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目的探讨血清肌酐(Scr)、血清胱抑素C(Cys-C)水平正常的T2DM患者eGFR水平的变化。方法选取2014年1月至2015年9月于我院住院的T2DM患者166例,根据Scr及Cys-C水平,将研究对象分为Scr及Cys-C正常组109例,Scr正常、Cys-C升高组(Cys-C升高组)40例,Scr及Cys-C均升高组(Scr及Cys-C升高组)17例。Scr及Cys-C正常组根据eGFR水平分为eGFR≥90ml/(min·1.73m~2)亚组和eGFR<90 ml/(min·1.73 m~2)亚组。记录各组临床基本资料、实验室数据。采用~(99m)Tc-DTPA肾动态显像法测定eGFR。结果 Scr及Cys-C正常组eGFR为(82.68±13.45)ml/(min·1.73 m~2),Cys-C升高组eGFR为(67.93±14.01)ml/(min·1.73m~2),Scr及Cys-C升高组eGFR为(50.54±15.10)ml/(min·1.73 m~2),各组比较,差异均有统计学意义(P<0.05)。Scr及Cys-C正常组26.6%的患者eGFR≥90 ml/(min·1.73 m~2),72.5%的患者eGFR 60~89 ml/(min·1.73 m~2),0.9%的患者eGFR 30~59 ml/(min·1.73 m~2)。经3个月随访观察,Scr及Cys-C正常组中4.6%处于T2DM合并慢性肾脏病(CKD)1期,34.9%处于T2DM合并CKD 2期,0.9%处于T2DM合并CKD 3期。多因素非条件Logistic回归分析结果显示,女性、高龄、高TC、低左室射血分数(LVEF)是eGFR下降的危险因素(P<0.05)。结论本研究中,Scr及Cys C水平均正常的T2DM患者,73.4%出现了eGFR轻到中度下降,40.4%进入CKD期,女性、高龄、高TC、低LVEF是T2DM患者eGFR下降高危因素,应加强对其eGFR水平的监测。
Objective To investigate the changes of eGFR in T2DM patients with normal serum creatinine (Scr) and serum cystatin C (Cys-C) levels. Methods A total of 166 T2DM patients were enrolled in our hospital from January 2014 to September 2015. According to the levels of Scr and Cys-C, 109 subjects with normal Scr and Cys-C were divided into two groups: normal Scr and Cys-C Elevated group (Cys-C elevated group) 40 cases, Scr and Cys-C were elevated group (Scr and Cys-C elevated group) 17 cases. The normal group of Scr and Cys-C were divided into subgroup of eGFR≥90ml / (min · 1.73m ~ 2) and eGFR <90ml / (min · 1.73m ~ 2) according to eGFR level. Record each group of basic clinical data, laboratory data. EGFR was measured by ~ (99m) Tc-DTPA renal dynamic imaging. Results The eGFR of Scr and Cys-C normal group were (82.68 ± 13.45) ml / (1.73 m 2) and that of Cys-C elevated group was (67.93 ± 14.01) ml / (min · 1.73m 2) The eGFR of Scr and Cys-C elevated group was (50.54 ± 15.10) ml / (min · 1.73 m ~ 2), and the difference was statistically significant (P <0.05). 26.6% of patients with normal Scr and Cys-C had eGFR≥90 ml / (min · 1.73 m ~ 2), 72.5% of patients with eGFR of 60-89 ml / (min · 1.73 m ~ 2) and 0.9% of patients with eGFR 30 ~ 59 ml / (min · 1.73 m ~ 2). After 3 months of follow-up, 4.6% of patients with normal Scr and Cys-C were in stage 1 with T2DM and chronic kidney disease (CKD), 34.9% with T2DM and 2 with CKD, 0.9% with T2DM and 3 with CKD. Multivariate non-conditional Logistic regression analysis showed that female, elderly, high TC and low left ventricular ejection fraction (LVEF) were the risk factors for the decline of eGFR (P <0.05). Conclusions In this study, 73.4% of patients with T2DM with normal Scr and Cys C levels showed mild to moderate eGFR decline and 40.4% entered CKD stage. Female, elderly, high TC and low LVEF were the risk factors for eGFR decline in T2DM patients. The monitoring of eGFR levels should be strengthened.