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相關文獻
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題名 | Prevalence and Clinical Characteristics of Normoalbuminuric Type 2 Diabetic Patients with Reduced Glomerular Filtration Rate=正常白蛋白尿在第二型糖尿病合併下降的腎小球過濾率之病人的盛行率與臨床特徵 |
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作者 | 陳勅因; 蘇聖棋; 鄭力升; 郭錫恭; 劉瑞川; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷期 | 23:2 2009.06[民98.06] |
頁次 | 頁96-102+128 |
分類號 | 415.6681 |
關鍵詞 | 白蛋白尿; 腎小球過濾率; 盛行率; 糖尿病視網膜病變; 糖尿病腎臟病變; 第二型糖尿病; Albuminuria; Glomerular filtration rate; Prevalence; Diabetic retinopathy; Diabetic nephropathy; Type 2 diabetes mellitus; |
語文 | 英文(English) |
中文摘要 | 背景:在糖尿病腎小球病變中,蛋白尿被認為是腎小球過濾率下降的必要條件,然而西方國家的資料顯明有相當一部分的例外存在。目的:以腎小球過濾率小於60ml/min每1.73平方公尺體表面積定義為下降的腎小球過濾率,來測出正常白蛋白尿在第二型糖尿病合併下降的腎小球過濾率之病人所佔的比例,並分析其臨床特徵。方法:總共蒐集了1147個第二型糖尿病人在這個橫斷面的研究,其中有952人有可供分級的眼底檢查資料,用「腎臟病的飲食改善」此研究所研發的公式來評估腎小球過濾率,並以兩次的尿液白蛋白與肌酸酐的比率或半定量的試紙來檢定白蛋白尿。結果:下降的腎小球過濾率佔24.2%(278/1147)的第二型糖尿病病人。沒有白蛋白尿(包括微白蛋白尿與巨白蛋白尿)佔36.7%(102/278)的第二型糖尿病合併下降的腎小球過濾率之病人。白蛋白尿與視網膜病變皆無的佔了23.5%(54/230)的第二型糖尿病合併下降的腎小球過濾率之病人。在565位正常白蛋白尿的病人當中,有14.3%有下降的腎小球過濾率。在單變數迴歸分析中,我們發現有下降的腎小球過濾率的這一組病人年紀較大、身體質量指數較高、腰圍較大、較高比例的高血壓、較多腎素血管張力素系統抑制劑的使用者以及降血脂藥的使用者。多變數迴歸分析則顯示年齡、腰圍以及高血壓獨立地相關於下降的腎小球過濾率。結論:有可觀的一部份第二型糖尿病合併下降的腎小球過濾率的病人表現出正常的白蛋白尿。在正常白蛋白尿的病人當中,年紀較大,腰圍較大以及有高血壓乃是獨立地相關於下降的腎小球過濾率。 |
英文摘要 | Background: In classical diabetic glomerulopathy, developing macroalbuminuria is thought to be the requisite for loss of glomerular filtration rate (GFR). However, emerging data in the western countries showed normoalbuminuria in a substantial proportion of patients with reduced GFR. Objective: To determine the frequency of normoalbuminuria in type 2 diabetic patients with reduced GFR, defined as a GFR <60 ml/min per 1.73 m2 body surface area and to analyze their clinical characteristics. Materials and methods: A total of 1147 type 2 diabetic patients were recruited in this cross-sectional study. Among them, 952 patients had gradeable fundus examinations. The Mothfication of Diet in Renal Disease formula was used to estimate GFR. At least two measures of albumin-to-creatinine ratio or semiquantitative strip test were used to determine albuminuria (microalbuminuria or macroalbuminuria). Results: Reduced GFR was noted in 24.2% (278/1147) of type 2 diabetic patients. The absence of albuminuria was noted in 36.7% (102/278) of type 2 diabetic patients with reduced CFR. Additionally, both absences of retinopathy and albuminuria were noted in 23.5% (54/230) of type 2 diabetic patients with reduced GFR. Among the 565 normoalbuminuric patients, 14.3% patients (81/565) had reduced GFR. In univariate analyses, we found that the patients with reduced GFR were older, had higher BMI, waist circumference, higher proportion of hypertension, and used more rennin-angiotensin system (RAS) inhibitors, and lipid-lowering agents than the group without reduced GFR. Multivariate logistic regression analysis revealed that age, waist circumference, and hypertension were independently associated with reduced GFR. After excluding the users of RAS inhibitors, only age and waist circumference were independently associated with reduced GFR. Conclusion: A substantial proportion of type2 diabetic patients with reduced GFR manifest normoalbuminuria. Older age, increased waist circumference and hypertension contribute independently to reduced GFR in normoalbuminuria type 2 diabetic patients. |
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