| Recent years,with the development of economy, the improvement of lifequality and the reign of unhealthy life style, the prevalence of diabetesmullitus (DM) has revealed a soaring tendency. In2010,a survey on theprevalence of diabetes mullitus in china, which was practiced by ChineseMedical Association Diabetology Branch and publiced on new englangjournal of medicine shew that the incidence of diabetes mullitus amongChinese who were over20years old was9.7﹪(about92,400,000person).Thepossession of diabetic of china had been the largest one around the world.What worse was the incidence of impaired glucose tolerance was15.5﹪(about148,000,000person). As the result of the removation of medicaltechnology, diabetic,s lifespan has been extended and microangiopathy hasbecome a principal diabetic complication. In china50﹪diabetic who havebeen disturbed by DM over10years have conformed to the stander of thediagnosis of diabetic nephropathy(DN) which contains30﹪-40﹪T1DMpatients and15﹪-20﹪T2DM patients.Because the munber of T2DM patientsis10times of that of T1DM patients,the ratio of T2DM patients in DNpatients is larger than that of T1DM patients in DN patients.One of the mostcommon and seriouse diabetic complication is kidney microangiopathy.At the early DN stage, there is not any sensitive clinical indication to discoverit,until the clinical albuminuria appears. But then it is difficult to contol theexpeditious progress to chronic kidney disease (CKD). According to a greatquantity of statistics, the CKD resulted by DN is the primary cause ofHemodialysis and Kindey Transplantation and the fatality rate among T2DMpatients with DN is30times of that who without DN.Above all, it is obvious that DN has seriously reduced the life quality ofpatients, imposed heavy burden on the patients themselves, their families and society. So it is imminent to prevent,discover and interfere DN at the earlystage.Object: to appraise the current situation,analyze the clinical andlaboratory features of type2diabetic patients with low eGFR andnormoalbuminuria, find out the risk factors of impaired renal function andprovide the directions that make for the prevention and discovery of theprophase of renal lesions of T2DM patients.Methods: we collect the patients,clinical data and information whowere diagnosed T2DM according with the standard of T2DM of WHO in1999, accepted hospitalization from october2008to september2011in thedepartment of endocrine of our hospital and whose result of UAER werenormal. Then eGFR was calculated using the Modification of Diet in RenalDisease formula:186×[plasma creatinine (mg/dl)-1.154×age (years)-0.203×(0.742if female)] and divide the patients into2groups based on therecommendation of K/DOQI. One is the normal GFR group(GFR≥90ml/min·1.73m2) and the other is the decreasing GFR group(GFR<90ml/min·1.73m2).120participants are included in the normal group,88men and32women (mean age46.61±14.48years, mean course of disease51.01±57.03monthes, mean HbA1c11.05﹪±10.55, mean BMI25.5±3.49, mean IR2.1±1.95).In another group,there is31patients,12men and19women (meanage55.61±10.54years, mean course of disease74±76.32monthes, meanHbA1c9.2﹪±2.6, mean BMI25.66±4.29, mean IR2.14±1.29).Allparticipants had dinner strictly in accordance with diabetic diet that wasdesigned by professional staffes and they were without any acutestresshypoproteinemial,urologic diseaseexample for calculus, tumor,infection.thereis not any record about constitutional or secondary glomerulonephritis,cardiacdysfunction,without pregmancy, case history of tumor. Then the dataconcluding age, sex, BMI, cigarette smoking, alcohol drinking,systolic bloodpressure, diastolic blood pressure,serum creatinine, blood uric acid, bloodurea nitrogen triglycerides, total cholesterol,LDL,HDL,A/C,UAER,HbA1C, IR, is anaiyzed by SPSS17.0statistical package. P values <0.05(two tailed) are considered significant.Result: A total of151normoalbuminuric type2diabetic patients areevaluated.31(20.6%) have low eGFR (<90ml/min per1.73㎡), and theremaining120comprise the reference group (79.4%). In a univariate analysisthe group of patients with low eGFR are older (P <0.001), have more women(P <0.001), and higher level of serum creatinine (P <0.001), SBP (P <0.001),BUN (P=0.006), HbA1C (P=0.002),A/C(P=0.038)than the reference group.In a multivariate Logistic regression analysis, eGFR correlate negatively withthe level of serum creatinine (OR=7556.56),SBP (OR=25.64) and female isone of risk factors associated with eGFR descent (OR=5.07).Conclutions: The prevalence of patients with low eGFR in this sampleof type2diabetic patients is high (20.6%) and is associated with high scrlevels, SBP and sex,and we should pay more attention on the evaluation ofeGFR of all diabetic patients even if they show normoalbuminuria. |
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