Diabetes Metab Res Rev:1型糖尿病与2型糖尿病相比更容易加速肾脏疾病的恶化

2019-07-17 国际糖尿病编辑部 国际糖尿病

终末期肾病(肾衰竭)是各种慢性肾脏病的终末阶段,需透析或进行肾移植治疗。糖尿病是终末期肾病的重要致病因素之一。韩国成均馆大学医学院内分泌与代谢系的临床助理教授Kim教授及其团队的研究结果显示1型糖尿病与2型糖尿病相比更容易加速肾脏疾病的恶化。该研究发表在近期Diabetes Metab Res Rev上。

终末期肾病(肾衰竭)是各种慢性肾脏病的终末阶段,需透析或进行肾移植治疗。糖尿病是终末期肾病的重要致病因素之一。韩国成均馆大学医学院内分泌与代谢系的临床助理教授Kim教授及其团队的研究结果显示1型糖尿病与2型糖尿病相比更容易加速肾脏疾病的恶化。该研究发表在近期Diabetes Metab Res Rev上。

在患有慢性肾脏病的韩国成年人中,合并1型糖尿病的患者与合并2型糖尿病的患者相比,更有可能发展为终末期肾病,并进一步增加代谢综合征的患病几率。尽管对肾功能受损的1型糖尿病患者的护理(包括血糖控制工具、血压管理和肾素-血管紧张素系统阻滞剂的应用)取得了一定进展,但在过去20年中,由1型糖尿病引起的终末期肾病的发生率并没有下降。然而,韩国关于1型糖尿病患者的终末期肾病的风险信息有限。  

韩国成均馆大学医学院三星医学中心内分泌与代谢系的临床助理教授Kim博士在2 429 485例肾功能受损患者(估算肾小球滤过率<60 ml/min/1.73 ㎡)中检测了终末期肾病的潜在进展情况,这些人在2009年至2016年间接受了两年一次的体检。根据来自韩国国家医疗保险局的数据显示,在平均4.4年的随访期间,在医疗保险服务记录中确认了终末期肾病的诊断。在整个队列中,1 945 433例受试者没有糖尿病(平均年龄57.29岁;女性占57.96%),480 543例受试者患有2型糖尿病(平均年龄66.28岁;女性占53.79%),3508例受试者患有1型糖尿病(平均年龄64.82岁;女性占51.57%)。              

研究结果显示,1型糖尿病患者中终末期肾病的比例较高(11.35%),2型糖尿病患者(4.53%)和非糖尿病者(1.11%,P<0.0001)相比差异有统计学意义。此外,与2型糖尿病患者(1126.12/100000人年)和无糖尿病者(245.67/100000人年)相比,1型糖尿病患者的终末期肾病发病率均较高(2928.14/100000人年)。事实上,1型糖尿病患者比无糖尿病患者发展为终末期肾病的风险高出9倍以上(OR=9.267),而基于完全校正模型(包括考虑到eGFR和心血管并发症,如卒中房颤等)的1型糖尿病患者终末期肾病的风险比2型糖尿病患者高出2倍以上(OR=2.58)。该模型还表明,与无糖尿病的人相比,2型糖尿病患者出现终末期肾病的风险要高出3倍以上(OR=3.642)  。 




图1. 不同糖尿病类型的肾脏终点累积发病率

同时,在将代谢综合征这一因素纳入研究分析中时,患有1型糖尿病的受试者与未患有代谢综合征的受试者相比,被诊断为终末期肾病的可能性将增加两倍(OR=2.023;95%CI,1.501-2.727)。因此,代谢综合征可能是慢性肾病患者终末期肾病的一个有用的预测因子。

研究结论认为在患有慢性肾脏病的韩国成年人中,合并1型糖尿病的患者与合并2型糖尿病的患者相比,更有可能发展为终末期肾病,并进一步增加代谢综合征的患病几率。   

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    2019-09-18 guojianrong
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    2019-12-10 一闲
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    2019-09-28 QFXL123456

    学习

    0

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    2019-08-04 jyzxjiangqin

    糖尿病患者的病因。

    0

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    2019-07-22 jyzxjiangqin

    糖尿病患者的影响。

    0

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    2019-07-18 misszhang

    谢谢MedSci提供最新的资讯

    0

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