BMC ENDOCR DISORD:T2DM患者想保护肾功能,更要控制好体重!

2021-09-20 MedSci原创 MedSci原创

一项代表亚洲人群,12年纵向随访研究——韩国2型糖尿病患者肥胖、体重变化和肾功能下降之间的关系。

肥胖是2型糖尿病、高血压和其他合并症的主要危险因素。由于人口老龄化,糖尿病在韩国的患病率有所上升。2016年,糖尿病已成为韩国肾脏替代治疗的最常见原因。据报道,韩国成年人中慢性肾脏疾病(CKD)的患病率为8.2%,临床因素如衰老,糖尿病和高血压可能与CKD的患病率上升有关。研究表明肥胖通过多种机制促进肾功能障碍,肥胖与高血压患者患肾病的风险呈U型关系,但与此同时也有报道指,高体重指数(BMI)对2型糖尿病和CKD患者肾功能恶化有保护作用。

本研究旨在调查韩国肾功能正常的2型糖尿病患者,肾功能下降、肥胖和体重变化的风险之间的关系。

本次调查覆盖2001年至2007年间就诊的韩国2型糖尿病患者(n = 1060),2015年至2017年完成后续调查。其中2型糖尿病患者肥胖(BMI≥25 kg/m2)患病率为45.8%。肥胖患者的糖化血红蛋白较高,谷丙转氨酶较高,血脂状况较差,但在eGFR或蛋白尿方面,三组之间没有发现差异(表1)。

在调整了年龄、性别、2型糖尿病持续时间、糖化血红蛋白、总胆固醇、甘油三酯和基线高血压等临床因素后,基线肥胖与肾功能下降风险升高有关(OR 1.40;CI 1.08-2.04;p = 0.025)(表2,图1)。未发现超重组更高的肾功能下降风险(OR 1.20:CI 0.966-1.63;p = 0.102)(表2)。

在基线调整临床变量后,肾功能正常的2型糖尿病患者中体重增加>10%与随访期间(平均=12年)肾功能下降的风险有关(OR 1.43;CI 1.111-2.00;p=0.016)。然而,对于基线肾功能正常的2型糖尿病患者,体重增加5%-10%和体重减轻5-10%与肾功能下降的风险无关。此外,任何程度的体重减轻与肾功能正常的2型糖尿病患者肾功能下降的风险无关(OR 0.98:CI 0.588-1.46;p=0.719) (表3)。

本研究表明,基线肥胖与肾功能下降的风险有关,体重增加>10%是韩国2型肾功能下降的独立预测因素。超重患者(23≤BMI<25)没有更高的肾功能下降的风险。体重减轻和体重增加<10%与2型糖尿病患者肾功能下降的风险无关。未来还需要进行大量前瞻性研究,以厘清肥胖、体重变化和2型糖尿病患者肾功能下降之间的因果关系。

 

原文来源:

Kim et al.Associations between obesity, weight change and decreased renal function in Korean type 2 diabetic patients:a longitudinal follow-up study.BMC Endocrine Disorders (2021) 21:188

https://doi.org/10.1186/s12902-021-00853-z

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    2022-03-18 yese
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    2022-07-31 cmsvly
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    2021-09-22 小小的丁香花

    肥胖对人体的的危害不言而喻。

    0

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