诊断学理论与实践

诊断学理论与实践 ›› 2017, Vol. 16 ›› Issue (02): 178-182.doi: 10.16150/j.1671-2870.2017.02.011

• 论著 • 上一篇    下一篇

社区糖尿病患者血压水平与慢性肾脏疾病及其进展的相关性研究

林安华, 王晨秀, 霍亚南, 陈志雄, 宋薇, 刘精东, 胡雅琴   

  1. 江西省人民医院内分泌科,江西 南昌 330006
  • 收稿日期:2016-06-20 出版日期:2017-04-25 发布日期:2017-04-25
  • 通讯作者: 霍亚南 E-mail: hyn_hyn0216@126.com

Correlation of blood pressure level with development and progression of chronic kidney disease in Chinese community diabetes patients

LIN Anhua, WANG Chenxiu, HUO Yanan, CHEN Zhixiong, SONG Wei, LIU Jingdong, HU Yaqin   

  1. Department of Endocrinology and Metabolism, Jiangxi Province People's Hospital, Jiangxi Nanchang 330006, China
  • Received:2016-06-20 Online:2017-04-25 Published:2017-04-25

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摘要： 目的 探讨江西省南昌市社区中老年糖尿病( diabetes mellitus,DM)患者的血压水平与慢性肾脏疾病（chronic kidney disease, CKD）及其进展间的相关性。方法 对南昌市社区中1 349例40岁以上的DM患者进行问卷调查和体格检查,并检测血糖、血脂和肾功能等,依据估算的肾小球滤过率(estimated glomerular filtration rate, eGFR)评估其CKD情况。根据血压对患者分组,并采用Logistic回归方程探讨血压与CKD间的相关性。结果 南昌市社区中老年DM患者的CKD患病率为28.97%（376/129 8）,CKD合并血压升高的百分比为83.51%( 314/376 ),其中高血压治疗率为95.22%( 299/314),血压控制率为49.36%(155/314)。非条件Logistic回归分析表明,年龄、体质量指数(body mass index, BMI)、DM病程、糖化血红蛋白（hemoglobin A1c,HbA1c）、收缩压、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、吸烟、每周外出就餐率高等均为社区DM合并CKD相关因素,DM患者的CKD患病风险随着年龄、DM病程、HbA1c、BMI及LDL-C、吸烟量和时间、每周外出就餐频次的增加而增加。收缩压控制在130 mmHg以上者较收缩压130 mmHg以下者,肾功能不全分期进展差异有统计学意义;收缩压控制在≥140 mmHg者较收缩压<140 mmHg者,肾功能不全分期进展差异有统计学意义;而舒张压控制在≥80 mmHg者较舒张压控制在<80 mmHg者,肾功能不全分期进展差异有统计学意义。结论 ①CKD是DM的常见并发症,南昌市社区中老年DM患者CKD合并血压升高的患病率高、治疗率高、控制率低。②年龄、DM病程、HbA1c、BMI、LDL-C、吸烟和每周外出就餐频次与CKD相关肾功能不全分期进展及血压控制相关。

关键词: 糖尿病, 慢性肾脏病, 相关因素, 肾小球率过滤, 血压

Abstract: Objective: To investigate the correlation between blood pressure level and development and progression of chronic kidney disease (CKD) in Chinese community diabetes (DM) patients. Methods: Questionnaires and physical examination were performed in 1 349 diabetic patients over 40 years old in a community in Nanchang. The laboratory examinations included blood sugar and blood lipids, and the estimated glomerular filtration rate (estimated GFR, eGFR) was calculated. Patients were grouped by blood pressure level on the basis for every 10 mmHg. Logistic regression was used to evaluate the correlation between different groups. Results: The prevalence of CKD in community DM patients was 28.97%（376/1298）, and the prevalence of CKD in subjects with hypertension was 83.51%（314/376）. The treated rate of hypertension was 95.21%（299/314）, and the hypertension control rate was 49.33%（155/314）. Non-conditional logistic regression analysis showed that age, BMI, duration of diabetes, glycosylated hemoglobin, systolic blood pressure, low density lipoprotein cholesterol(LDL-C), smoking, taking meals at restaurant weekly were correlated with CKD in community diabetic patients. The prevalence of CKD in community patients with DM increased with the elder age, longer duration of dia-betes, higher glycated hemoglobin, larger body mass index, higher LDL-C, smoking, and higher frequency of taking meals at restaurant weekly. CKD staging was different between systolic blood pressure≥; 130 mmHg and<; 130 mmHg, as well as between systolic blood pressure ≥; 140 mmHg and <; 140 mmHg. There was also significant difference in progress of renal disease between patients having diastolic blood pressure <; 80 mmHg and ≥; 80 mmHg. Conclusions: CKD is a common complication of DM, and CKD is associated with a high prevalence rate and low control rate of hypertension. Age, duration of diabetes, glycosylated hemoglobin, body mass index(BMI), LDL-C, smoking and taking meals at restaurant weekly are correlated with the stage and progress of chronic kidney disease (CKD) and control of hypertension.

Key words: Diabetes, Chronic kidney disease, Relevant factors, Rate of glomerular filtration, Blood pressure

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