2型糖尿病肾病患者贫血的特点及影响因素分析

俞红霞; 陈肖蓉

doi:10.16766/j.cnki.issn.1674-4152.002366

2型糖尿病肾病患者贫血的特点及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002366

俞红霞^1, ,,
陈肖蓉²

1.
杭州市富阳区第一人民医院科教科，浙江杭州 542899
2.
杭州市富阳区第一人民医院肾内科

基金项目:

浙江省医药卫生科技计划项目 2020ZH030

详细信息

通讯作者:
俞红霞，E-mail：hongdeshuzi@163.com

中图分类号: R587.2 R556
计量
- 文章访问数: 175
- HTML全文浏览量: 123
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2021-08-04
- 网络出版日期: 2022-08-13

Characteristics and influencing factors of anaemia in patients with type 2 diabetic nephropathy

YU Hong-xia^{1
, ,},
CHEN Xiao-rong²

1.
Department of Science and Education, First People's Hospital of Fuyang District, Hangzhou, Hangzhou, Zhejiang 542899, China

摘要

摘要: 目的分析2型糖尿病肾病患者的贫血特点及其影响因素。方法选取2019年1月—2020年4月杭州市富阳区第一人民医院门诊就诊和住院治疗的2型糖尿病肾病患者185例为观察组，并根据贫血情况分为贫血组(52例)和非贫血组(133例)；另选取同期在我院门诊就诊和住院的2型糖尿病尿蛋白正常患者105例为对照组。分析2型糖尿病肾病患者的贫血特点及其影响因素。结果观察组贫血发生率(28.11%)明显高于对照组(3.81%，P＜0.01)；88.46%的贫血患者为正细胞正色素性贫血，23.08%的贫血患者肾小球滤过率(eGFR)>90 mL/(min·1.73 m²)，34.62%的贫血患者血肌酐(Scr)在正常水平时已发生贫血。贫血组Scr水平、胱抑素-C(Cys-C)水平明显高于非贫血组(均P＜0.01)，而血红蛋白(Hb)浓度、eGFR水平、白蛋白(ALB)水平、前白蛋白(PLB)水平明显低于非贫血组(均P＜0.05)；Scr升高、Cys-C升高、eGFR降低、ALB降低、PLB降低为2型糖尿病肾病患者发生贫血的独立危险因素。结论 2型糖尿病肾病患者的贫血发生率较高，以正细胞正色素型贫血为主，很多患者在eGFR下降之前和Scr正常时已经出现贫血；Scr升高、Cys-C升高、eGFR降低、ALB降低、PLB降低为2型糖尿病肾病患者发生贫血的独立危险因素。
- 2型糖尿病 /
- 糖尿病肾病 /
- 贫血 /
- 肾小球滤过率 /
- 血肌酐
Abstract: Objective To analyse the characteristics and influencing factors of anaemia in patients with type 2 diabetic nephropathy. Methods A total of 185 patients with type 2 diabetic nephropathy treated in our hospital from January 2019 to April 2020 were selected as the observation group and divided into an anaemia group (n=52) and a non-anaemia group (n=133). A total of 105 patients with type 2 diabetes mellitus with normal urinary protein were selected as the control group. The characteristics and influencing factors of anaemia in patients with type 2 diabetic nephropathy were analysed. Results The incidence of anaemia in the observation group (28.11%) was significantly higher than that in the control group (3.81%, P < 0.01). In addition, 88.46% of the patients with anaemia had positive cell orthochromatic anaemia, 23.08% of the patients with anaemia had glomerular filtration rate (EGFR)>90 mL/(min·1.73 m²), 34.62% of the patients with anaemia had anaemia at the normal level of serum creatinine (SCR). The levels of SCR and cystatin C (Cys C) in the anaemia group were significantly higher than those in the non-anaemia group (all P < 0.01), whereas the levels of haemoglobin, EGFR, albumin (ALB) and prealbumin (PLB) in the anaemia group were significantly lower than those in the non-anaemia group (all P < 0.05). Elevated SCR, Cys-C, decreased EGFR, ALB and PLB were independent risk factors for anaemia in patients with type 2 diabetic nephropathy. Conclusion Patients with type 2 diabetic nephropathy have a high incidence of anaemia, mainly positive cell and positive pigment anaemia, and many patients have anaemia before the decrease of EGFR and when SCR is normal. Elevated SCR, Cys-C, decreased EGFR, ALB and PLB are independent risk factors for anaemia in patients with type 2 diabetic nephropathy.
- Type 2 diabetes mellitus /
- Diabetic nephropathy /
- Anaemia /
- Glomerular filtration rate /
- Serum creatinine

HTML全文

表 1 2组糖尿病肾病患者一般临床资料、生化指标和尿液检查结果比较

Table 1. Comparison of general clinical data, biochemical indexes and urine test results between two groups of diabetic nephropathy patients

