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目的 探讨2型糖尿病(T2DM)患者肾小球滤过率(GFR)及微量白蛋白尿/肌酐比值(UACR)水平与外周血管病变发病危险性之间的关系.方法 回顾性分析2011年1月至2013年8月上海市第六人民医院住院患者信息,纳入符合1999年WHO糖尿病诊断标准的T2DM患者3 611例,男2 053例,女1 558例,年龄(58±14)岁.收集患者临床资料,应用颈血管及下肢血管超声检测联合诊断外周血管疾病.通过基于胱抑素C/肌酐的慢性肾脏病流行病学协作组公式(CKD-EPI)计算GFR值.根据GFR水平将患者分为五组:GFR≥90、75≤GFR＜90、60≤GFR＜75、30≤GFR＜60和GFR＜30 ml·min-1·1.73 m-2组,根据UACR水平将患者分为0≤UACR＜30、30≤UACR＜300及UACR≥300 mg/g三组.比较不同组患者外周血管疾病的患病率,评估不同GFR组及UACR组外周血管硬化、斑块、狭窄和闭塞的发生风险.采用方差分析、卡方检验、多因素回归进行统计学分析.结果 随着糖尿病患者GFR水平下降或UACR水平升高,外周血管病变的患病率增加.以GFR≥90 ml·min-1· 1.73 m-2作为参照组,GFR＜90 ml· min-1·1.73 m-2时,外周血管硬化和斑块的患病风险即可增加[OR(95％CI):2.020(1.558～2.620)和2.104(1.611～2.748),均P＜0.05].在GFR＜75 ml·min-1· 1.73 m-2时,外周血管狭窄和闭塞的患病风险明显增加[OR (95％ CI):2.432 (1.541～3.839)和2.785 (1.419～5.466),均P＜0.05].此外,一旦UACR≥30 mg/g,糖尿病患者患各种外周血管疾病的风险即较UACR 0～30 mg/g组增加49.2％～268.1％.结论 对于T2DM患者,一旦出现UACR≥30 mg/g或GFR≤75 ml· min-1· 1.73m-2,即应该定期进行外周血管超声检查,加强外周血管疾病的早期预防.

Objective To investigate the association between peripheral vascular disease risk and indicators of kidney function,such as glomeruar filtration rate (GFR) and urinary albumin/creatinine ratios (UACR) in type 2 diabetes patients.Methods We performed a cross-sectional analysis in 3 611 diabetic inpatients (male:2 053,female:1 558,age:58± 14) from Shanghai Diabetes Centre at Shanghai Jiaotong University-Affiliated Sixth People's Hospital from January 2011 to August 2013.Diabetes was diagnosed by 1999 WHO diabetic diagnostic criteria.Clinic parameters were collected from electronic medical records system.Peripheral vascular diseases (PVD) were diagnosed by combined carotid and lower extremity ultrasonography.GFR was estimated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Creatinine-Cystatin C Equation.Patients were classified into five groups by GFR (GFR≥90,75≤GFR ＜ 90,60GFR ＜ 75,30≤GFR ＜ 60 and GFR ＜ 30 ml· min-1· 1.73 m-2 group) or three groups (0≤UACR ＜ 30,30≤UACR ＜ 300 and UACR≥300 mg/g) by UACR.Morbidities of PVD prevalence rate,peripheral vascular sclerosis,plaque,stenosis and occlusion was compared by ANOVA,chi-square.Meanwhile,multivariable logistic regression analysis was used to estimate the risk between different groups with kidney dysfunction (assessed by GFR and UACR) and PVD.SPSS 17.0 was used for statistical analysis and P value＜0.05 were considered statistically significant.Results The deteriorated albuminuria and kidney dysfunction was found correlated to increased morbidities and risks of incident peripheral vascular disease (PVD).The odd ratio(OR)s of mild peripheral sclerosis and plaques for patients with GFR 75-90 ml · min-1 · 1.73 m-2 were 2.020(1.558-2.620) and 2.104(1.611-2.748),respectively (all P＜0.01),while OR of more severe peripheral arterial stenosis and occlusion for patients with GFR 60-75 ml· min-1· 1.73 m-2 were 2.432 (1.541-3.839) and 2.785 (1.419-5.466) (all P＜0.01) when compared with GFR ≥90 ml· min 1· 1.73 m-2.Meanwhile the increased risk of incident PVD with abnormal UACR could range from 49.2％ to 268.1％ (P＜0.05).Conclusion Our study indicates that it's time to take action for early prevention of macrovascular complications once T2DM patients with UACR＞30 mg/g or GFR ＜75 ml·min-1· 1.73 m-2.