原发性肾病综合征患者发生类固醇糖尿病的危险因素分析

发布时间：2018-06-03 14:04

本文选题：肾病综合征 + 糖皮质激素　；参考：《肾脏病与透析肾移植杂志》2017年03期

【摘要】：目的:探讨原发性肾病综合征患者类固醇糖尿病(SDM)的发病率及危险因素。方法:回顾分析2011年1月至2015年12月,南京总医院国家肾脏疾病临床医学研究中心糖皮质激素(GC)治疗后发生SDM的原发性肾病综合征患者的临床资料。根据糖代谢的变化分为SDM组,糖调节受损组和糖代谢正常组。比较各组间患者的基线临床特征及实验室指标,行Logistic回归分析SDM的危险因素。结果:2 281例原发性肾病综合征患者中671例出现糖代谢紊乱,其中142例为SDM。81.7%的SDM在GC治疗1年内诊断,中位时间为108d。年龄、局灶性节段性肾小球硬化症、肾小球滤过率及空腹血糖与糖代谢紊乱的发生具有相关性,三组间统计学差异显著。SDM组患者的体质量指数、高血压2级以上(含2级)所占比例、合并使用他克莫司的比例、高尿酸血症及三酰甘油水平与糖代谢正常组相比,统计学差异显著,而与糖调节受损组相比无统计学差异。多因素Logistic回归分析显示:女性、高龄、空腹血糖、高尿酸血症、三酰甘油、GC起始剂量以及合并使用他克莫司是使用GC治疗原发性肾病综合征患者发生SDM的独立危险因素。结论:原发性肾病综合征患者使用GC治疗后糖代谢紊乱的发病率高。女性、高龄、空腹血糖升高、高尿酸血症、高三酰甘油血症、GC起始剂量较大及合并使用他克莫司是SDM的独立危险因素。
[Abstract]:Objective: To investigate the incidence and risk factors of steroid diabetes (SDM) in patients with primary nephrotic syndrome. Methods: To review and analyze the clinical data of SDM patients with primary nephrotic syndrome (SDM) after the treatment of Glucocorticoid (GC) from the National Center for renal disease clinical medicine in Nanjing general hospital from January 2011 to December 2015. The changes were divided into the SDM group, the impaired glucose regulation group and the normal glucose metabolism group. Compared the baseline clinical features and the laboratory indexes of the patients in each group, the risk factors of SDM were analyzed by Logistic regression. Results: in 2281 patients with primary nephrotic syndrome, 671 cases had glucose metabolism disorder, of which 142 cases were SDM.81.7% SDM in the 1 year of GC treatment. At the time of 108d. age, focal segmental glomerulosclerosis, glomerular filtration rate and fasting blood glucose were associated with glucose metabolism disorders. The three groups were statistically significant in the body mass index of the.SDM group, the proportion of higher than grade 2 (2), the proportion of tacrolimus, hyperuricemia and three acyl The statistical difference was significant compared with the normal glucose metabolism group, but there was no statistical difference compared with the impaired glucose regulation group. Multiple factor Logistic regression analysis showed that women, older age, fasting blood glucose, hyperuricemia, three glycerol, GC initial dose, and combined use of Kmos were used to treat patients with primary nephrotic syndrome with GC SDM independent risk factors. Conclusion: the incidence of glucose metabolism disorder in patients with primary nephrotic syndrome is high after the use of GC. Women, age, high fasting blood glucose, hyperuricemia, hypertriglyceridemia, higher initial GC dose and tacrolimus combined use of tacrolimus are the independent risk factors for SDM.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所;南京大学医学院附属金陵医院(南京军区南京总医院)内分泌科;
【基金】：国家自然科学基金(81270799) 国家科技支撑计划项目课题(2015BAI09B05) 国家“精准医学”重点研发计划项目(2016YFC090-4100)
【分类号】：R587.1;R692

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