糖尿病患者短期血糖波动与慢性肾脏病发病风险的前瞻性队列研究

目的:探讨糖尿病患者短期血糖波动与慢性肾脏病(CKD)发病风险之间的关系。方法:为前瞻性队列研究。分析来自中国糖尿病患者恶性肿瘤发生风险的流行病学(REACTION)研究贵阳分中心的数据,基线数据于2011年5至8月采集,通过整群抽样法选取贵阳市云岩区40岁以上常驻居民共10 140名,并在2014年对以上研究对象进行随访,最终纳入400例糖尿病患者。对所有研究对象采用问卷调查收集社会人口学特征,测量身高、体重、血压,检测空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA 1c)、甘油三酯(TG)、空腹胰岛素及血肌酐等。采用2hPG与FPG的差值(2hPG-FPG)作为评价短...

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Published in中华糖尿病杂志 Vol. 13; no. 6; pp. 584 - 590
Main Authors 牛心灵, 张淼, 张巧, 彭年春, 胡颖, 时立新
Format Journal Article
LanguageChinese
Published 贵州医科大学附属医院内分泌与代谢病科,贵阳 550004 27.06.2021
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ISSN1674-5809
DOI10.3760/cma.j.cn115791-20210125-00045

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Abstract 目的:探讨糖尿病患者短期血糖波动与慢性肾脏病(CKD)发病风险之间的关系。方法:为前瞻性队列研究。分析来自中国糖尿病患者恶性肿瘤发生风险的流行病学(REACTION)研究贵阳分中心的数据,基线数据于2011年5至8月采集,通过整群抽样法选取贵阳市云岩区40岁以上常驻居民共10 140名,并在2014年对以上研究对象进行随访,最终纳入400例糖尿病患者。对所有研究对象采用问卷调查收集社会人口学特征,测量身高、体重、血压,检测空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA 1c)、甘油三酯(TG)、空腹胰岛素及血肌酐等。采用2hPG与FPG的差值(2hPG-FPG)作为评价短期血糖波动的指标。根据HbA 1c水平将研究对象分为血糖控制达标组(HbA 1c<7%)和血糖控制不达标组(HbA 1c≥7%),采用 t检验、 χ2检验、非参数检验对各组指标的差异进行比较,使用Spearman相关分析探究基线2hPG-FPG与CKD的相关性,采用线性回归分析法分析基线2hPG-FPG与3年后估算的肾小球滤过率(eGFR)之间的关系,logistic回归模型评估基线2hPG-FPG不同水平(四分位分组)与3年后新发CKD风险关系。 结果:血糖控制不达标组患者225例,血糖控制达标组患者175例。血糖控制不达标组患者中TG、FPG、2hPG、2hPG-FPG水平均高于血糖控制达标组,差异具有统计学意义(均 P<0.05)。在血糖控制不达标组患者中,基线2hPG-FPG与3年后eGFR呈负相关[ β=-1.178,95%可信区间(CI) -2.038~-0.319, P=0.007],与3年后发生CKD的可能性呈正相关( r s=0.147, P=0.027)。logistic回归分析结果显示,基线2hPG-FPG水平越高,3年后发生CKD风险呈递增趋势( P<0.05),校正性别、年龄、体重指数、血压、血脂、空腹胰岛素、吸烟、饮酒及病程后,在血糖控制不达标组患者中,基线2hPG-FPG水平最高组,3年后发生CKD风险显著增加(比值比4.474,95%CI 1.039~19.268, P=0.044)。 结论:在血糖控制不达标的糖尿病患者中,2hPG-FPG水平越高,3年后发生CKD风险增加;2hPG-FPG可能为发生CKD的独立危险因素。
AbstractList 目的:探讨糖尿病患者短期血糖波动与慢性肾脏病(CKD)发病风险之间的关系。方法:为前瞻性队列研究。分析来自中国糖尿病患者恶性肿瘤发生风险的流行病学(REACTION)研究贵阳分中心的数据,基线数据于2011年5至8月采集,通过整群抽样法选取贵阳市云岩区40岁以上常驻居民共10 140名,并在2014年对以上研究对象进行随访,最终纳入400例糖尿病患者。对所有研究对象采用问卷调查收集社会人口学特征,测量身高、体重、血压,检测空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA 1c)、甘油三酯(TG)、空腹胰岛素及血肌酐等。采用2hPG与FPG的差值(2hPG-FPG)作为评价短期血糖波动的指标。根据HbA 1c水平将研究对象分为血糖控制达标组(HbA 1c<7%)和血糖控制不达标组(HbA 1c≥7%),采用 t检验、 χ2检验、非参数检验对各组指标的差异进行比较,使用Spearman相关分析探究基线2hPG-FPG与CKD的相关性,采用线性回归分析法分析基线2hPG-FPG与3年后估算的肾小球滤过率(eGFR)之间的关系,logistic回归模型评估基线2hPG-FPG不同水平(四分位分组)与3年后新发CKD风险关系。 结果:血糖控制不达标组患者225例,血糖控制达标组患者175例。血糖控制不达标组患者中TG、FPG、2hPG、2hPG-FPG水平均高于血糖控制达标组,差异具有统计学意义(均 P<0.05)。在血糖控制不达标组患者中,基线2hPG-FPG与3年后eGFR呈负相关[ β=-1.178,95%可信区间(CI) -2.038~-0.319, P=0.007],与3年后发生CKD的可能性呈正相关( r s=0.147, P=0.027)。logistic回归分析结果显示,基线2hPG-FPG水平越高,3年后发生CKD风险呈递增趋势( P<0.05),校正性别、年龄、体重指数、血压、血脂、空腹胰岛素、吸烟、饮酒及病程后,在血糖控制不达标组患者中,基线2hPG-FPG水平最高组,3年后发生CKD风险显著增加(比值比4.474,95%CI 1.039~19.268, P=0.044)。 结论:在血糖控制不达标的糖尿病患者中,2hPG-FPG水平越高,3年后发生CKD风险增加;2hPG-FPG可能为发生CKD的独立危险因素。
Abstract_FL Objective:To investigate the relationship between short-term blood glucose fluctuation and chronic kidney disease (CKD) in diabetic patients.Methods:In this prospective cohort study, we analyzed the data from the Guiyang subcenter of the Risk Evalution of cAncers in Chinese dibeTic Individual: alONgitudinal (REACTION) Study. A total of 10 140 residents aged over 40 in Yunyan District of Guiyang were selected from the baseline data by cluster sampling from May 2011 to August 2011, and the above subjects were followed up in 2014, and 400 subjects were eventually included in the study. All subjects were surveyed by questionnaire to collect sociodemographic characteristics, height, weight, blood pressure, fasting plasma glucose (FPG), 2 hours postprandial glucose (2hPG), glycated hemoglobin A 1c (HbA 1c), triglyceride (TG), fasting insulin and serum creatinine. The difference between 2hPG and FPG (2hPG-FPG) was used