·糖尿病性肾脏疾病·

　　张萌 简小金 黄清梅 方红娟 杨金奎

　　作者单位：338025江西省新余市人民医院内分泌科(张萌、简小金、黄清梅);中华医院管理杂志编辑部(方红娟);首都医科大学附属北京同仁医院内分泌科(杨金奎)

　　通讯作者：杨金奎

　　【摘要】目的探讨T2DM患者中慢性肾脏病(CKD)及外周动脉病变(PAD)的相关性 方法横断面研究501例住院T2DM患者。以踝臂指数(ABI)<0.9定为PAD，肾小球滤过率(GFR)<60 ml·min-1·(1.73 m2)-1定为CKD，尿白蛋白排泄率(UAER)≥20 μg/min定为微量白蛋白尿。结果35.7%患者GFR<60 ml·min-1·(1.73 m2)-1，61.5%有微量白蛋白尿。与对照组相比，ABI<0.9的糖尿病患者CKD的患病率更高(58.9% vs 29.4%，P<0.01)。调整传统危险因素后，CKD和微量白蛋白尿是ABI<0.9的独立危险因素。结论T2DM患者GFR<60 ml·min-1·(1.73 m2)-1和微量白蛋白尿与PAD的发生独立相关，在具有CKD及微量白蛋白尿的T2DM人群中并发PAD的比例增加，应对这一高危人群进行PAD的进行早期诊断及治疗。

　　【关键词】糖尿病，2型;慢性肾脏病;外周动脉病变;危险因素

　　doi:10.3969/j.issn.1006-6187.2012.02.005

　　Relationship between Peripheral Arterial Disease and Chronic Kidney Disease in Type 2 Diabetic PatientsZHANG Meng, JIAN Xiao-jin, HUANG Qing-mei, et al.Department of Endocrinology,Xinyu city People′s Hospital, Jiangxi province Xinyu 338025, China

　　Corresponding author:YANG Jin-kui

　　【Abstract】ObjectiveDiagnosing peripheral arterial disease (PAD) and recognizing its associated risk factors in diabetes is important due to high risk of cardiovascular disease and limb loss. The aim of this study was to discuss the relationship between PAD and chronic kidney disease (CKD) in patients with type 2 diabetes mellitus(T2DM). MethodsWe examined the cross-sectional association of PAD, defined as an ankle-brachial index (ABI)<0.9, and CKD, defined as measured GFR(using 99mTc-DTPA)<60 ml/min/1.73m2, among hospitalized patients with T2DM in China (n=501 , mean age 59 y,52.1% male). Microalbuminuria was defined as urinary albumin excretion rate (UAER)≥20μg/min ResultsAmong all these patients,35.7% patientes had CKD, 61.5% patientes had microalbuminuria .The prevalence of CKD was greater in patients with PAD(ABI<0.9) compared to controls(ABI≥0.9) (58.9% vs 29.4%，P<0.01). The association of PAD(ABI<0.9) with CKD (OR 1.384 ,95% CI 1.12 1to 1.846, P<0.05 )and microalbuminuria(OR 2.379 ,95% CI 1.452 to 3.897, P<0.01)was independent of potential confounders such as age, hypertension, and hypercholesterolemia. ConclusionsIn patients with T2DM, reduced GFR and microalbuminuria were associated independently with PAD(ABI<0.9). Their combined presence characterized a subgroup of the population who have an elevated prevalence of PAD and could benefit from early diagnosis and treatment.

　　【Key words】Diabetes mellitus, type 2;Chronic kidney disease; Peripheral arterial disease; Risk factor