2型糖尿病患者肾周脂肪与肾小球滤过率及尿微量白蛋白的关系

黄颖孜; 任红旗; 王玉丹; 沙俊诚; 潘智阳; 吴舜; 尹忠诚

doi:10.3969/j.issn.2096-3882.2022.07.001

2型糖尿病患者肾周脂肪与肾小球滤过率及尿微量白蛋白的关系

Relationship between perirenal fat and glomerular filtration rate and urinary microalbumin in patients with type 2 diabetes mellitus

摘要

摘要: 目的研究2型糖尿病患者的肾周脂肪厚度（perirenal fat thickness, PRFT）、肾窦脂肪(renal sinus fat, RSF)体积与肾小球滤过率（estimated glomerular filtration rate, eGFR）、尿白蛋白肌酐比值(urinary albumin creatinine ratio, UACR)的关系。方法选取徐州医科大学附属医院2019年1月至2021年6月205例2型糖尿病患者，回顾性收集患者住院期间的病史资料、实验室检查结果及影像学资料以及测量PRFT、肾静脉水平肾脏面积（renal area, RA）、双侧RSF的体积、肾脏体积（renal volume, RV）。比较糖尿病肾病（diabetic kidney disease, DKD）组和糖尿病无肾病组（non-DKD）的临床资料。在不同水平的体重指数（body mass index, BMI）和腰围（waist circumference, WC）、代谢相关实验室指标组间比较PRFT、RSF的差异。采用线性回归分析eGFR下降的独立相关因素。比较正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组的一般资料、实验室资料以及肾周围脂肪指标。多元Logistic回归分析步进法研究与UACR相关的危险因素。评价肾周脂肪对DKD肾功能下降的预测价值。结果DKD组的PRFT、RSF、PRFT/RA、RSF/RV均大于non-DKD组（P＜0.05）。超重或肥胖（BMI≥24 kg/m2）、向心性肥胖、高尿酸血症的T2DM患者有更厚的PRFT，RSF也更大；胰岛素抵抗指数大于2.69的T2DM患者有更厚的PRFT。线性回归分析得出RSF/RV与 eGFR独立负相关。多元Logistic回归分析得出，PRFT≥12.035 mm是大量白蛋白尿的独立危险因素。RSF/RV对eGFR下降预测价值的ROC曲线下面积0.738（P＜0.05）。结论在2型糖尿病患者中，RSF/RV与eGFR独立负相关，对eGFR具有一定预测价值；PRFT≥12.035 mm是发生大量白蛋白尿的独立危险因素。

Abstract: ob＜x＞jective To explore the relationship between the thickness of Perirenal fat thickness (PRAT) or the volume of renal sinus fat (RSF) and estimated glomerular filtration rate (eGFR) or urinary albumin creatinine ratio (UACR) in patients with type 2 diabetes mellitus. Methods 205 patients with type 2 diabetes in the Affiliated Hospital of Xuzhou Medical University from January 2019 to June 2021 were selected for retrospective analysis. The medical history data, laboratory examination results, PRFT and RSF were measured. The patients were divided into diabetic kidney disease (DKD) group and non-DKD group. The clinical data between the two groups were compared. The differences of PRFT and RSF were compared among groups with different levels of BMI, WC and me＜x＞tabolic laboratory indexes. Univariate linear regression analysis and multivariate linear regression analysis were used to screen the independent risk factors of eGFR decline. According to the size of UACR, the patients were divided into normal group, microalbuminuria group and macroalbuminuria group, and the general data, laboratory data and perirenal fat indicators were compared among the three groups. The risk factors associated with UACR were studied by stepwise multiple logistic regression analysis. Results The PFRT, RSF, PRFT/RA and RSF/RV of DKD group were higher than those of non-DKD group (P < 0.05). T2DM patients with overweight or obesity (BMI ≥ 24 kg/m2), central obesity and hyperuricemia had thicker PRFT and larger RSF. HOMA-IR greater than 2.69 had thicker PRFT. Linear regression analysis showed that RSF/RV was independently and negatively correlated with eGFR. Multiple logistic regression analysis showed that PRFT ≥ 12.035 mm was an independent risk factor for massive proteinuria. ROC curve analysis of the predictive value of RSF/RV on eGFR decline showed that the area under the curve was 0.738 (P < 0.05). Conclusion RSF/RV is independently and negatively correlated with eGFR in patients with type 2 diabetes, which has a certain predictive value for eGFR and PRFT ≥ 12.035 mm is an independent risk factor for massive proteinuria.

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