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目的探讨2型糖尿病患者慢性肾脏病(CKD)的患病率及肾小球滤过率与尿白蛋白排泄间的关系。方法收集自2008年1月至2009年12月在江苏省省级机关医院就诊的2型糖尿病患者资料,采用MDRD公式评估肾小球滤过率(eGFR),CKD定义为存在白蛋白尿或者eGFR<60 ml/(min·1.73 m2)。白蛋白尿定义为尿白蛋白/肌酐比值(ACR)≥30 mg/g。采用多项式回归及曲线拟合分析eGFR与尿ACR之间的关系。结果研究纳入1521例2型糖尿病患者,平均年龄(63.9±12.0)岁,CKD及白蛋白尿的患病率分别为31.0%和28.9%。eGFR≥90、60~89、30~59、15~29 ml/(min·1.73 m2)患者白蛋白尿的患病率分别为19.9%、34.5%、65.6%和100%。在正常蛋白尿、微量白蛋白尿及大量白蛋白尿患者中,肾功能不全的比率分别为3.0%、9.3%和40.4%。多项式回归分析显示当患者尿ACR<90 mg/g时,eGFR下降缓慢且稳定保持在90 ml/(min·1.73 m2)以上,而当尿ACR≥90 mg/g时,eGFR则迅速下降。结论 2型糖尿病患者CKD及白蛋白尿发生率高,对2型糖尿病人群进行CKD的筛查应该同时检测尿白蛋白与eGFR,为了延缓CKD的进展,应尽早对白蛋白尿进行干预治疗。
Objective To investigate the prevalence of chronic kidney disease (CKD) and the relationship between glomerular filtration rate and urinary albumin excretion in type 2 diabetic patients. Methods The data of type 2 diabetic patients from January 2008 to December 2009 in Jiangsu Provincial Provincial Hospital were collected and the glomerular filtration rate (eGFR) was assessed by the MDRD formula. CKD was defined as the presence of albuminuria or eGFR <60 ml / (min · 1.73 m2). Albuminuria was defined as urinary albumin / creatinine ratio (ACR) ≥30 mg / g. Polynomial regression and curve fitting were used to analyze the relationship between eGFR and urinary ACR. Results A total of 1521 patients with type 2 diabetes mellitus (mean age 63.3 ± 12.0 years) were enrolled in this study. The prevalences of CKD and albuminuria were 31.0% and 28.9%, respectively. The prevalences of albuminuria in patients with eGFR≥90, 60-89, 30-59 and 15-29 mL / (min · 1.73 m2) were 19.9%, 34.5%, 65.6% and 100%, respectively. In patients with normal albuminuria, microalbuminuria, and extensive albuminuria, rates of renal insufficiency were 3.0%, 9.3%, and 40.4%, respectively. Polynomial regression analysis showed that eGFR decreased slowly and steadily above 90 ml / (min · 1.73 m2) when urinary ACR <90 mg / g, while eGFR decreased rapidly when ACR was 90 mg / g. Conclusions Patients with type 2 diabetes have a high incidence of CKD and albuminuria. Urinary albumin and eGFR should be detected in patients with type 2 diabetes mellitus for CKD screening. In order to delay the progression of CKD, albuminuria should be treated as soon as possible.