as an index to evaluate short-term blood glucose fluctuations. According to the HbA 1c levels, the subjects were divided into two groups: patients with good glycemic control (HbA 1c<7%) and patients with poor glycemic control (HbA 1c≥7%), The t test, Chi-square test and non-parametric test were used to compare the differences of indicators in each group. Associations between baseline 2hPG-FPG and CKD were performed by Spearman correlation. Associations between baseline 2hPG-FPG and eGFR after 3 years were performed by linear regression. A logistic regression model was used to analyze the relationship between baseline 2hPG-FPG levels (quartiles) and the risk of new CKD at 3 years. Spearman correlation was used to explore the correlation between baseline 2hPG-FPG and CKD, and linear regression analysis was used to analyze the relationship between baseline 2hPG-FPG and estimated glomerular filtration rate (eGFR) at 3 years. Logistic regression model was used to evaluate the relationship between different levels of baseline 2hPG-FPG (quartiles) and the risk of new onset of CKD at 3 years. Results:There were 175 patients in good glycemic control group and 225 patients in poor glycemic control group. In patients with poor glycemic control, the TG, FPG, 2hPG and 2hPG-FPG were higher than those in patients with good glycemic control, and the difference between the two groups was statistically significant ( P<0.05). In patients with poor glycemic control, baseline 2hPG-FPG was negatively correlated with eGFR at 3 years [ β=-1.178, 95% confidence interval (CI) -2.038 to -0.319 , P=0.007], and positively correlated with the likelihood of CKD at 3 years ( r s=0.147, P=0.027). Logistic regression analysis showed that the risk of CKD increased with the increase of baseline 2hPG-FPG level ( P<0.05). After adjusting for gender, age, body mass index, blood pressure, blood lipid, fasting insulin, smoking, alcohol consumption and disease course, in patients with poor glycemic control, the group with the highest baseline 2hPG-FPG level had a significantly increased risk of developing CKD after 3 years (odds ratio 4.474, 95%CI 1.039 to 19.268, P=0.044). Conclusions:In previous diabetes patients with poor glycemic control, higher levels of 2hPG-FPG were associated with an increased risk of CKD after 3 years. 2hPG-FPG may be an independent risk factor for CKD.
Author 牛心灵
张巧
彭年春
胡颖
时立新
张淼
AuthorAffiliation 贵州医科大学附属医院内分泌与代谢病科,贵阳 550004
AuthorAffiliation_xml – name: 贵州医科大学附属医院内分泌与代谢病科,贵阳 550004
Author_FL Zhang Qiao
Shi Lixin
Hu Ying
Niu Xinling
Peng Nianchun
Zhang Miao
Author_FL_xml – sequence: 1
  fullname: Niu Xinling
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  fullname: Zhang Miao
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  fullname: Zhang Qiao
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  fullname: Peng Nianchun
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  fullname: Hu Ying
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  fullname: Shi Lixin
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DocumentTitle_FL Short-term blood glucose fluctuations and the risk of chronic kidney disease in diabetic patients: a prospective cohort study
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Keywords 慢性肾脏病
Chronic kidney disease
糖尿病
Diabetes mellitus
Blood glucose fluctuations
短期血糖波动
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PublicationTitle 中华糖尿病杂志
PublicationTitle_FL Chinese Journal of Diabetes Mellitus
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Publisher 贵州医科大学附属医院内分泌与代谢病科,贵阳 550004
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Title 糖尿病患者短期血糖波动与慢性肾脏病发病风险的前瞻性队列研究
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