MMC中心优秀研究汇展① | 中国成人2型糖尿病肾病参数、代谢达标与动脉硬化风险
2022年5月,MMC总中心医院——上海交通大学医学院附属瑞金医院内分泌代谢病科王卫庆教授团队联合MMC中心医院——郑州人民医院内分泌代谢科董其娟教授团队在《Journal of Diabetes》(IF2020:4.006)在线发表了题名为“Kidney Disease Parameters, Metabolic Goal achievement, and Arterial Stiffness Risk in Chinese Adult People with Type 2 Diabetes”——中国成人2型糖尿病肾病参数、代谢达标和动脉硬化风险的研究论文。
MMC总中心医院——上海交通大学医学院附属瑞金医院内分泌代谢病科的王卫庆教授以及MMC分中心医院——郑州人民医院内分泌代谢科的董其娟教授为通信作者。
图1:文章标题和作者
简介
心血管疾病是糖尿病患者死亡的主要原因,这一事实强调了检测动脉粥样硬化早期变化的重要性。脉搏波速度(PWV)越高,反映压力波返回越早,左心室负荷随之增加。因此,这一指标可以反映血管的动脉粥样硬化损伤,并与心血管风险的增加密切相关。
为了评估心血管疾病的风险,两种非传统的危险因素——尿白蛋白-肌酐比(UACR)和肾小球滤过率(eGFR)也被使用。慢性肾脏疾病(CKD),定义为肾功能异常(eGFR<60 ml/min/1.73 m2)和/或蛋白尿(UACR≥ 30 mg/g),在以人群为基础或社区为基础的队列研究或2型糖尿病(T2D)的小样本研究人群中,蛋白尿也被证明与不同动脉段的动脉硬化(AS)指标密切相关。与蛋白尿相比,eGFR对CV风险的贡献尚不清楚。一些小样本的早期研究发现,心血管疾病与肾脏损害的程度或极低水平的eGFR有关,另一项研究发现AS与轻到中度的CKD无关。需要更多的大型研究来探讨UACR和eGFR在糖尿病患者AS中的作用。
此外,传统的危险因素,如糖尿病,高血压,血脂异常,已被充分证明与较高的AS相关。因此,控制血糖、血压(BP)、血脂水平的有效干预措施已被证实对动脉健康产生积极影响。在2011年美国糖尿病协会糖尿病医疗指南中,建议大多数成人糖尿病患者糖化血红蛋白(HbA1c) <7.0% (A),血压<130/80 mm Hg (B),低密度脂蛋白胆固醇(LDL-C) <2.6 mmol/L (C),代表良好的控制代谢管理。同时评估上述传统和非传统AS决定因素对预防心血管疾病很重要。然而,目前还缺乏关于ABCs和肾脏疾病参数联合影响AS风险的研究。
摘要
背景:
研究尿白蛋白-肌酐比(UACR)和肾小球滤过率(eGFR)类别中的动脉硬化(AS)风险,以及肾脏疾病参数和代谢达标对成年2型糖尿病(T2D)患者AS风险的联合影响。
结论:
较高的UACR和较低的eGFR都是AS风险的决定因素,在T2D的成人中,UACR比eGFR与AS的相关性更强。蛋白尿/ eGFR下降与AS之间的相关性被多种代谢达标所修正。
划重点:
● 通过对2型糖尿病患者尿液白蛋白-肌酐比值和肾小球滤过率的评估,可以同时提供肾脏疾病指标和动脉硬化之间相关性的关键信息。
● 在临床实践中应该强调,在患者发展到慢性肾脏疾病阶段之前,采取措施改善动脉硬化的管理。
● 蛋白尿/估计肾小球滤过率下降与动脉硬化之间的相关性被多种代谢指标的实现所修正,强调了在动脉健康管理中针对多种代谢风险因素的重要性。
附英文摘要(滑动查看):
Abstract
Background:
To investigate the arterial stiffness (AS) risk within urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) categories and the joint effect between kidney disease parameters and metabolic goal achievement on AS risk in adult people with type 2 diabetes (T2D).
Methods:
A total of 27 439 Chinese participants with T2D from 10 National Metabolic Management Centers (MMC) were categorized into four albumin-uria/decreased eGFR groups. The criteria for decreased eGFR and AS were eGFR <90 ml/min/1.73 m2 and brachial-ankle pulse wave velocity value >the 75th percentile (1770.0 cm/s). Three metabolic goals were defined as glycated hemoglobin <7%, BP <130/80 mmHg, andlow-density lipoprotein cholesterol <2.6 mmol/L.
Results:
After full adjustment, odds ratios (ORs) for AS were highest for albu minuria and decreased eGFR (2.23 [1.98–2.52]) and were higher for albumin uria and normal eGFR (1.52 [1.39–1.67]) than for those with nonalbuminuria and decreased eGFR (1.17 [1.04–1.32]). Both UACR and eGFR in the subgroup or overall population independently correlated with AS risk. The achievement of ≥2 metabolic goals counteracted the association between albuminuria and AS risk (OR: 0.93; 95% CI: 0.80–1.07; p = .311). When the metabolic goals added up to ≥2 for patients with decreased eGFR, they showed significantly lower AS risk (OR: 0.65; 95% CI: 0.56–0.74; p < .001).
Conclusions:
Both higher UACR and lower eGFR are determinants of AS risk, with UACR more strongly related to AS than eGFR in adults with T2D.The correlation between albuminuria/decreased eGFR and AS was modified by the achievement of multiple metabolic elements.
Highlights:
• Provide key information on the correlation between kidney disease measures and arterial stiffness by evaluating urine albumin-creatinine ratio and estimated glomerular filtration rate simultaneously in a large sample with type 2 diabetes.
• Improving management of arterial stiffness, before reaching the chronic kidney disease stage, should also be emphasized in clinical practice.
• The correlation between albuminuria/decreased estimated glomerular filtration rate and arterial stiffness was modified by the achievement of multiple metabolic elements, underlining the importance of targeting multiple metabolic risk factors in the management of arterial health.
通信作者
• 医学博士,主任医师,博士生导师
• 中华医学会内分泌学分会候任主任委员,中国医师协会内分泌代谢科医师分会副会长,垂体学组组长。
• 国家自然及国家科技进步奖二审专家,《Journal of Diabetes》等杂志副主编,《Nature Reviews Endocrinology》(中文版)等编委。
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