| 侯悦,张梅,张笑,赵振平,李纯,于梦婷,王丽敏.中国居民糖尿病前期与肾小球高滤过状况的关联研究[J].中华流行病学杂志,2025,46(1):18-25 |
| 中国居民糖尿病前期与肾小球高滤过状况的关联研究 |
| Association between prediabetes and glomerular hyperfiltration status in residents in China |
| 收稿日期:2024-04-08 出版日期:2025-01-11 |
| DOI：10.3760/cma.j.cn112338-20240408-00177 |
| 中文关键词: 糖尿病前期 肾小球高滤过 肾小球滤过率 |
| 英文关键词: Prediabetes Glomerular hyperfiltration Glomerular filtration rate |
| 基金项目:国家重点研发计划（2021YFC2500201） |
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| 中文摘要: |
| 目的 探讨我国居民糖尿病前期与肾小球高滤过状况的关联性。方法 研究对象为2018年中国慢性病及危险因素监测中的非糖尿病人群。根据糖尿病前期的定义，将研究对象分为正常血糖组和糖尿病前期组，采用多因素logistic回归分析糖尿病前期分别与肾小球高滤过和肾小球滤过率下降风险的关联，采用限制性立方样条探讨不同血糖指标与肾小球高滤过风险的剂量-反应关系。结果 筛选符合条件的18~74岁研究对象129 735名，其中糖尿病前期45 336名。调整混杂因素后，与正常血糖组相比，糖尿病前期组肾小球高滤过的OR值为1.26（95%CI：1.20~1.32），糖尿病前期与肾小球滤过率下降无关联（OR=1.03，95%CI：0.96~1.12）。年龄分层的结果表明，18~59岁人群中糖尿病前期组较正常血糖组肾小球高滤过风险增加28%（OR=1.28，95%CI：1.21~1.35），60~74岁老年人风险增加15%（OR=1.15，95%CI：1.05~1.25）；女性（OR=1.38，95%CI：1.29~1.47）糖尿病前期肾小球高滤过风险高于男性（OR=1.14，95%CI：1.06~1.22）；身体活动不足人群（OR=1.29，95%CI：1.22~1.36）糖尿病前期肾小球高滤过风险高于身体活动充足人群（OR=1.16，95%CI：1.04~1.29）。限制性立方样条结果显示，FPG、糖化血红蛋白与肾小球高滤过风险均呈U形关联；服糖后2 h血糖肾小球高滤过风险呈近似J形关联。结论 我国居民糖尿病前期人群存在肾小球高滤过的风险，糖尿病前期与肾小球滤过率下降无关。在早期和可逆阶段控制高血糖，对防止肾小球高滤过进一步转变为低滤过并导致肾功能损伤具有重要意义。 |
| 英文摘要: |
| Objective To explore the association between pre-diabetes and glomerular hyperfiltration status in residents in China. Methods The study subjects were the non-diabetes population in China Chronic Disease and Risk Factor Surveillance in 2018. According to the definition of prediabetes, the study subjects were divided into normoglycemic and pre-diabetes groups, and multivariate factorial logistic regression model was used to analyze the association between prediabetes and the risk for glomerular hyperfiltration and glomerular filtration rate decline, respectively. Restricted cubic spline was used to explore the dose-response relationship between different glycemic indexes and the risk for glomerular hyperfiltration. Results A total of 129 735 eligible study subjects aged 18 to 74 years were included, including 45 336 persons with prediabetes. After adjusting for confounders, the OR for glomerular hyperfiltration in the prediabetes group was 1.26 (95%CI: 1.20-1.32) compared with the normoglycemic group, and prediabetes was not associated with decreased glomerular filtration rate (OR=1.03, 95%CI: 0.96-1.12). Age-stratified results showed a 28% increase of risk for glomerular hyperfiltration in prediabetes group compared with normoglycemic group in those aged 18-59 year (OR=1.28, 95%CI: 1.21-1.35), and a 15% increase of risk in old adults aged 60-74 years (OR=1.15, 95%CI: 1.05-1.25); the risk for glomerular hyperfiltration in women with prediabetes (OR=1.38, 95%CI: 1.29-1.47) was higher than that in men with prediabetes (OR=1.14, 95%CI: 1.06-1.22); and the risk for prediabetes glomerular hyperfiltration was higher in those with insufficient physical activity (OR=1.29, 95%CI: 1.22-1.36) than in those who were physically active (OR=1.16, 95%CI: 1.04-1.29). Restricted cubic spline results showed that fasting plasma glucose, glycosylated hemoglobin and glomerular hyperfiltration risk all showed U-shaped associations, and 2 hours blood glucose glomerular hyperfiltration risk after taking sugar showed an approximate J-shaped association. Conclusions The risk for glomerular hyperfiltration exists in the prediabetes population, and prediabetes is not associated with the decrease in glomerular filtration rate. Hyperglycemia control at an early and reversible stage is important to prevent glomerular hyperfiltration developing to hypofiltration and renal impairment. |
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