摘要目的 探讨2型糖尿病患者室间隔厚度(IVS)与肾功能水平及预后之间的关系.方法 选取265例非透析糖尿病患者,按IVS分为正常组(IVS≤11 mm)和增厚组(IVS＞11 mm);按照基线估算肾小球滤过率(eGFR)分为eGFR≥60 ml· min-1·(1.73 m2)-1组和＜60 ml·min-1·(1.73 m2)-1组.比较各组患者人口学及生化指标、eGFR、IVS等的差异.分析IVS、eGFR与年龄、糖尿病病程、24 h尿蛋白量、血压及生化指标的相关性.采用二兀Logistic回归分析eGFR＜ 60 ml· min-1·(1.73 m2)-1及IVS增厚的危险因素.采用多因素Cox回归分析影响2型糖尿病患者肾功能预后的相关危险因素.结果 与IVS正常组相比,IVS增厚组患者收缩压较高(P=0.002),血清肌酐、尿素氮、24 h尿蛋白量、24 h尿白蛋白量增加(均P＜0.05),合并高血压病史患者比例较高(81.16％比58.67％,x2=11.273,P=0.001),eGFR、白蛋白、血红蛋白、空腹血糖水平偏低(均P＜ 0.05).两组患者在CKD各个分期所占比例差异有统计学意义(x2=34.593,P＜ 0.01).相关性分析结果提示,IVS与BMI、收缩压、血清肌酐、尿素氮、24 h尿蛋白量、24 h尿白蛋白量呈正相关(均P＜ 0.05),与eGFR、血红蛋白、白蛋白、血钙水平呈负相关(均P＜0.05),与高血压病史及肾损伤程度(CKD分期)亦有显著相关(均P＜0.01).Logistic多因素回归分析结果显示糖尿病病程、收缩压、尿素氮增加是eGFR＜ 60 ml· min-1·(1.73 m2)-1的独立危险因素(均P＜ 0.05),而血红蛋白、血浆白蛋白水平增加为eGFR＜ 60 ml· min-1·(1.73 m2)-1的独立保护因素(均P＜ 0.05);基线血清肌酐水平增高是IVS增厚的独立危险因素(P＜0.05),空腹血糖水平增高为IVS增厚的独立保护因素(P＜0.05).COX多因素预后分析结果显示IVS增厚(HR=1.396,95％CI=1.098 ～ 1.774,P=0.006)为预测糖尿病患者eGFR下降50％或进展至ESRD的独立危险因素.结论 2型糖尿病患者IVS与肾功能状态密切相关,是预测糖尿病患者肾功能预后的独立影响因素.

abstractsObjective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus.Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study.According to their IVS,the patients were divided into normal group (IVS≤ 11 mm) and higher IVS group (IVS ＞ 11 mm).All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml· min-1 · (1.73 m2) 1 group and eGFR ＜ 60 ml· min-1 · (1.73 m2)-1 group.The demographic characteristic,biochemical examination,eGFR,and proteinuria of different groups were compared.Pearson or spearman correlation was used to analyze the relationship between eGFR,IVS and other parameters.eGFR ＜ 60 ml · min-1 · (1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression.Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis.Results Compared with normal group,patients in the higher IVS group had higher systolic pressure (P=0.002),their level of Scr,BUN,24 h urinary protein were increased (all P ＜ 0.05),while the level of eGFR,albumin (ALB),hemoglobin (Hb) and fasting blood glucose were decreased (all P ＜ 0.05).The prevalence of hypertension was increased (81.16％ vs 58.67％,x2=11.273,P=0.001),and there was also a difference in the proportion of patients in each stage of CKD (x2=34.593,P ＜ 0.001).Correlation analysis showed that IVS was positively correlated with BMI,systolic BP,Scr,BUN,24 h urinary albumin,24 h urinary protein (all P ＜ 0.05),while negative correlation was observed between the thickened degree of IVS and Hb,albumin,eGFR and total calcium (all P ＜ 0.05).It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P ＜ 0.01).Logistic regression analysis showed that longer duration of diabetes,higher systolic pressure and BUN were independent risk factors for eGFR ＜ 60 ml·min-1·(1.73 m2)-1 (all P ＜ 0.05),while higher Hb and Alb were independent protective factors for eGFR ＜ 60 ml· min-1· (1.73 m2)-1 (all P ＜ 0.05).Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P ＜ 0.05),while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P ＜ 0.05).Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396,95％ CI=1.098-1.774,P=0.006).Conclusion Interventricular septum thickness is closely related to the state of renal function,as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.