中美两种2型糖尿病肾病诊断标准中疾病进展及预后因素对比(1)
摘 要：目的 通过对美国肾脏病基金会肾脏病预后质量倡议(NKF K/DOQI)标准及中华医学会糖尿病学分会微血管并发症学组的标准所描述的2型糖尿病肾病疾病进展及预后因素进行对比，评估两种标准的临床应用价值。方法 选取2016年4月～2017年4月于佛山市第二人民医院就诊的2型糖尿病患者共280例作研究对象，其中符合NKF K/DOQI标准的2型糖尿病肾病患者70例，符合中华医学会标准者80例。记录两种标准2型糖尿病肾病患者的肾小球滤过率，两组患者接受1年回访后对上述指标进行复查，统计两种标准患者的肾功能进展性下降的比例并进行对比。使用Spearson法分析eGFR下降幅度与各可能危险因素的相关性，使用Logistic回归模型分析随访后eGFR下降与各可能危险因素的相关性。结果 中华医学会标准诊断2型糖尿病患者的糖尿病肾病患病率为：28.57%(80/280)；NKF K/DOQI标准诊断2型糖尿病患者的糖尿病肾病患病率为25.00%(70/280)；按中华医学会标准，正常白蛋白尿的2型糖尿病肾病患者占2型糖尿病肾病患者的12.50%(10/80)；两种标准下，糖尿病肾病患者出现eGFR降低≥4%/年的比例均高于非糖尿病肾病者，中华医学会标准组为：20.00% vs 9.00%(P<0.05)；NKF K/DOQI標准组为：17.14% vs 6.67%(P<0.05)；两种标准下糖尿病肾病与非糖尿病肾病在eGFR降低<4%及eGFR无下降的患者比较，差异无统计学意义(P>0.05)；Logistic回归分析中，校正年龄、血糖、病程等危险因素后，中华医学会标准下糖尿病病程≥10年、HbA1C、基线eGFR与eGFR进展性下降存在显著相关性；NKF K/DOQI标准下糖尿病病程≥10年、高血压、HbA1C、基线eGFR、糖尿病视网膜病变与eGFR进展性下降存在显著相关性。结论 两种标准诊断的糖尿病肾病患者肾功能进展性下降程度均高于非糖尿病肾病患者，预测两种标准糖尿病肾病发生肾功能进展性下降的基线预后因素相似，本研究对中华医学会标准将正常白蛋白尿但eGFR下降的临床亚型归入2型糖尿病肾病诊断范畴的建议提供了流行病学的间接证据。
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关键词：2型糖尿病肾病；肾小球滤过率；诊断标准；
中图分类号：R587.2 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.22.019
文章编号：1006-1959(2018)22-0068-05
Comparison of Disease Progression and Prognostic Factors in Two Diagnostic Criteria for Type 2 Diabetic Nephropathy in China and the United States
HUANG Bing-wen
(Department of Endocrinology，the Second People's Hospital of Foshan，Foshan 528000，Guangdong，China)
, http://www.100md.com
Abstract：Objective To make a comparison of progression and prognostic factors on type 2 diabetic nephropathy severally described by National Kidney Foundation of clinical practice guidelines of America(NKF K/DOQI) and the standard of microvascular complication Group of Diabetes Society of Chinese Medical Association，and to evaluate the clinical value of the two criteria.Methods 280 patients with type 2 diabetes mellitus were selected from April 2016 to April 2017 in Foshan Second People's Hospital.There were 70 patients with type 2 diabetic nephropathy who met the NKF K/DOQI standard and 80 cases met the standard of Chinese Medical Association.The glomerular filtration rate was recorded in patients with type 2 diabetic nephropathy diagnose by the two standards.The two groups of patients received a year's visit to review the above indicators，the rate of progressive decline in renal function was measured and compared between the two groups of patients with standards.Spearson method was used to analyze the correlation between the decrease of eGFR and possible risk factors.Logistic regression model was used to analyze the correlation between eGFR decline and possible risk factors after follow-up.Results The prevalence of diabetic nephropathy was 28.57%(80/280) in type 2 diabetic patients diagnosed by the standard of Chinese Medical Association.The prevalence of diabetic nephropathy in patients with type 2 diabetes diagnosed by NKF K/DOQI criteria was 25.00%(70/280)；According to the Chinese Medical Association standards，normal albuminuria type 2 diabetic nephropathy patients accounted for 12.50%(10/80) of type 2 diabetic nephropathy patients.Under both standards，the proportion of patients with diabetic nephropathy who had decreased eGFR≥4%/a year was higher than that with non-diabetic nephropathy.The group of the standard of Chinese Medical Association was 20.00% vs 9.00% (P<0. 05)；The NKF K/DOQI standard group was 17.14% vs 6.67%(P<0. 05).There was no significant difference (P>0. 05) between diabetic nephropathy and non-diabetic nephropathy in patients with decreased eGFR <4% and no decrease in eGFR under two standards.And in Logistic regression analysis，after adjusting for age， blood glucose， course of disease and other risk factors，there was a significant correlation between a duration of diabetes≥10 years，HbA1C， baseline eGFR and progressive decline of eGFR under the standard of Chinese Medical Association；A duration of diabetes≥10 years，Hypertension， HbA1C， baseline eGFR， diabetic retinopathy and progressive eGFR decreased significantly under the NKF K/DOQI standard.Conclusion The degree of progressive decline of renal function in patients with diabetic nephropathy diagnosed by both criteria was higher than that in patients with non-diabetic nephropathy under both of the standards，and the baseline prognostic factors for predicting progressive decline of renal function in two standard diabetic nephropathy were similar.This study provides epidemiological circumstantial evidence for the recommendation of the Chinese Medical Association to classify the clinical subtypes of normal albuminuria but decreased eGFR into the diagnostic category of type 2 diabetic nephropathy., http://www.100md.com(黄秉文)
