江苏省盐城市滨海县社区糖尿病患者慢性肾功能不全发病率及危险因素分析
目的:探讨江苏省盐城市滨海县社区糖尿病患者慢性肾功能不全（CRI）的发病率及其危险因素。方法:为回顾性队列研究。选取江苏省盐城市滨海县2018年1月1日—12月31日参与居民健康体检，并连续4年（截至2021年12月31日）完成每年1次体检随访的糖尿病患者为研究对象。收集患者一般资料（性别、年龄）、血液学指标［空腹血糖（FPG）、甘油三酯（TG）、总胆固醇（TC）、肌酐］，尿蛋白定性结果（阴性、微量、1+、2+或3+；其中，中等量蛋白尿定义为尿蛋白1+，大量蛋白尿被定义为尿蛋白≥2+），并根据慢性肾脏病流行病学协作公式（CKD-EPI）计算估算的肾小球滤过率（eGFR）。CRI诊断标准为患者肾...
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| Published in | 中华糖尿病杂志 Vol. 15; no. 12; pp. 1237 - 1243 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
南京医科大学第二附属医院肾脏病中心，南京 210003%江苏省盐城市滨海县人民医院肾内科，盐城 224500
01.12.2023
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1674-5809 |
| DOI | 10.3760/cma.j.cn115791-20230916-00157 |
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| Abstract | 目的:探讨江苏省盐城市滨海县社区糖尿病患者慢性肾功能不全（CRI）的发病率及其危险因素。方法:为回顾性队列研究。选取江苏省盐城市滨海县2018年1月1日—12月31日参与居民健康体检，并连续4年（截至2021年12月31日）完成每年1次体检随访的糖尿病患者为研究对象。收集患者一般资料（性别、年龄）、血液学指标［空腹血糖（FPG）、甘油三酯（TG）、总胆固醇（TC）、肌酐］，尿蛋白定性结果（阴性、微量、1+、2+或3+；其中，中等量蛋白尿定义为尿蛋白1+，大量蛋白尿被定义为尿蛋白≥2+），并根据慢性肾脏病流行病学协作公式（CKD-EPI）计算估算的肾小球滤过率（eGFR）。CRI诊断标准为患者肾功能不全［eGFR<60 ml·min
-1·（1.73 m
2）
-1］病史持续≥3个月。终点事件设定为患者在随访期间，首次出现肾功能不全，并通过后续门诊、查询电子病历系统或电话随访，调取参与者至少2次血清肌酐水平，证实患者符合CRI诊断。采用Poisson回归模型计算患者CRI发病率，采用多因素Cox回归分析评估糖尿病患者发生CRI的独立危险因素。
结果:最终纳入8 244例糖尿病患者。基线时，患者年龄（62.2±9.1）岁，男性占39.3%（3 238/8 244）。中位随访时间为3.4（3.3，3.5）年，8.7%（715/8 244）患者在随访期内发生CRI，CRI发病率为2.64（95%CI 2.60~2.67）/百人年。多因素Cox回归分析显示，女性（HR=1.634，95%CI 1.389~1.921）、TG增加（每增加1 mmol/L，HR=1.044，95%CI 1.014~1.075）、FPG增加（每增加1 mmol/L，HR=1.063，95%CI 1.040~1.087）、中等量蛋白尿（HR=1.290，95%CI 1.003~1.667）及大量蛋白尿（HR=2.086，95%CI 1.645~2.644）是新发CRI风险的独立危险因素。基线eGFR水平与CRI患病风险独立负相关［每增加5 ml·min
-1·（1.73 m
2）
-1，HR=0.623，95%CI 0.604~0.642］。
结论:社区糖尿病患者CRI发病率较高。女性、TG及FPG的升高、中等及大量蛋白尿、低eGFR与新发CRI风险独立相关。 |
|---|---|
| AbstractList | 目的:探讨江苏省盐城市滨海县社区糖尿病患者慢性肾功能不全（CRI）的发病率及其危险因素。方法:为回顾性队列研究。选取江苏省盐城市滨海县2018年1月1日—12月31日参与居民健康体检，并连续4年（截至2021年12月31日）完成每年1次体检随访的糖尿病患者为研究对象。收集患者一般资料（性别、年龄）、血液学指标［空腹血糖（FPG）、甘油三酯（TG）、总胆固醇（TC）、肌酐］，尿蛋白定性结果（阴性、微量、1+、2+或3+；其中，中等量蛋白尿定义为尿蛋白1+，大量蛋白尿被定义为尿蛋白≥2+），并根据慢性肾脏病流行病学协作公式（CKD-EPI）计算估算的肾小球滤过率（eGFR）。CRI诊断标准为患者肾功能不全［eGFR<60 ml·min
-1·（1.73 m
2）
-1］病史持续≥3个月。终点事件设定为患者在随访期间，首次出现肾功能不全，并通过后续门诊、查询电子病历系统或电话随访，调取参与者至少2次血清肌酐水平，证实患者符合CRI诊断。采用Poisson回归模型计算患者CRI发病率，采用多因素Cox回归分析评估糖尿病患者发生CRI的独立危险因素。
结果:最终纳入8 244例糖尿病患者。基线时，患者年龄（62.2±9.1）岁，男性占39.3%（3 238/8 244）。中位随访时间为3.4（3.3，3.5）年，8.7%（715/8 244）患者在随访期内发生CRI，CRI发病率为2.64（95%CI 2.60~2.67）/百人年。多因素Cox回归分析显示，女性（HR=1.634，95%CI 1.389~1.921）、TG增加（每增加1 mmol/L，HR=1.044，95%CI 1.014~1.075）、FPG增加（每增加1 mmol/L，HR=1.063，95%CI 1.040~1.087）、中等量蛋白尿（HR=1.290，95%CI 1.003~1.667）及大量蛋白尿（HR=2.086，95%CI 1.645~2.644）是新发CRI风险的独立危险因素。基线eGFR水平与CRI患病风险独立负相关［每增加5 ml·min
-1·（1.73 m
2）
-1，HR=0.623，95%CI 0.604~0.642］。
结论:社区糖尿病患者CRI发病率较高。女性、TG及FPG的升高、中等及大量蛋白尿、低eGFR与新发CRI风险独立相关。 |
| Abstract_FL | Objective:To evaluate the incidence and risk factors associated with chronic renal insufficiency (CRI) in people with diabetes mellitus (DM) in the community of Binhai County, Yancheng City, Jiangsu Province.Methods:This was a retrospective cohort study. Adults with DM who participated in the health checkups from 1
st January 2018 to 31
st December 2018 in Binhai, and completed annual physical examinations for 4 consecutive years (up to 31