组别	例数	性别[例(%)]		年龄 (x±s，岁)	病程 (x±s，年)	Hb (x±s，g/L)	BMI (x±s)	Scr (x±s，μmol/L)	Cys-C (x±s，mg/L)
组别	例数	男性	女性	年龄 (x±s，岁)	病程 (x±s，年)	Hb (x±s，g/L)	BMI (x±s)	Scr (x±s，μmol/L)	Cys-C (x±s，mg/L)
贫血组	52	25(48.08)	27(51.92)	62.05±2.78	12.65±1.83	103.67±8.92	24.61±2.63	145.62±11.75	2.71±0.24
非贫血组	133	71(53.38)	62(46.62)	61.87±2.91	12.81±1.53	131.76±8.81	24.71±2.81	88.73±12.68	1.28±0.23
统计量		0.422^a		0.383^b	-0.604^b	-19.427^b	-0.221^b	27.989^b	37.552^b
P值		0.516		0.702	0.547	＜0.001	0.825	＜0.001	＜0.001

组别	例数	HbA1c (x±s，%)	ALB (x±s，g/L)	PLB (x±s，g/L)	eGFR[x±s， mL/(min·1.73 m²)]	TG (x±s，mmol/L)	TC (x±s，mmol/L)	LDL-C (x±s，mmol/L)	HDL-C (x±s，mmol/L)
贫血组	52	8.95±1.15	33.73±2.92	0.19±0.05	53.15±3.62	2.59±0.12	5.17±0.16	3.27±0.11	1.09±0.21
非贫血组	133	9.13±1.17	38.82±2.81	0.29±0.09	85.21±3.73	2.61±0.13	5.21±0.18	3.29±0.25	1.06±0.23
统计量		-0.945^b	-10.945^b	-7.561^b	-52.989^b	-0.961^b	-1.343^b	-0.556^b	0.817^b
P值		0.346	＜0.001	＜0.001	＜0.001	0.338	0.181	0.579	0.415
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2型糖尿病肾病患者发生贫血的相关因素赋值

Table 2. The assignment of risk factors of anemia in patients with type 2 diabetic nephropathy

变量	赋值方法
Scr(μmol/L)	实际值
Cys-C(mg/L)	实际值
eGFR[mL/(min·1.73 m²)]	实际值
ALB(g/L)	实际值
PLB(g/L)	实际值
贫血	无=0，有=1

下载: 导出CSV

表 3 2型糖尿病肾病患者发生贫血的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of anemia in patients with type 2 diabetic nephropathy

项目	B	SE	Wald χ²	P值	OR值	95% CI
Scr	1.371	0.615	4.970	< 0.001	3.939	1.180~13.146
Cys-C	1.135	0.576	3.883	< 0.001	3.111	1.006~9.619
eGFR	-1.108	0.531	4.354	< 0.001	3.028	1.107~8.572
ALB	-0.982	0.487	4.066	0.003	2.670	1.028~6.933
PLB	-0.945	0.478	3.908	0.004	2.573	1.008~6.565

下载: 导出CSV

参考文献(16)

