Poor Renal and Cardiovascular Outcomes in Patients with Biopsy-Proven Diabetic Nephropathy
Poor Renal and Cardiovascular Outcomes in Patients with Biopsy-Proven Diabetic Nephropathy
复制标题
活检证实的糖尿病肾病患者的肾脏和心血管结局不佳
DOI：
10.1159/000505919
复制
发表时间：
2020
影响因子：
2.8
通讯作者：
Wang Niansong
中科院分区：
文献类型：
--
作者：
Wang Yiyun;Zhou Ting;Zhang Qiming;Fei Yang;Li Ze;Li Shiqi;He Li;Zhang Qunzi;Dong Yang;Fan Ying;Wang Niansong
背景：尽管糖尿病合并肾脏损害患者的心血管疾病(CVD)死亡率很高，但很少有研究比较糖尿病肾病(DN)和非糖尿病肾病(NDRD)患者的心血管特征和预后。方法：将326例接受肾活检的2型糖尿病患者分为糖尿病肾病组和糖尿病肾病组。超声心动图和多普勒超声评价左心室肥厚(LVH)和外周动脉粥样硬化性疾病(PAD)。用Kaplan-Meier分析比较糖尿病肾病组和糖尿病肾病组的肾脏和心血管存活率。糖尿病肾病患者发生肾脏和心血管事件的危险因素通过COX比例风险模型确定。结果：179例患者进入糖尿病肾病组(54.9%)，147例患者进入非糖尿病肾病组(45.1%)。糖尿病视网膜病变的存在、糖尿病家族史和对胰岛素治疗的依赖与糖尿病肾病的存在相关。糖尿病肾病患者有更多的心血管病变，并伴有更严重的左心室肥厚和PAD。肾病组的肾脏(对数等级χ2=26.534，p<；0.001)和心血管(对数等级χ2=16.257，p<；0.001)预后较差。DR(HR 1.539，95%CI 1.332-1.842)、EGFR(HR 0.943，95%CI 0.919-0.961)和24小时蛋白尿(HR 1.211，95%CI 1.132-1.387)是肾脏终点的危险因素。年龄(HR 1.672，95%CI 1.487-1.821)、HbA1C(HR 1.398，95%CI 1.197-1.876)和24小时蛋白尿(HR 1.453，95%CI 1.289-1.672)与心血管终点相关。结论：与非糖尿病肾病患者相比，糖尿病肾病患者心血管疾病严重，肾脏和心血管预后较差。
Background: Despite the high mortality of cardiovascular disease (CVD) in diabetic patients with renal injury, few studies have compared cardiovascular characteristics and outcomes between patients with diabetic nephropathy (DN) and non-diabetic renal disease (NDRD). Methods: A total of 326 type 2 diabetes mellitus patients with renal biopsy were assigned to DN and NDRD groups. Echocardiography and Doppler ultrasound were performed to evaluate left ventricular hypertrophy (LVH) and peripheral atherosclerosis disease (PAD). Renal and cardiovascular survival rates were compared between the DN and NDRD groups by Kaplan-Meier analysis. Risk factors for renal and cardiovascular events in DN patients were identified by a Cox proportional hazards model. Results: In total, 179 patients entered the DN group (54.9%) and 147 made up the NDRD group (45.1%). The presence of diabetic retinopathy, family history of diabetes, and dependence on insulin therapy were associated with the presence of DN. DN patients had more CVD with more severe LVH and PAD. Poorer renal (log-rank χ2 = 26.534, p < 0.001) and cardiovascular (log-rank χ2 = 16.257, p < 0.001) prognoses were seen in the DN group. DR (HR 1.539, 95% CI 1.332–1.842), eGFR (HR 0.943, 95% CI 0.919–0.961), and 24-h proteinuria (HR 1.211, 95% CI 1.132–1.387) were identified as risk factors for renal endpoints. Age (HR 1.672, 95% CI 1.487–1.821), HbA1C (HR 1.398, 95% CI 1.197–1.876), and 24-h proteinuria (HR 1.453, 95% CI 1.289–1.672) were associated with cardiovascular endpoints. Conclusion: Patients with DN had more severe CVD along with poorer renal and cardiovascular prognoses than those with NDRD.