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目的:探讨原发性肾病综合征患者类固醇糖尿病(SDM)的发病率及危险因素。方法:回顾分析2011年1月至2015年12月,南京总医院国家肾脏疾病临床医学研究中心糖皮质激素(GC)治疗后发生SDM的原发性肾病综合征患者的临床资料。根据糖代谢的变化分为SDM组,糖调节受损组和糖代谢正常组。比较各组间患者的基线临床特征及实验室指标,行Logistic回归分析SDM的危险因素。结果:2 281例原发性肾病综合征患者中671例出现糖代谢紊乱,其中142例为SDM。81.7%的SDM在GC治疗1年内诊断,中位时间为108d。年龄、局灶性节段性肾小球硬化症、肾小球滤过率及空腹血糖与糖代谢紊乱的发生具有相关性,三组间统计学差异显著。SDM组患者的体质量指数、高血压2级以上(含2级)所占比例、合并使用他克莫司的比例、高尿酸血症及三酰甘油水平与糖代谢正常组相比,统计学差异显著,而与糖调节受损组相比无统计学差异。多因素Logistic回归分析显示:女性、高龄、空腹血糖、高尿酸血症、三酰甘油、GC起始剂量以及合并使用他克莫司是使用GC治疗原发性肾病综合征患者发生SDM的独立危险因素。结论:原发性肾病综合征患者使用GC治疗后糖代谢紊乱的发病率高。女性、高龄、空腹血糖升高、高尿酸血症、高三酰甘油血症、GC起始剂量较大及合并使用他克莫司是SDM的独立危险因素。
Objective: To investigate the incidence and risk factors of steroid diabetes mellitus (SDM) in patients with primary nephrotic syndrome. Methods: The clinical data of patients with idiopathic nephrotic syndrome who developed SDM after glucocorticoid (GC) treatment at National Kidney Disease Clinical Medical Center of Nanjing General Hospital from January 2011 to December 2015 were retrospectively analyzed. According to changes in glucose metabolism is divided into SDM group, impaired glucose regulation group and normal glucose metabolism group. Baseline clinical characteristics and laboratory parameters of patients in each group were compared. Logistic regression analysis was used to analyze the risk factors of SDM. Results: Among 2 281 patients with primary nephrotic syndrome, 671 patients had disorders of glucose metabolism, of which 142 were SDM. 81.7% of SDMs were diagnosed within 1 year of GC treatment with a median time of 108 days. Age, focal segmental glomerulosclerosis, glomerular filtration rate, and fasting plasma glucose and glucose metabolism disorders are related, statistically significant differences between the three groups. In the SDM group, the body mass index, the proportion of hypertension with grade 2 or above, the proportion of patients with combined tacrolimus, hyperuricemia and triglyceride levels were significantly higher than those in the normal glucose metabolism group The difference was significant, but no significant difference compared with the impaired glucose regulation group. Multivariate logistic regression analysis showed that female, advanced age, fasting glucose, hyperuricemia, triglyceride, initial dose of GC and combined use of tacrolimus were independent risk factors for developing SDM in patients with primary nephrotic syndrome using GC factor. Conclusions: The incidence of disorders of glucose metabolism after treatment with GC in patients with primary nephrotic syndrome is high. Female, elderly, fasting hyperglycemia, hyperuricemia, hypertriglyceridemia, larger initial GC dose and combined tacrolimus are independent risk factors for SDM.