the counts of enterococci in the eGFR reduction group were slightly lower than those in the eGFR normal group,but there was no significant difference(P>0.05).Multivariate logistic regression analysis showed that enterobacter and yeast were risk factors for eGFR reduction(OR=1.456,1.278,P<0.05);while lactobacillus,bifidobacteriumand bacteroides were protective factors for eGFR in elderly patients with type 2 diabetes mellitus and hypertension(OR=0.472,0.510,0.673,all P<0.05).Conclusion The incidence of renal dysfunction in type 2 diabetes mellitus patients with hypertension is high,and intestinal flora disorders are closely related to eGFR.In the treatment of these patients,we should pay close attention to the intestinal flora disorders,and early intervention in order to reduce the risk of renal damage.
作者
蔡雅卫
李建辉
叶森森
蔡珂丹
朱瑶
徐宁
CAI Yawei;LI Jianhui;YE Sensen(Department of Geriatrics,Ningbo Huamei Hospital,University of Chinese Academy of Sciences,Ningbo 315010,China)
出处
《浙江医学》
CAS
2019年第19期2067-2071,共5页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目(2019KY174)
关键词
老年人
2型糖尿病
高血压病
估算肾小球滤过率
肠道菌群
Elderlypeople Type2diabetesmellitus
Hypertension
Estimatedglomerular filtrationrate
Intestinal flora
