Treatment of Metabolic Syndrome Slows Progression of Diabetic Nephropathy
Treatment of Metabolic Syndrome Slows Progression of Diabetic Nephropathy
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DOI：
10.1089/met.2011.0056
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发表时间：
2011-12-01
影响因子：
2.1
通讯作者：
Gomez-Perez, Francisco J.
中科院分区：
文献类型：
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作者：
Duran-Perez, Edgar G.;Almeda-Valdes, Paloma;Gomez-Perez, Francisco J.
背景资料：代谢综合征导致2型糖尿病患者出现蛋白尿和肾小球滤过率（GFR）降低。本研究的目的是分析MS治疗对糖尿病肾病（DN）进展的影响。在2型糖尿病患者中获得与代谢综合征、微量白蛋白尿（mA）和GFR相关的基线和随访数据。受试者分为两组：（1）在随访时纠正代谢综合征和（2）未纠正代谢综合征。此外，他们被分为四个亚组：（A）在基线和随访时没有代谢综合征，（B）有代谢综合征和代谢综合征的纠正，（C）没有代谢综合征和代谢综合征的发展，和（D）有代谢综合征和代谢综合征的持续。第2组与第1组的最终GFR和mA分别较低和较高[89.8 - 32.3 vs. 98.3 - 32.0mL/min，P = 0.010和51.0（13.5-195）vs. 7.9（4-31）mg/天，P < 0.001]。缺乏代谢综合征校正[风险比（HR）= 2.8，95%置信区间（CI）1.9-4.2，P < 0.001]，属于亚组C（HR = 2.05，95% CI 1.03-4.1，P = 0.04）和D（HR = 3.3，95% CI 2.0-5.3，P < 0.001），以及两个（HR = 3.4，95% CI 1.9-6.1，P < 0.001），3（HR = 5.0，95% CI 2.5-9.9，P < 0.001），4（HR = 4.2，95% CI 1.5-12.1，P = 0.006）在校正了年龄、性别、基线mA和GFR的考克斯回归分析中，代谢综合征组分是与mA发生相关的独立因素，结论：代谢综合征的治疗和控制与DN进展较小独立相关。
Background: Metabolic syndrome contributes to the development of albuminuria and to the decrease of glomerular filtration rate (GFR) in type 2 diabetes patients. The aim of this study was to analyze the effect of MS treatment on the progression of diabetic nephropathy (DN).Methods: This was a retrospective and comparative cohort study. Baseline and follow-up data related to the presence of metabolic syndrome, microalbuminuria (mA), and GFR were obtained in individuals with type 2 diabetes. Subjects were classified in two groups: (1) With correction of metabolic syndrome and (2) without correction of metabolic syndrome at follow-up. Furthermore, they were stratified in four subgroups: (A) Without metabolic syndrome at baseline and at follow-up, (B) with metabolic syndrome and correction of metabolic syndrome, (C) without metabolic syndrome and development of metabolic syndrome, and (D) with metabolic syndrome and persistence of metabolic syndrome.Results: Final GFR and mA were lower and higher, respectively, in group 2 versus 1 [89.8 -3 2.3 vs. 98.3 -32.0mL/min, P = 0.010, and 51.0 (13.5-195) vs. 7.9 (4-31) mg/day, P < 0.001, respectively]. Lack of metabolic syndrome correction [hazard ratio (HR) = 2.8, 95% confidence interval (CI) 1.9-4.2, P < 0.001], being in subgroups C (HR = 2.05, 95% CI 1.03-4.1, P = 0.04) and D (HR = 3.3, 95% CI 2.0-5.3, P < 0.001), and the presence of two (HR = 3.4, 95% CI 1.9-6.1, P < 0.001), three (HR = 5.0, 95% CI 2.5-9.9, P < 0.001), and four (HR = 4.2, 95% CI 1.5-12.1, P = 0.006) metabolic syndrome components were independent factors associated with development of mA in Cox regression analysis adjusted for age, gender, baseline mA and GFR, glycosylated hemoglobin (HbA1c), hypertension, and obesity.Conclusions: Metabolic syndrome treatment and control are independently associated with a lesser progression of DN.