1480例2型糖尿病患者估...滤过率的分布情况及影响因素_张佳乐.pdf

世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1临床研究DOI:10 13935/j cnki sjzx 230124基金项目:中医药行业科研专项基金资助项目(201207012)作者单位:1 北京中医药大学东直门医院，北京 100700;2 北京中医药大学东直门医院肾内科，北京 100700通信作者:刘晴晴，Email:seven881125 hotmail com1480 例 2 型糖尿病患者估算肾小球滤过率的分布情况及影响因素张佳乐1孙卫卫2薛哲哲1王艺1魏蜀吴1姜伟民1王耀献2柳红芳2刘晴晴2【摘要】目的探讨 2 型糖尿病(Type 2 diabetes mellitus，T2DM)患者的估算肾小球滤过率(Estimated glo-merular filtration rate，eGF)的分布情况及其影响因素。方法选取北京市东城区 38 个社区卫生服务中心，在该社区居住了至少 5 年以上的 T2DM 患者，于 2014 年统一进行问卷调查、中医证型及实验室指标的采集。按纳入标准选择 T2DM 患者 1480 例，其中男 559 例和女 921 例，采用慢性肾脏病流行病学协作公式(The chronic kidney dis-ease epidemiology collaboration equation，CKD EPI)计算eGF，并用SPSS 200 统计学软件分析数据。结果(1)T2DM患者 eGF 水平分布:eGF90 ml/(min173 m2)组、60 ml/(min1 73 m2)eGF 90 ml/(min1 73 m2)组、eGF 60 ml/(min1 73 m2)组占比分别为:51 7%、41 2%、7 1%。其中，性别、年龄、教育程度、糖尿病病程、饮酒史、合并脑血管疾病等各组间比较，差异有统计学意义(P 0 05)。(2)中医证候:总体证型分布:内热证 阴虚证 气虚证 血瘀证 痰湿证 阳虚证 气郁证 血虚证。(3)logistic 回归分析显示，在 T2DM 患者中，高龄、女性人群、有吸烟饮酒史、舒张压(Diastolic blood pressure，DBP)、HDL(High density lipoprotein，HDL)、空腹血糖(Fasting Blood Glucose，GLU)、尿酸(Uric acid，UA)、同型半胱氨酸(Homocysteine，Hcy)及痰湿证、内热证等与肾功能下降相关，差异有统计学意义(P 0 05)。结论肾功能的轻中度下降在 T2DM 患者中并不少见，除性别、年龄等不可干预因素外，主要在于强化健康教育，改善患者的生活方式(戒烟限酒);在临床中要积极防治血压、血糖及血脂、UA、Hcy 等可干预因素，同时针对中医证型分布，对糖尿病肾功能下降患者进行有效预防和中西医结合治疗。【关键词】2 型糖尿病;估算肾小球滤过率;影响因素;中医证型【中图分类号】781 6+4【文献标识码】ADistribution and Influencing Factors of Estimated Glomerular Filtration ate in1480 Patients with Type 2 Diabetes MellitusZHANG Jia le1，SUN Wei wei2，XUE Zhe zhe1，WANG Yi1，WEI Shu wu1，JIANG Wei min1，WANG Yao xian2，LIU Hong fang2，LIU Qing qing2(1 Dongzhimen Hospital，Beijing University of Chinese Medicine，Beijing 100700;2 Department of Nephrology，Dongzhi-men Hospital，Beijing University of Chinese Medicine，Beijing 100700)【Abstract】ObjectiveTo analyze the distribution and influencing factors of estimated glomerular filtration rate(eGF)in patients with type 2 diabetes mellitus(T2DM)MethodsPatients with T2DM who had lived in 38 communityhealth service centers in Dongcheng District，Beijing for at least five years were recruited to conduct a questionnaire sur-vey，and traditional Chinese medicine syndromes and laboratory indexes were collected A total of 1480 patients with T2DMwere included according to the inclusion criteria，including 559 men and 921 women eGF was calculated by the chronickidney disease epidemiology collaboration equation(CKD EPI)，and the data were analyzed by SPSS 20 0 esults(1)The distribution of eGF of patients with T2DM in eGF90 ml/(min1 73 m2)，60eGF 90 ml/(min1 73m2)，and eGF 60 ml/(min1 73 m2)groups was 51 7%，41 2%，and 7 1%，respectively There were significantdifferences in gender，age，educational level，course of diabetes，history of drinking，and combined cerebrovascular diseaseamong groups(P 0 05)(2)In terms of traditional Chinese medicine(TCM)syndromes，the distribution of TCM syn-drome types was internal heat syndrome yin deficiency syndrome qi deficiency syndrome blood stasis syndrome phlegm dampness syndrome yang deficiency syndrome qi depression syndrome blood deficiency syndrome(3)Logistic regression analysis showed that in patients with T2DM，old age，female population，history of smoking and241世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1drinking，diastolic blood pressure(DBP)，high density lipoprotein(HDL)，fasting blood glucose(FBG)，uric acid(UA)，homocysteine(Hcy)，phlegm dampness syndrome and internal heat syndrome were related to the decline of renal func-tion(P 0 05)ConclusionThe mild to moderate decline of renal function is common in patients with T2DM In addi-tion to inevitable factors such as gender and age，the prevention and treatment of diabetic nephropathy mainly lies instrengthening health education and improving patients lifestyle，such as quitting smoking and limiting alcohol In clinical，we should emphasize the management of interventional factors such as blood pressure，blood sugar，blood lipid，UA，andHcy Meanwhile，the distribution of TCM syndrome should be taken into consideration in the treatment and prevention of di-abetic nephropathy，and western medicine should be integrated with TCM【Keywords】Type 2 Diabetes Mellitus;eGF;Influencing Factors;TCM Syndromes2 型糖尿病(Type 2 diabetes mellitus，T2DM)是临床医学中常见的慢性疾病类型，从 1980 年2017年，随着生活方式的改变，我国成人糖尿病的患病率从 0 67%上升至 11 2%1。而糖尿病肾脏疾病(Diabetic kidney disease，DKD)，是一种常见的由糖尿病引起的肾脏的微血管并发症，是进展为终末期肾病的主要病因2。数据显示，我国糖尿病肾脏疾病的患病率高达 33 6%，严重威胁着人类生命健康3，4。估算肾小球滤过率(Estimated glomerular fil-tration rate，eGF)是目前国际公认的计算肾小球滤过率(Glomerular filtration rate，GF)方法，是慢性肾脏疾病的重要检测指标之一。本研究通过分析1480 例社区 T2DM 患者 eGF 的分布特征及其影响因素，为糖尿病肾功能下降的研究及治疗提供依据，现报道如下。1资料与方法1 1临床资料1 1 1一般资料本研究为 2012 年中医药行业专项中医药防治慢病社区管理模式的研究 的部分内容。选取北京市东城区 38 个社区卫生服务中心，在该社区居住了至少 5 年以上的 T2DM 患者，于 2014 年统一进行问卷调查、中医证型及实验室指标的采集。本研究的总人数是 1480 名，包括男 559 例和女 921 例，平均年龄(66 34 9 13)岁。本研究已获得北京中医药大学东直门医院临床伦理委员会批准许可(审批号:ECPJ BDY 2014 08)。1 1 2诊断标准1 1 2 1西医诊断标准参照世界卫生组织(World Health Organization，WHO)(1999 年)标准5 进行。具有典型糖尿病症状(烦渴多饮、多尿、多食、不明原因的体重下降)且随机静脉血浆葡萄糖11 1 mmol/L;或空腹静脉血浆