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
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- 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

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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。

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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

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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

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