Diabetes Care:低HDL-C和高TG水平是糖尿病肾病的危险因素

2016-10-19 MedSci MedSci原创

2型糖尿病患者就算血糖、血压、胆固醇和低密度脂蛋白胆固醇(LDL-C)等指标达到了目标值,但是患者的糖尿病肾病(DKD)仍是高风险。这项回顾性研究旨在调查糖尿病血脂异常——高甘油三酯(TG)和/或低的高密度脂蛋白胆固醇(HDL-C)水平——是否与DKD高残余风险有关。一共有47177例患者参与意大利糖尿病中心研究,15362例患者的基线估计肾小球滤过率(eGFR)≥60 mL/min/1.73 m

2型糖尿病患者就算血糖、血压、胆固醇和低密度脂蛋白胆固醇(LDL-C)等指标达到了目标值,但是患者的糖尿病肾病(DKD)仍是高风险。

这项回顾性研究旨在调查糖尿病血脂异常——高甘油三酯(TG)和/或低的高密度脂蛋白胆固醇(HDL-C)水平——是否与DKD高残余风险有关。

一共有47177例患者参与意大利糖尿病中心研究,15362例患者的基线估计肾小球滤过率(eGFR)≥60 mL/min/1.73 m2、正常白蛋白尿、LDL-C ≤130 mg/dL、完成了长达4年的随访,数据用于分析。主要终点为DKD发生率,定义为低eGFR (<60 mL/min/1.73 m2)或eGFR减少> 30%和/或蛋白尿。

总体而言,12.8%的患者出现低eGFR, 7.6%的患者eGFR减少> 30%,23.2%的患者出现蛋白尿,4%的患者有蛋白尿,且有eGFR <60 mL/min/1.73 m2或eGFR减少> 30%。

TG ≥150 mg/dL增加约26%的低eGFR的风险,增加约29%的eGFR减少> 30%的风险,增加约19%的蛋白尿风险,以及出现其中一项异常的风险增加35%。

男性HDL-C <40 mg/dL、女性HDL-C<50 mg/dL时,增加约27%的低eGFR的风险,增加约28%的eGFR减少> 30%的风险,增加约24%的蛋白尿风险,以及出现其中一项异常的风险增加44%。将TG和HDL-C浓度作为连续变量时,这些联系仍具有统计学意义;对多种混杂因素校正后,这些联系只是衰减,但仍存在。

结果表明,在超过4年的时间里,低HDL-C和高TG水平是DKD的独立危险因素。

原始出处:

Giuseppina T. Russo,et al.Plasma Triglycerides and HDL-C Levels Predict the Development of Diabetic Kidney Disease in Subjects With Type 2 Diabetes: The AMD Annals Initiative.Diabetes Care 2016 Sep

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    2016-10-21 ZGMFX24A
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