[1]黃秉文.中美兩種2型糖尿病腎病診斷標準中疾病進展及預后因素對比[J].醫學信息,2018,(22):68-72.[doi:10.3969/j.issn.1006-1959.2018.22.019]
 HUANG Bing-wen.Comparison of Disease Progression and Prognostic Factors in Two Diagnostic Criteria for Type 2 Diabetic Nephropathy in China and the United States[J].Medical Information,2018,(22):68-72.[doi:10.3969/j.issn.1006-1959.2018.22.019]
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中美兩種2型糖尿病腎病診斷標準中疾病進展及預后因素對比()
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醫學信息[ISSN:1006-1959/CN:61-1278/R]

卷:
期數:
2018年22期
頁碼:
68-72
欄目:
論著
出版日期:
2018-11-15

文章信息/Info

Title:
Comparison of Disease Progression and Prognostic Factors in Two Diagnostic Criteria for Type 2 Diabetic Nephropathy in China and the United States
文章編號:
1006-1959(2018)22-0068-05
作者:
黃秉文
(佛山市第二人民醫院內分泌科,廣東 佛山 528000)
Author(s):
HUANG Bing-wen
(Department of Endocrinology,the Second People's Hospital of Foshan,Foshan 528000,Guangdong,China)
關鍵詞:
2型糖尿病腎病腎小球濾過率診斷標準
Keywords:
Type 2 diabetic nephropathyGlomerular filtration rateDiagnostic standard
分類號:
R587.2
DOI:
10.3969/j.issn.1006-1959.2018.22.019
文獻標志碼:
A
摘要:
目的 通過對美國腎臟病基金會腎臟病預后質量倡議(NKF K/DOQI)標準及中華醫學會糖尿病學分會微血管并發癥學組的標準所描述的2型糖尿病腎病疾病進展及預后因素進行對比,評估兩種標準的臨床應用價值。方法 選取2016年4月~2017年4月于佛山市第二人民醫院就診的2型糖尿病患者共280例作研究對象,其中符合NKF K/DOQI標準的2型糖尿病腎病患者70例,符合中華醫學會標準者80例。記錄兩種標準2型糖尿病腎病患者的腎小球濾過率,兩組患者接受1年回訪后對上述指標進行復查,統計兩種標準患者的腎功能進展性下降的比例并進行對比。使用Spearson法分析eGFR下降幅度與各可能危險因素的相關性,使用Logistic回歸模型分析隨訪后eGFR下降與各可能危險因素的相關性。結果 中華醫學會標準診斷2型糖尿病患者的糖尿病腎病患病率為:28.57%(80/280);NKF K/DOQI標準診斷2型糖尿病患者的糖尿病腎病患病率為25.00%(70/280);按中華醫學會標準,正常白蛋白尿的2型糖尿病腎病患者占2型糖尿病腎病患者的12.50%(10/80);兩種標準下,糖尿病腎病患者出現eGFR降低≥4%/年的比例均高于非糖尿病腎病者,中華醫學會標準組為:20.00% vs 9.00%(P<0.05);NKF K/DOQI標準組為:17.14% vs 6.67%(P<0.05);兩種標準下糖尿病腎病與非糖尿病腎病在eGFR降低<4%及eGFR無下降的患者比較,差異無統計學意義(P>0.05);Logistic回歸分析中,校正年齡、血糖、病程等危險因素后,中華醫學會標準下糖尿病病程≥10年、HbA1C、基線eGFR與eGFR進展性下降存在顯著相關性;NKF K/DOQI標準下糖尿病病程≥10年、高血壓、HbA1C、基線eGFR、糖尿病視網膜病變與eGFR進展性下降存在顯著相關性。結論 兩種標準診斷的糖尿病腎病患者腎功能進展性下降程度均高于非糖尿病腎病患者,預測兩種標準糖尿病腎病發生腎功能進展性下降的基線預后因素相似,本研究對中華醫學會標準將正常白蛋白尿但eGFR下降的臨床亞型歸入2型糖尿病腎病診斷范疇的建議提供了流行病學的間接證據。
Abstract:
Objective To make a comparison of progression and prognostic factors on type 2 diabetic nephropathy severally described by National Kidney Foundation of clinical practice guidelines of America(NKF K/DOQI) and the standard of microvascular complication Group of Diabetes Society of Chinese Medical Association,and to evaluate the clinical value of the two criteria.Methods 280 patients with type 2 diabetes mellitus were selected from April 2016 to April 2017 in Foshan Second People's Hospital.There were 70 patients with type 2 diabetic nephropathy who met the NKF K/DOQI standard and 80 cases met the standard of Chinese Medical Association.The glomerular filtration rate was recorded in patients with type 2 diabetic nephropathy diagnose by the two standards.The two groups of patients received a year's visit to review the above indicators,the rate of progressive decline in renal function was measured and compared between the two groups of patients with standards.Spearson method was used to analyze the correlation between the decrease of eGFR and possible risk factors.Logistic regression model was used to analyze the correlation between eGFR decline and possible risk factors after follow-up.Results The prevalence of diabetic nephropathy was 28.57%(80/280) in type 2 diabetic patients diagnosed by the standard of Chinese Medical Association.The prevalence of diabetic nephropathy in patients with type 2 diabetes diagnosed by NKF K/DOQI criteria was 25.00%(70/280);According to the Chinese Medical Association standards,normal albuminuria type 2 diabetic nephropathy patients accounted for 12.50%(10/80) of type 2 diabetic nephropathy patients.Under both standards,the proportion of patients with diabetic nephropathy who had decreased eGFR≥4%/a year was higher than that with non-diabetic nephropathy.The group of the standard of Chinese Medical Association was 20.00% vs 9.00% (P<0. 05);The NKF K/DOQI standard group was 17.14% vs 6.67%(P<0. 05).There was no significant difference (P>0. 05) between diabetic nephropathy and non-diabetic nephropathy in patients with decreased eGFR <4% and no decrease in eGFR under two standards.And in Logistic regression analysis,after adjusting for age, blood glucose, course of disease and other risk factors,there was a significant correlation between a duration of diabetes≥10 years,HbA1C, baseline eGFR and progressive decline of eGFR under the standard of Chinese Medical Association;A duration of diabetes≥10 years,Hypertension, HbA1C, baseline eGFR, diabetic retinopathy and progressive eGFR decreased significantly under the NKF K/DOQI standard.Conclusion The degree of progressive decline of renal function in patients with diabetic nephropathy diagnosed by both criteria was higher than that in patients with non-diabetic nephropathy under both of the standards,and the baseline prognostic factors for predicting progressive decline of renal function in two standard diabetic nephropathy were similar.This study provides epidemiological circumstantial evidence for the recommendation of the Chinese Medical Association to classify the clinical subtypes of normal albuminuria but decreased eGFR into the diagnostic category of type 2 diabetic nephropathy.

參考文獻/References:


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