·糖尿病临床研究·

　　李 芸、傅淑霞、段建召、王 晶

　　作者单位：050000石家庄，河北医科大学第二医院肾内科

　　【摘要】  目的   探讨肾小球疾病患者糖代谢异常的患病状况及其危险因素。   方法   选取无糖尿病史、初治的肾小球疾病患者1885例。监测血糖或OGTT，并收集临床、病理及化验资料进行统计学分析和比较。   结果   (1)T2DM患病率15.3%，糖调节异常(IGR)26.6%。若单纯检测FPG将漏诊全部IGR的72.9%及全部T2DM中的61.5%;(2)糖代谢异常的患病率随着增龄和肾功能下降而升高(P<0.01);有DM家族史、伴高血压、肥胖、高尿酸或高甘油三酯血症者糖代谢异常患病率均明显升高(P<0.05);(3)糖代谢异常组肾内小血管病变、小管间质病变及肾小球硬化发生率均明显增加(P<0.05);(4)Logistic回归分析显示，年龄(OR=3.156)、BMI、T2DM家族史(OR=1.334和2.541)、伴高血压、高甘油三酯血症(OR=1.587和1.669)、肾功能异常是糖代谢异常的高危因素。   结论   无糖尿病史的肾小球疾病患者中糖代谢异常患病率41.9%，其相关因素包括年龄、DM家族史、伴高血压、肥胖、高尿酸和(或)高甘油三酯血症。

　　【关键词】肾小球疾病;糖代谢异常;患病率;危险因素

　　doi:10.3969/j.issn.1006-6187.2011.12.011

　　Research on changes of glucose metabolism and the relative factors in patients with glomerular diseaseLI Yun , FU Shu-xia , DUAN Jian-zhao, et al. Department of Nephrolopy , the Second Hospital of Hebei Medical University , Hebei 05000 , China

　　【Abstract】   Objective   To explore glucose metabolic abnormality and its relative factors in patients with glomerular disease.    Methods    From Oct 2006 to Aug 2009, 1885 cases of glomerular disease without the history of diabetes were recruited. The clinical data, fasting and 2h postprandial or 75 g OGTT (if necessary) blood glucose levels, and kidney pathological results were collected and analyzed.   Results   (1) Of 1885 participants (male 1033,female 852),15.3% developed diabetes, 26.6% had abnormal glucose regulation(IGR). If only fasting plasma glucose(FPG) was tested, 72.9% of IGR and 61.5% of diabetes would be missed. (2)The prevalence of abnormal glucose metabolism was increased along with aging and decreased glomerular filtration rate(eGFR)(P<0.01), and increased in patients with overweight or obesity, hypertriglyceridemia, hypertension,and DM family history(P<0.05). (3)Compared with the normal group, the abnormal glucose metabolism group(IGR/T2DM) had higher incidence of renal vessel disease, tubulointerstitial lesions and glomerular sclerosis[(54.5%,69.8% vs 44.1%),(70.0%, 78.6% vs 63.6%) and (49.6%, 57.9% vs 40.6%)](P<0.05); (4)By logistic analysis, age(OR,3.156), BMI, a history of hypertension, T2DM family history(OR,2.541), blood lipids(OR,1.669),renal function were positively associated with the development of glucometabolic abnormality in patients with CKD independently.     Conclusion   The prevalence of abnormal glucose metabolism in patients with CKD is 41.9%. Age, BMI, history of hypertension, T2DM family history, blood lipids, renal function are the risk factors for development of glucometabolic abnormality.

　　【Key words】Glomerular disease; Abnormal glucose regulation; Prevalence; Risk factors