诊断学理论与实践

诊断学理论与实践 ›› 2025, Vol. 24 ›› Issue (03): 268-278.doi: 10.16150/j.1671-2870.2025.03.005

• 论著 • 上一篇    下一篇

1990年至2021年全球及中国2型糖尿病导致的慢性肾脏病疾病负担及危险因素分析

史曼曼1, 马毓华1, 郑金鑫2,3, 柯燕容1, 王语欣1, 刘剑2(), 王伟铭2()   

  1. 1.扬州大学附属昆山市中医医院肾病科，江苏 215300
    2.上海交通大学医学院附属瑞金医院肾脏内科，上海 200025
    3.上海交通大学医学院全球健康学院，中国热带病研究中心，上海 200025
  • 收稿日期:2025-01-28 接受日期:2025-06-09 出版日期:2025-06-25 发布日期:2025-06-25
  • 通讯作者: 王伟铭 E-mail：wwm11120@rjh.com.cn；刘剑 E-mail：lewis_963@163.com
  • 基金资助:
    国家自然科学基金(82070740);国家自然科学基金(81700647);国家自然科学基金(81870492);国家重点研发计划(2016YFC1305402);苏州市科技计划项目(SKYD2022017);国家重点基础研究发展计划（973计划）重点项目(2012CB517700)

Global and Chinese burden of chronic kidney disease due to type 2 diabetes and associated risk factors from 1990 to 2021

SHI Manman1, MA Yuhua1, ZHENG Jinxin2,3, KE Yanrong1, WANG Yuxin1, LIU Jian2(), WANG Weiming2()   

  1. 1. Department of Nephrology, Kunshan Traditional Chinese Medicine Hospital Affiliated to Yangzhou University, Jiangsu Kunshan 215300, China
    2. Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    3. School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
  • Received:2025-01-28 Accepted:2025-06-09 Published:2025-06-25 Online:2025-06-25

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摘要：

目的：评估1990年至2021年间，全球及中国不同年龄、性别、区域和社会人口指数（socio-demographic index，SDI）人群中2型糖尿病（type 2 diabetes，T2D）导致的慢性肾脏病（chronic kidney disease，CKD）（CKD-T2D）的疾病负担。方法：基于2021年全球疾病负担研究（Global Burden of Disease Study，GBD）数据，分析204个国家和地区的CKD-T2D发病率、患病率、死亡率和伤残调整寿命年（disability-adjusted life years，DALYs），计算绝对数值及其95%不确定性区间（uncertainty interval，UI）。结果：1990年至2021年间，全球CKD-T2D的疾病负担显著增加，2021年新发病例达2 012 024例（95% UI为1 857 800~2 154 288），较1990年增长167.2%（95%UI为153.5%~182.6%），年龄标准化发病率（age-standardized incidence rate，ASIR）为23.07/10万[95%UI为（21.40~24.72）/10万]，较1990年上升21.0%（95%UI为15.0%~27.5%）。区域分析显示，北非和中东地区CKD-T2D的ASIR较高（42.802/10万）。相比于1990年，2021年中国的CKD-T2D发病人数显著增加，达354 157例（95% UI为321 265~382 784）粗发病率增长177.6%（95%UI为154.8%~205.5%），ASIR仅微升7.8%[95%UI为（-0.1%）~17.8%]；其余指标的粗率增长，而年龄标准化率（age-standardized rate，ASR）下降。2021年，全球65~74岁人群的CKD-T2D发病最高[65~69岁人群新发364 163例（95%UI为272 571~475 468例），70~74岁人群新发366 045例（95%UI为286 728~459 891例）]，其中男性负担高于女性[65~69岁，男性新发187 097例（95%UI为140 064~243 571例），女性新发177 066例（95%UI为132 338~231 769例）；70~74岁，男性新发187 216例（95%UI为146 377~234 997例），女性新发178 830例（95%UI为140 938~224 801例）]。SDI分层显示，在1990年至2021年间，高SDI地区CKD-T2D的ASIR最高，且持续上升；而低SDI地区的CKD-T2D死亡率最高，且改善有限。高血糖、肥胖、高热量饮食和高血压是CKD-T2D的主要危险因素。结论：CKD-T2D仍是重大公共卫生问题，中低收入国家及老年、男性群体的疾病负担突出。中国的粗率攀升，但年龄标准化死亡率（age-standardized mortality rates，ASMR）和DALYs下降。

关键词: 慢性肾脏病, 2型糖尿病, 全球疾病负担, 年龄标准化率, 伤残调整寿命年

Abstract:

Objective To assess the burden of chronic kidney disease (CKD) caused by type 2 diabetes (T2D) (CKD-T2D) among populations of different ages, genders, regions, and socio-demographic index (SDI) levels globally and in China from 1990 to 2021. Methods Based on data from the 2021 Global Burden of Disease Study (GBD), incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of CKD-T2D in 204 countries and regions were analyzed, with absolute numbers and their 95% uncertainty intervals (UIs) calculated. Results From 1990 to 2021, the global burden of CKD-T2D increased significantly. In 2021, there were 2 012 024 (95%UI: 1 857 800-2 154 288) new cases, marking a 167.2% (95%UI: 153.5%-182.6%) increase from 1990. The age-standardized incidence rate (ASIR) reached 23.07 per 100 000 (95%UI: 21.40-24.72), an increase of 21.0% (15.0%-27.5%) since 1990. Regional analysis showed that North Africa and the Middle East had the highest ASIR (42.802 per 100 000). Compared to 1990, China's CKD-T2D incidence rose significantly to 354,157 cases (95%UI: 321 265-382 784), with crude incidence increasing by 177.6% (95%UI: 154.8%- 205.5%) and ASIR rising slightly by 7.8% [95%UI: (-0.1%) to 17.8%]. For other indicators, crude rates increased whereas age-standardized rates declined. In 2021, CKD-T2D incidence was highest among people aged 65-74 worldwide [364 163 new cases in ages 65-69 (95%UI: 272 571-475 468) and 366 045 in ages 70-74 (95%UI: 286 728-459 891)], with males bearing a higher burden than females [65-69: males 187 097 (95%UI: 140 064-243 571), females 177 066 (95%UI: 132 338-231 769); 70-74: males 187 216 (95%UI: 146 377-234 997), females 178 830 (95%UI: 140 938-224 801)]. SDI stratification indicated that from 1990 to 2021, high-SDI regions had the highest ASIR with a continuous upward trend, while low-SDI regions had the highest mortality rates with limited improvement. Hyperglycemia, obesity, high-calorie diets, and hypertension were the main risk factors for CKD-T2D. Conclusion CKD-T2D remains a major public health issue, with a particularly high disease burden among elderly males and in low- and middle-income countries. While crude rates have risen in China, age-standardized mortality rate (ASMR) and DALYs have declined.

Key words: Chronic kidney disease, Type 2 diabetes mellitus, Global burden of disease, Age-standardized rate, Disability-adjusted life year

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