, http://www.100md.com
关键词：2型糖尿病肾病；肾小球滤过率；诊断标准；
中图分类号：R587.2 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.22.019
文章编号：1006-1959(2018)22-0068-05
Comparison of Disease Progression and Prognostic Factors in Two Diagnostic Criteria for Type 2 Diabetic Nephropathy in China and the United States
HUANG Bing-wen
(Department of Endocrinology，the Second People's Hospital of Foshan，Foshan 528000，Guangdong，China)
, http://www.100md.com
Abstract：Objective To make a comparison of progression and prognostic factors on type 2 diabetic nephropathy severally described by National Kidney Foundation of clinical practice guidelines of America(NKF K/DOQI) and the standard of microvascular complication Group of Diabetes Society of Chinese Medical Association，and to evaluate the clinical value of the two criteria.Methods 280 patients with type 2 diabetes mellitus were selected from April 2016 to April 2017 in Foshan Second People's Hospital.There were 70 patients with type 2 diabetic nephropathy who met the NKF K/DOQI standard and 80 cases met the standard of Chinese Medical Association.The glomerular filtration rate was recorded in patients with type 2 diabetic nephropathy diagnose by the two standards.The two groups of patients received a year's visit to review the above indicators，the rate of progressive decline in renal function was measured and compared between the two groups of patients with standards.Spearson method was used to analyze the correlation between the decrease of eGFR and possible risk factors.Logistic regression model was used to analyze the correlation between eGFR decline and possible risk factors after follow-up.Results The prevalence of diabetic nephropathy was 28.57%(80/280) in type 2 diabetic patients diagnosed by the standard of Chinese Medical Association.The prevalence of diabetic nephropathy in patients with type 2 diabetes diagnosed by NKF K/DOQI criteria was 25.00%(70/280)；According to the Chinese Medical Association standards，normal albuminuria type 2 diabetic nephropathy patients accounted for 12.50%(10/80) of type 2 diabetic nephropathy patients.Under both standards，the proportion of patients with diabetic nephropathy who had decreased eGFR≥4%/a year was higher than that with non-diabetic nephropathy.The group of the standard of Chinese Medical Association was 20.00% vs 9.00% (P<0. 05)；The NKF K/DOQI standard group was 17.14% vs 6.67%(P<0. 05).There was no significant difference (P>0. 05) between diabetic nephropathy and non-diabetic nephropathy in patients with decreased eGFR <4% and no decrease in eGFR under two standards.And in Logistic regression analysis，after adjusting for age， blood glucose， course of disease and other risk factors，there was a significant correlation between a duration of diabetes≥10 years，HbA1C， baseline eGFR and progressive decline of eGFR under the standard of Chinese Medical Association；A duration of diabetes≥10 years，Hypertension， HbA1C， baseline eGFR， diabetic retinopathy and progressive eGFR decreased significantly under the NKF K/DOQI standard.Conclusion The degree of progressive decline of renal function in patients with diabetic nephropathy diagnosed by both criteria was higher than that in patients with non-diabetic nephropathy under both of the standards，and the baseline prognostic factors for predicting progressive decline of renal function in two standard diabetic nephropathy were similar.This study provides epidemiological circumstantial evidence for the recommendation of the Chinese Medical Association to classify the clinical subtypes of normal albuminuria but decreased eGFR into the diagnostic category of type 2 diabetic nephropathy., http://www.100md.com(黄秉文)