[1]	郑利. 2型糖尿病肾病患者中早发糖尿病与终末期肾病的关系研究[D]. 重庆: 重庆医科大学, 2020. ZHENG L. Relationship between early-onset diabetes and end-stage renal disease in patients with type 2 diabetic nephropathy[D]. Chongqing: Chongqing Medical University, 2020.
[2]	丁波, 李冬梅, 马建华. 糖尿病患者合并贫血临床原因分析[J]. 中国医药导报, 2016, 13(26): 124-127. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201626030.htm DING B, LI D M, MA J H. Analysis of clinic anemic causes in diabetic patients[J]. China Medical Herald, 2016, 13(26): 124-127. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201626030.htm
[3]	吕晴, 陈卫东, 刘磊. 维持性血液透析患者肾性贫血的多因素分析及相关性研究[J]. 中华全科医学, 2021, 19(5): 871-874. doi: 10.16766/j.cnki.issn.1674-4152.001938 LYU Q, CHEN WD, LIU L. Multivariate analysis and correlation study of anaemia in patients with maintenance haemodialysis[J]. Chinese Journal of General Practice, 2021, 19(5): 871-874. doi: 10.16766/j.cnki.issn.1674-4152.001938
[4]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中国实用内科杂志, 2018, 38(4): 292-344. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201804009.htm Chinese Diabetes Society. Guidelines for the prevention and control of type 2 diabetes in China (2017 Edition)[J]. Chinese Journal of Practical Internal Medicine, 2018, 38(4): 292-344. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201804009.htm
[5]	杨俊, 顾刘宝, 娄青林. 贫血对老年2型糖尿病患者肾功能的影响[J]. 实用老年医学, 2015, 29(12): 1025-1027, 1030. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLA201512017.htm YANG J, GU L B, LOU Q L. Effect of anemia on the decline of renal function in the elderly patients with type 2 diabetes mellitus[J]. Practical Geriatrics, 2015, 29(12): 1025-1027, 1030. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLA201512017.htm
[6]	费选文, 张苏伟. 肾功能异常患者MSCV与MCV比值的变化及临床意义[J]. 中国校医, 2015, 29(7): 534-536, 538. https://www.cnki.com.cn/Article/CJFDTOTAL-XIYI201507029.htm FEI X W, ZHANG S W. Clinical significance of MSCV and MCV ratio changes in patients with abnormal renal function[J]. Chinese Journal of School Doctor, 2015, 29(7): 534-536, 538. https://www.cnki.com.cn/Article/CJFDTOTAL-XIYI201507029.htm
[7]	陈曦. 2型糖尿病肾病患者贫血相关因素分析[D]. 沈阳: 中国医科大学, 2018. CHEN X. Analysis of related factors of anemia in patients with type 2 diabetic nephropathy[D]. Shenyang: China Medical University, 2018.
[8]	罗贞. 糖尿病肾病合并贫血的相关发病机制研究进展[J]. 中外医学研究, 2018, 16(5): 184-186. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY201805094.htm LUO Z. Advances in the pathogenesis of diabetic nephropathy complicated with anemia[J]. Chinese and Foreign Medical Research, 2018, 16(5): 184-186. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY201805094.htm
[9]	张关亭. CysC、β2微球蛋白、肌酐、尿素氮在2型糖尿病肾病不同阶段的水平变化及诊断价值[J]. 中华全科医学, 2017, 15(5): 850-852. doi: 10.16766/j.cnki.issn.1674-4152.2017.05.037 ZHANG G T. Change of cystatin C, β2-microglobulin, creatinine and blood urea nitrogen in different stages of type 2 diabetic nephropathy and their diagnostic value[J]. Chinese Journal of General Practice, 2017, 15(5): 850-852. doi: 10.16766/j.cnki.issn.1674-4152.2017.05.037
[10]	HASSLACHER C, KULOZIK F, LORENZO BERMEJO J. Treatment with insulin analogs, especially Glargine and Lispro, associates with better renal function and higher hemoglobin levels in Type 1 diabetic patients with impaired kidney function[J]. Ther Adv Endocrinol Metab, 2016, 7(4): 166-177. doi: 10.1177/2042018816644393
[11]	尚朋. 胱抑素C和血肌酐检测在慢性肾脏病诊断和肾功能损伤程度评估中的临床价值[J]. 中外女性健康研究, 2020(12): 175-176. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWVJ202012114.htm SHANG P. Clinical value of cystatin C and serum creatinine in the diagnosis of chronic kidney disease and evaluation of renal function injury[J]. Women's Health Research, 2020(12): 175-176. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWVJ202012114.htm
[12]	任琳. 腹膜透析患者合并贫血的相关因素分析[D]. 合肥: 安徽医科大学, 2020. REN L. Analysis of factors related to anemia in peritoneal dialysis patients[D]. Hefei: Anhui Medical University, 2020.
[13]	万三红. CKD患者贫血的多因素及特点分析[D]. 长春: 吉林大学, 2018.
[14]	黄俊, 王永红, 马华兰. 血清胱抑素C、β₂微球蛋白、尿微量白蛋白联合检测在糖尿病肾病早期诊断中的临床价值[J]. 中国卫生检验杂志, 2017, 27(1): 54-56. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201701018.htm HUANG J, WANG Y H, MA H L. The clinical value of combined detection of serum cystatin C, β₂-microglobulin and urinary albumin in the early diagnosis of diabetic nephropathy[J]. Chinese Journal of Health Laboratory Technology, 2017, 27(1): 54-56. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201701018.htm
[15]	肖知周, 黄莺, 梅稳, 等. 糖尿病肾病患者贫血的相关因素分析[J]. 中国现代医学杂志, 2018, 28(29): 79-86. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY201829017.htm XIAO Z Z, HUANG Y, MEI W, et al. Associated factors of anemia in patients with diabetic nephropathy diagnosed by renal biopsy[J]. China Journal of Modern Medicine, 2018, 28(29): 79-86. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY201829017.htm
[16]	别昕, 张益民, 马祖, 等. 绿茶提取物抗氧化应激治疗对血液透析患者肾性贫血的影响[J]. 中国中西医结合肾病杂志, 2020, 21(7): 585-588. https://www.cnki.com.cn/Article/CJFDTOTAL-JXSB202007008.htm BIE X, ZHANG Y M, MA Z, et al. Effects of EGCG on renal anemia in patients with maintenance hemodialysis[J]. Chinese Journal of Integrated Traditional and Western Nephrology, 2020, 21(7): 585-588. https://www.cnki.com.cn/Article/CJFDTOTAL-JXSB202007008.htm