Clinical Characteristics and Predictive Factors of Subclinical Diabetic Nephropathy
Clinical Characteristics and Predictive Factors of Subclinical Diabetic Nephropathy
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亚临床糖尿病肾病的临床特征及预测因素
DOI：
10.1055/s-0034-1396810
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发表时间：
2015-02-01
影响因子：
1.8
通讯作者：
Chang, B.
中科院分区：
文献类型：
--
作者：
Zhang, Y.;Yang, J.;Chang, B.
背景：探讨2型糖尿病患者亚临床糖尿病肾病的临床特点及预测因素。研究方法：根据24 h尿微量白蛋白和估计的肾小球滤过率将298例2型糖尿病患者分为3组：正常白蛋白尿和肾小球滤过率（NC）组、正常白蛋白尿和肾小球高滤过（SDN）组和微量白蛋白尿（EDN）组。分析肾脏大小、肾小管损伤标志物和动态血压。结果如下：与NC组相比，SDN和EDN组的肾脏大小增加（P < 0.05），而SDN组的肾脏长度大于EDN组（P < 0.05）。SDN组和EDN组患者尿视黄醇结合蛋白和N-乙酰-β-D氨基葡萄糖苷酶水平较高，大多数患者发生近端肾小管功能障碍。SDN组24 h平均血压和夜间舒张压高于NC组（P < 0.05），EDN组收缩压和脉压高于SDN组（P < 0.01）。SDN组和EDN组中更多患者出现血压节律异常。随着尿微量白蛋白的增加，夜间收缩压降低的可能性降低。肾体积增大、肾小管损伤标志物异常增多、24小时平均血压和夜间血压升高均为亚临床糖尿病肾病的危险因素。结论：亚临床糖尿病肾病患者肾脏体积增大，肾小管损伤标志物异常，血压升高，昼夜节律异常。
Background: To investigate the clinical characteristics and predictive factors of subclinical diabetic nephropathy in type 2 diabetes patients. Methods: A total of 298 type 2 diabetes patients were divided into 3 groups based on 24- h urinary microalbumin and estimated glomerular filtration rate: patients with normal albuminuria and glomerular filtration rate ( NC), patients with normoalbuminuria and glomerular hyperfiltration ( SDN) and patients with microalbuminuria ( EDN). The renal size, tubular injury markers and ambulatory blood pressure were analyzed. Results: Renal size increased in the SDN and EDN groups compared to the NC group ( P < 0.05), while renal length in the SDN group was greater than the EDN group ( P < 0.05). Patients in the SDN and EDN groups had higher level of urine retinol binding protein and N- acetyl- beta- Dglucosaminidase and most of them developed proximal tubular dysfunction. The SDN group had higher 24- h mean and nocturnal diastolic blood pressure than the NC group ( P < 0.05), while the EDN group had higher systolic blood pressure and pulse pressure than the SDN group ( P < 0.01). More patients developed abnormal blood pressure rhythm in the SDN and EDN groups. The likelihood of a decrease in nocturnal systolic blood pressure was lower as the microalbuminuria increased. Increased renal size, more abnormal tubular injury markers and higher 24- h mean and nocturnal blood pressure were all risk factors of subclinical diabetic nephropathy. Conclusion: Patients with subclinical diabetic nephropathy had increased renal size, abnormal tubular injury markers, high blood pressure and abnormal circadian rhythm.