老年2型糖尿病肾功能异常的相关影响因素分析

目的探讨老年2型糖尿病（T2DM）肾功能异常的相关影响因素及临床意义。方法回顾性分析1997-2006年在解放军总医院住院治疗的老年T2DM患者临床资料,根据其肾小球滤过率（GFR）水平分为：GFR≥90（A组）、60～90（B组）、〈60（C组,肾功能异常组）ml/（min.1.73m^2）。对各组临床及实验室指标进行比较。结果共收集老年T2DM病例525例,A组159例（30.3%）,B组239例（45.5%）,C组127例（24.2%）。临床诊断糖尿病肾病（DN）者占13.7%,合并高血压者占71.05%;肾功能异常组中,DN仅占29.9%。在老年T2DM中,高血压病程、收缩压（SBP）、舒张压（DBP）、餐后2h血糖（2hPBG）、血清总胆固醇（TC）、血尿酸（BUa）为肾功能异常的独立相关影响因素,且高血压对其肾功能的影响更为显著。随血压水平增高、DM病程延长、尿白蛋白/肌酐比值（Alb/Cr）增加,GFR下降,肾功能异常发生率增加。血压〈130/80mmHg、≥130/80mmHg者,肾功能异常发生率分别为4.09%、41.72%;DM病程〈5年、5～10年、〉10年者,肾功能异常发生率依次为18.64%、26.09%和28.90%;尿Alb/Cr〈30、30～299、≥300mg/g者,肾功能异常发生率分别为10.53%、40.38%和75%。结论老年T2DM肾功能异常的影响因素较多,高血压病程、SBP、DBP、2hPBG、TC、BUa与之独立相关,高血压对其影响更为显著。血压、血糖控制良好为保护因素,针对上述影响因素的综合治疗对预防及延缓肾功能异常的发生、发展有重要的临床意义。

Impact factors correlated with renal dysfunction in elderly patients with type 2 diabetes mellitus

Objective To approach the impact factors correlated with renal dysfunction in elderly patients with type 2 diabetes mellitus（T2DM）. Methods The data from the elderly patients with T2DM admitted in our hospital between 1997 and 2006 were reviewed. According to the difference of glomerular filtration rate （GFR）, they were di- vided into three groups： group A[GFR≥90ml/（min· 1.73m^2）], group B （60-90）, group C （〈60）. The clinical and biochenmical indexes were compared and analysed. Results A total of 525 cases were studied. There were 159 （30.3%） in group A, 239（45.5%） in group B and 127（24.2%） in group C of renal dysfunction. History of hyper- tension, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, postprandial blood glucose （PBG）, choles- terol （TC） and blood uric acid （BUa） were independently associated impact factors of renal dysfunction in aged T2DM patients, and hypertension contributed more than DM. Of these data, only 13.7 % was diagnosed as diabetic nephrop- athy （DN）, while 71.05% was hypertension. In group C of renal dysfunction , there were only 29.9% patients who were diagnosed as DN. With the prolongation of history of DM, the progression of hypertension and the increasing of urine Alb/Cr, GFR was declining and the incidence （IN） of renal dysfunction was increasing. Matched along with patients of BP〈130/85mmHg or of BP≥130/85mmHg, the IN was 4.09% and 41.72% respectively; when the history of DM was less than 5 years,5 to l0 years or more than 10 years, the IN of renal dysfunction was 18.64%, 26.09% or 28.90%; when the urine Alb/Cr was 〈30,30--299 or ≥300mg/g, the IN of renal dysfunction was 10. 53%, 40.38% or 75%. Conclusion There are multiple factors correlated with renal dysfunction of aged T2DM patients. And the history of hypertension, SBP,DBP,PBG,TC and BUa are independently associated impact factors. Hyper tension contributes more than DM in renal dysfunction of aged T2DM patients. Favorable control of blood glucose and blood pressure is the protecting factor, and available treatment aimed directly at the above impact factors could delay the progression of renal dysfunction.