糖化白蛋白对慢性肾脏病患者的血糖评估价值及其影响因素

发布时间：2018-05-04 05:38

  本文选题：糖化白蛋白 + 糖尿病肾病　； 参考：《上海医学》2016年05期

【摘要】：目的探讨糖化白蛋白(GA)对糖尿病肾病(DN)与非DN的慢性肾脏病(CKD)患者的血糖评估价值及其影响因素。方法共入选782例CKD患者,其中DN患者579例,非DN患者203例。根据估算肾小球滤过率(eGFR)将患者分为CKD 1至2期组(374例),CKD 3至4期组(207例)和CKD 5期组(201例)。CKD 1至2期组中DN患者343例,非DN患者31例;CKD 3至4期组中DN患者108例,非DN患者99例;CKD 5期组中DN患者128例,非DN患者73例。收集所有患者的一般资料,测定其空腹血糖(FBG)、餐后2h血糖(2hPBG)、GA、糖化血红蛋白(HbA1c)、血红蛋白(Hb)、24h尿蛋白定量(24hUP)和各项生化指标的水平。采用单因素、多因素分析方法分析GA与其他变量间的相关性。结果 CKD 1至2期组、CKD 3至4期组和CKD 5期组中非DN患者的年龄、FBG、2hPBG、HbA1c、GA均显著低于同组DN患者(P值均0.01)。CKD 3至4期组和CKD 5期组的DN患者的eGFR、FBG、2hPBG、HbA1c、GA、GA/HbA1c、血清血蛋白(sA)、Hb均显著低于CKD 1至2期组的DN患者(P值均0.01),24hUP均显著高于CKD 1至2期组的DN患者(P值均0.01);CKD 3至4期组和CKD 5期组的非DN患者的eGFR、sA、Hb均显著低于CKD 1至2期组的非DN患者(P值均0.01),CKD 5期组的非DN患者的24hUP显著高于CKD 1至2期组的非DN患者(P0.01)。CKD 5期组的DN患者的eGFR、FBG、2hPBG、HbA1c、GA、sA、Hb均显著低于CKD 3至4期组的DN患者(P值均0.01),24hUP显著高于CKD 3至4期组的DN患者(P0.01);CKD 5期组的非DN患者的eGFR、Hb均显著低于CKD 3至4期组的非DN患者(P值均0.01),24hUP显著高于CKD 3至4期组的非DN患者(P0.01)。在所有患者中,以GA为因变量行单因素线性回归分析显示,GA与FBG(R~2=0.145)、2hPBG(R~2=0.174)、HbA1c(R~2=0.649)呈正相关(P值均0.01),与24hUP呈负相关性(R~2=0.187,P值均0.01);多因素回归分析显示,BMI(β=-0.278)、FBG(β=0.334)、2hPBG(β=0.388)、24hUP(β=-1.044)和eGFR(β=-0.019)为GA的共同影响因素(R~2=0.414,P值均0.05)。DN患者中GA相关性分析显示,BMI(β=-0.341)、FBG(β=0.254)、2hPBG(β=0.347)、24hUP(β=-1.306)为GA的共同影响因素(R~2=0.375,P值均0.05)。结论 GA在不同CKD分期中均有血糖评估价值,CKD患者的GA除受血糖影响外,还受到BMI、蛋白尿和肾功能的影响。
[Abstract]:Objective to evaluate the value of glycosylated albumin (GA) in the evaluation of blood glucose in patients with diabetic nephropathy (DN) and non-DN patients with chronic kidney disease (CKD) and its influencing factors. Methods A total of 782 patients with CKD were enrolled, including 579 patients with DN and 203 patients with non DN. According to the estimated glomerular filtration rate (GFR), the patients were divided into three groups: CKD stage 1 to 2 (n = ), CKD stage 5 (n = 201) and non-DN (n = 31). There were 128 cases of DN and 73 cases of non-DN in 99 patients with non DN. The general data of all the patients were collected and the levels of fasting blood glucose (FBGG), 2 h postprandial blood glucose (2 h) PBGG, HbA1cI, HbA1C (24 h UP24 h) and biochemical indexes were measured. The correlation between GA and other variables was analyzed by single factor and multivariate analysis. Results the age of non-DN patients in CKD stage 1 to 2 group and CKD stage 5 group were significantly lower than those in 0.01).CKD 3 to 4 stage 0.01).CKD group and CKD 5 stage group. The P values in DN patients with CKD from stage 1 to stage 2 were significantly higher than those in patients with DN from stage 1 to stage 2 of CKD group. All the P values of patients with CKD from stage 1 to stage 2 were significantly lower than those of non-DN patients from stage 1 to stage 2 of CKD group (P < 0.01). All of them were significantly lower than those of non-DN patients from stage 1 to stage 2 of CKD group. The 24hUP of non-DN patients in stage 5 group was significantly higher than that of non-DN patients in stage 1 to 2 of CKD group. The level of 24hUP in patients with DN in phase 5 of CKD group was significantly lower than that in patients with DN in stage 3 to 4 of CKD group (P < 0.05). The levels of 24hUP in patients with non-DN group were significantly lower than those in patients with CKD stage 3 to stage 4. The levels of 24hUP in non-DN patients were significantly lower than those in patients with DN of stage 3 to stage 4. The levels of 24hUP were significantly higher than those in patients with DN of stage 3 to stage 4. The levels of eGFR- Hb in non-DN patients were significantly lower than those in non-DN patients with CKD from stage 3 to stage 4 (P < 0.01), respectively, and were significantly higher than those in non-DN patients with CKD from stage 3 to stage 4 (P < 0.01). Of all patients, 浠�GA涓哄洜鍙橀噺琛屽崟鍥犵礌绾挎，

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