摘要
目的建立糖尿病合并肾功能不全患者糖化血红蛋白(HbA_(1c))估算平均血糖的校正模型。方法回顾性分析2018年1月-2021年12月于陆军特色医学中心(大坪医院)高血压内分泌科住院治疗的329例2型糖尿病患者的临床资料,依据肾小球滤过率(eGFR)水平分为对照组[eGFR≥60 ml/(min.1.73 m^(2)),n=165]与肾功能不全组[eGFR<60 ml/(min.1.73 m^(2)),n=164]。收集两组患者的人口学基本特征、口服葡糖糖耐量试验(OGTT)2 h血糖水平及其他实验室检查结果,分别采用HbA_(1c)和OGTT两种模型估计入组患者的24 h平均血糖,并计算24 h平均血糖差值,分析影响肾功能不全患者HbA_(1c)估算血糖偏差的影响因素,建立HbA_(1c)估算平均血糖的校正模型。收集2022年1-3月于陆军特色医学中心(大坪医院)高血压内分泌科住院治疗的29例2型糖尿病合并肾功能不全患者进行外部验证。结果与对照组比较,肾功能不全组的年龄大(P=0.001)、糖尿病病程长(P<0.001),同时HbA_(1c)(P=0.034)、eGFR(P<0.001)、Hb(P<0.001)及ALB(P<0.001)水平较低。通过HbA_(1c)估算两组平均血糖,肾功能不全组24 h平均血糖差值较对照组明显增高[(0.88±1.64)mmol/L vs.(–0.09±2.10)mmol/L,P<0.001],且与Hb水平呈明显负相关(r=–0.377,P<0.001),而与ALB水平无明显相关性(P=0.551)。采用线性回归模型将HbA_(1c)、Hb、年龄、糖尿病病程、eGFR及ALB纳入分析,建立合并肾功能不全的糖尿病患者24 h平均血糖估算模型:平均血糖(mmol/L)=4.539+0.95×HbA_(1c)-0.016×Hb(校正R^(2)=0.829,P<0.001)。应用该模型估算的糖尿病合并肾功能不全患者24 h平均血糖差值明显减小[(0.02±1.05)mmol/L vs.(0.88±1.64)mmol/L,P<0.001]。对29例患者进行外部验证,拟合优度指标RNL=0.830,表明模型可行性较高。结论成功建立了糖尿病合并肾功能不全患者HbA_(1c)估算平均血糖的校正模型,对进一步制定个体化HbA_(1c)控制标准、改善患者预后具有重要意义。
Objective To establish an improved method for estimating the mean blood glucose by glycosylated hemoglobin(HbA_(1c))in diabetic patients with renal insufficiency.Methods The clinical data were retrospectively analyzed of 329 patients with type 2 diabetes mellitus who were hospitalized in the Department of Hypertension and Endocrinology of Daping Hospital of Army Medical Center of PLA from January 2018 to December 2021.All patients were divided into control group[estimated glomerular fraction rate,eGFR≥60 ml/(min.1.73 m2),n=165]and renal insufficiency group[eGFR<60 ml/(min.1.73 m^(2)),n=164]based on their eGFR levels.The basic demographic data,oral glucose tolerance test(OGTT)2 hours post plasma glucose,and other laboratory test results of the patients were collected.The HbA_(1c)and OGTT models were adopted separately to estimate the 24-hour average blood glucose of the enrolled patients,and the gap glucose level of the two methods was calculated.The influencing factors of estimating blood glucose deviation with HbA_(1c)in patients with renal insufficiency were analyzed,and a correction model of estimating average blood glucose with HbA_(1c)was established.A total of 29 patients with type 2 diabetes mellitus and renal insufficiency hospitalized in the Department of Hypertension and Endocrinology of Daping Hospital of Army Medical Center of PLA from January to March 2022 were collected for external verification.Results Compared with control group,diabetic patients with renal insufficiency were relatively older(P=0.001),with longer course of diabetes(P<0.001),and had lower HbA_(1c)(P=0.034),eGFR(P<0.001),Hb(P<0.001),and ALB(P<0.001)levels.The mean blood glucose of the two groups was estimated by HbA_(1c).The gap of estimated blood glucose was significantly higher in renal insufficiency group than in control group[(0.88±1.64)mmol/L vs.(–0.09±2.10)mmol/L,P<0.001],and was negatively correlated with the Hb level(r=–0.377,P<0.001),while with no relation with ALB level(P=0.551).A linear regression model was used to include HbA_(1c),Hb,age,diabetes course,eGFR and ALB into the analysis,and to establish an estimation model for estimating the daily mean blood glucose of diabetic patients with renal insufficiency:mean blood glucose(mmol/L)=4.539+0.95×HbA_(1c)-0.016×Hb(adjusted R^(2)=0.829,P<0.001).Using this model,the gap glucose level between the estimated mean blood glucose and the detected blood glucose were remarkably reduced in renal insufficiency group[(0.02±1.05)mmol/L vs.(0.88±1.64)mmol/L,P<0.001].The goodness-of-fit index RNL=0.830 was obtained by external validation of 29 patients,indicating that the model obtained is highly feasible.Conclusions A correction model of estimating mean blood glucose by HbA_(1c)for diabetic patients with renal insufficiency has been successfully established.It is of great significance to further develop individualized HbA_(1c)control and improve the prognosis of diabetes patients.
作者
刘肖肖
李书青
张倩
李强
何洪波
李英莎
祝之明
闫振成
Liu Xiao-Xiao;Li Shu-Qing;Zhang Qian;Li Qiang;He Hong-Bo;Li Ying-Sha;Zhu Zhi-Ming;Yan Zhen-Cheng(Department of Hypertension and Endocrinology,Daping Hospital of Army Medical Center of PLA/Center for Hypertension and Metabolic Diseases/Chongqing Institute of Hypertension,Chongqing 400042,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2022年第5期458-463,共6页
Medical Journal of Chinese People's Liberation Army
基金
国家自然科学基金面上项目(32171152)
重庆市自然科学基金面上项目(CSTC2019jcyj-msxmX0152)。
关键词
糖尿病
肾功能不全
血糖监测
线性回归
diabetes mellitus
renal insufficiency
blood glucose monitoring
linear regression
作者简介
刘肖肖,硕士研究生,主要从事糖尿病肾病方面的研究;通信作者:闫振成,E-mail:zhenchengyan@sina.com。
