Reduced GFR and microalbuminuria are independently associated with prevalent cardiovascular disease in Type 2 diabetes: JDDM study 16
Reduced GFR and microalbuminuria are independently associated with prevalent cardiovascular disease in Type 2 diabetes: JDDM study 16
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DOI：
10.1111/j.1464-5491.2008.02592.x
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发表时间：
2008-12-01
影响因子：
3.5
通讯作者：
Sone, H.
中科院分区：
文献类型：
--
作者：
Yokoyama, H.;Oishi, M.;Sone, H.
我们研究了肾小球滤过率（eGFR）降低是否与心血管疾病（CVD）患病率相关，而与糖尿病患者微量白蛋白尿的影响无关。在一项包括3002例日本2型糖尿病患者（无大量白蛋白尿）的多中心、大规模队列研究中，研究了eGFR降低和微量白蛋白尿与CVD的关系。在这些患者中，4.8%的患者eGFR和微量白蛋白尿降低，12.7%的患者eGFR降低但无微量白蛋白尿，18.7%的患者有微量白蛋白尿但eGFR正常。eGFR降低和微量白蛋白尿均与CVD患病率加倍相关。与无微量白蛋白尿/eGFR正常的患者相比[比值比（OR）1.0]，无微量白蛋白尿的eGFR降低的患者（OR 1.97）CVD的OR显著更高，而无微量白蛋白尿的eGFR降低的患者（OR 1.85）CVD的OR也同样更高。eGFR降低和微量白蛋白尿患者的OR最高（OR 3.97，95%置信区间2.55-6.20）。在校正年龄、性别、高血压、血脂异常、吸烟、体重指数、糖化血红蛋白和糖尿病病程后，CVD的OR仍然显著，如果将微量白蛋白尿的临界点设定为中位白蛋白：肌酐比值（13.7 mg/g肌酐），则仍显著。在无微量白蛋白尿的患者中，eGFR降低仅与老年组和男性组的CVD相关。eGFR降低和微量白蛋白尿的存在均与CVD患病率接近翻倍相关，与2型糖尿病患者的传统CVD风险因素和血糖控制无关。25，1426-1432（2008）。
We investigated whether a reduced estimated glomerular filtration rate (eGFR) was associated with cardiovascular disease (CVD) prevalence, independent of the effect of microalbuminuria in patients with diabetes.In a multicentre, large-scale cohort including 3002 Japanese patients with Type 2 diabetes without macroalbuminuria, the relationship of a reduced eGFR and microalbuminuria with CVD was investigated.Of those patients, 4.8% had a reduced eGFR and microalbuminuria, 12.7% had a reduced eGFR without microalbuminuria and 18.7% had microalbuminuria but normal eGFR. A reduced eGFR and microalbuminuria were each associated with a doubling of the prevalence of CVD. Compared with patients with no microalbuminuria/normal eGFR [odds ratio (OR) 1.0], the OR for CVD was significantly higher in those with a reduced eGFR without microalbuminuria (OR 1.97) and similarly higher in those with microalbuminuria without a reduced eGFR (OR 1.85). The OR was highest in those with both a reduced eGFR and microalbuminuria (OR 3.97, 95% confidence interval 2.55-6.20). The OR for CVD remained significant after adjustments for age, sex, hypertension, dyslipidaemia, smoking, body mass index, glycated haemoglobin and the duration of diabetes, and remained significant if the cut-off point for microalbuminuria was set at the median albumin : creatinine ratio (13.7 mg/g creatinine). In patients without microalbuminuria, a reduced eGFR was associated with CVD only in the older and male groups.A reduced eGFR and the presence of microalbuminuria were each associated with a near doubling of the prevalence of CVD, independently of traditional CVD risk factors and glycaemic control in patients with Type 2 diabetes.Diabet. Med. 25, 1426-1432 (2008).