st December 2021) were selected as subjects. General information (sex, age), hematological indicators [fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), and creatinine] were collected. In addition, urinary protein was reported as negative, trace, 1+, 2+, or 3+. Among them, moderate proteinuria was defined as 1+, massive proteinuria was defined as ≥2+, and estimated glomerular filtration rate（eGFR) was calculated according to the chronic kidney disease epidemiology collaboration creatinine equation (CKD-EPI). The diagnostic criteria for CRI was a history of renal insufficiency [eGFR<60 ml·min
-1·(1.73 m
2)
-1] lasting≥3 months. The endpoint event was defined as the initial occurrence of renal insufficiency in patients during the follow-up period, and the diagnosis of CRI was confirmed by subsequent outpatient visits, electronic medical record systems, or telephone follow-up. Poisson regression was employed to compute the incidence of CRI within this population, while multivariate Cox regression analysis was used to assess independent risk factors for CRI in individuals with diabetes.
Results:A total of 8 244 individuals were included in this study. The average age was (62.2±9.1) years old and 39.3% (3 238/8 244) individuals were male at baseline. The average baseline eGFR was (98.8±12.8) ml·min
-1·(1.73 m
2)
-1, and FPG was (10.1±3.0) mmol/L in this population. Seven hundred and fifteen (8.7%) individuals developed incident CRI during a median follow-up time of 3.4 years (interquartile range, 3.3, 3.5 years). The overall CRI incidence rate was 2.64 (95%CI 2.60-2.67) per 100 person-years. In the multivariable Cox regression analysis, women (HR=1.634, 95%CI 1.389-1.921), elevating triglycerides(per 1 mmol/L increase, HR=1.044, 95%CI 1.014-1.075), elevating FPG (per 1 mmol/L increase, HR=1.063, 95%CI 1.040-1.087), moderate proteinuria (HR=1.290, 95%CI 1.003-1.667), and severe proteinuria (HR=2.086, 95%CI 1.645-2.644) were independent risk factors for CRI. Baseline eGFR was negatively associated with CRI [per 5 ml·min
-1·(1.73 m
2)
-1 increase, HR=0.623, 95%CI 0.604-0.642].
Conclusions:The incidence of CRI was high in people with DM in community. Female, elevated TG, elevated FPG, and proteinuria were positively and independently associated with decline in kidney function, while baseline eGFR was negatively associated with the risk of CRI. |
| Author | 周阳 李冬玲 杨俊伟 刘瑾 徐玲玲 |
| AuthorAffiliation | 南京医科大学第二附属医院肾脏病中心，南京 210003%江苏省盐城市滨海县人民医院肾内科，盐城 224500 |
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| Author_FL | Liu Jin Xu Lingling Li Dongling Zhou Yang Yang Junwei |
| Author_FL_xml | – sequence: 1 fullname: Xu Lingling – sequence: 2 fullname: Zhou Yang – sequence: 3 fullname: Li Dongling – sequence: 4 fullname: Liu Jin – sequence: 5 fullname: Yang Junwei |
| Author_xml | – sequence: 1 fullname: 徐玲玲 – sequence: 2 fullname: 周阳 – sequence: 3 fullname: 李冬玲 – sequence: 4 fullname: 刘瑾 – sequence: 5 fullname: 杨俊伟 |
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| Keywords | Renal insufficiency, chronic 危险因素 Diabetes mellitus 肾功能不全，慢性 发病率 糖尿病 Risk factors Incidence |
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| PublicationTitle | 中华糖尿病杂志 |
| PublicationTitle_FL | Chinese Journal of Diabetes Mellitus |
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| Publisher | 南京医科大学第二附属医院肾脏病中心，南京 210003%江苏省盐城市滨海县人民医院肾内科，盐城 224500 |
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