2018 年第 9 期 第 13 卷

尿微量白蛋白/尿肌酐比值正常2型糖尿病患者肾功能减退与血同型半胱氨酸水平的关系

Relevance between renal dysfunction and serum homocysteine in type 2 diabetic patients with normal urinary albumin-to-creatinine ratio

作者：苗艳菊周迎生

英文作者：

单位：100029首都医科大学附属北京安贞医院内分泌代谢科

英文单位：

关键词：2型糖尿病；尿微量白蛋白/尿肌酐比值；肾功能减退；同型半胱氨酸

英文关键词：

• 摘要：

• 【摘要】目的    探讨尿微量白蛋白/尿肌酐比值（ACR）正常的2型糖尿病患者肾功能减退与血同型半胱氨酸（Hcy）水平的相关性。方法    回顾性分析2015年1—12月首都医科大学附属北京安贞医院内分泌代谢科收治的343例ACR正常的2型糖尿病患者的临床资料。用慢性肾脏病（CKD）流行病合作组公式计算估算肾小球滤过率（eGFR），将eGFR≥90 ml/(min·1.73 m2)者划为肾功能正常组（CKD1期），eGFR 60～89 ml/(min·1.73 m2)者为早期肾损伤组（CKD2期），比较2组Hcy及相关临床指标差异。采用二分类Logistic回归分析法分析相关指标与患者肾功能减退的相关性。结果    早期肾损伤组患者血Hcy水平高于肾功能正常组患者［（15±6）μmol/L比（12±6）μmol/L］，差异有统计学意义（P<0.01）。早期肾损伤组高Hcy血症患病率为37.1%（39/105），高于肾功能正常组的17.2%（41/238）（P<0.05）。另外早期肾损伤组患者年龄、腹围大于，男性、高血压、冠状动脉粥样硬化性心脏病、脑梗死病史比例、收缩压、空腹胰岛素、血尿酸水平高于，糖尿病病程长于肾功能正常组；而舒张压、三酰甘油水平低于肾功能正常组，差异均有统计学意义（均P<0.05）。二分类Logistic回归分析结果表明，高Hcy组发生肾功能减退的风险为血Hcy正常组的2.342倍（95%置信区间：1.276～4.297，P=0.006）。结论    正常ACR的2型糖尿病患者中高Hcy血症的患病率较高，并且高Hcy血症是早期肾功能减退的独立危险因素。

• 【Abstract】Objective    To explore the relevance between renal dysfunction and serum homocysteine（Hcy） in type 2 diabetic patients with normal urinary albumin-to-creatinine ratio(ACR). Methods    Clinical data of 343 type 2 diabetic patients with normal ACR admitted in Department of Endocrinology and Metabolism, Beijing Anzhen Hospital, Capital Medical University from January to December 2015 were retrospectively analyzed. The patients were divided into 2 groups according to the value of estimated glomerular filtration rate(eGFR) calculated by the formula of Cooperating Group of Chronic Kidney Disease(CKD): eGFR≥90 ml/(min·1.73 m2) was defined as normal renal function (stage 1 CKD), eGFR 60-89 ml/(min·1.73 m2) was defined as early renal injury (stage 2 CKD). Hcy level and clinical indicators were tested in all patients. The correlation between clinical indicators and renal dysfunction was analyzed by binary Logistic regression. Results    Hcy level in early renal injury group was higher than that in normal renal function group［（15±6）μmol/L vs （12±6）μmol/L］（P<0.01）. The prevalence rate of hyper-Hcy was 37.1%（39/105） in early renal injury group, which is higher than that in normal renal function group［17.2%（41/238）］(P<0.05). In early renal injury group, age was older, abdominal circumference was larger, ratios of male, hypertension, coronary atherosclerotic heart disease, stroke history, systolic pressure, fasting insulin and blood uric acid level were higher, the course of diabetes was longer, diastolic blood pressure and triglyceride level were lower than those in normal renal function group(all P<0.05). Logistic regression showed that hyper-Hcy was associated with an approximate 2.342-fold greater risk of renal dysfunction(95% confidence interval: 1.276-4.297, P=0.006). Conclusion    There is a high prevalence of hyper-Hcy in type 2 diabetic patients with normal ACR, and hyper-Hcy is an independent risk factor of early renal dysfunction.