老年2型糖尿病患者镁排泄分数与慢性肾脏病相关性研究

Association of fractional excretion of magnesium with chronic kidney disease in elderly patients with type 2 diabetes mellitus

关键词:  2型糖尿病  镁排泄分数  老年  慢性肾脏病

Key words:  diabetes mellitus, type 2  fractional excretion of magnesium  elderly  chronic kidney disease

摘要:

目的探讨老年2型糖尿病(type 2 diabetes mellitus, T2DM)患者镁排泄分数(fractional excretion of magnesium, FEMg)与慢性肾脏病(chronic kidney disease, CKD)的相关性。方法选取2018年8月—2023年1月于同济大学附属第十人民医院住院的1 311名老年T2DM患者作为研究对象。根据FEMg四分位数将患者分为四组，分析四组患者的肾功能指标，如估计肾小球滤过率(estimated glomerular filtration rate, eGFR)和尿白蛋白排泄(urinary albumin excretion, UAE)情况。采用多变量Logistic回归模型分析FEMg与CKD之间的相关性。 结果在校正混杂因素后，与FEMg其他四分位数组患者比较，FEMg最高四分位数组患者CKD患病率显著升高(P<0.001)；FEMg最高四分位数组患者的微量白蛋白尿和大量白蛋白尿患病率升高(均P<0.001)。同时，eGFR水平随着FEMg四分位数增加显示出明显的下降趋势(P<0.001)，并且eGFR中重度下降的患者[临界值为30~59、15~30、<15 mL/(min·1.73 m2)]主要出现在FEMg最高四分位数组(P<0.001)。多变量Logistic回归分析结果显示，FEMg与CKD患病风险相关(OR=6.97,95%CI: 3.54~13.71，P<0.001)。

Abstract:

ObjectiveTo investigate the correlation between fractional excretion of magnesium(FEMg) and chronic kidney disease(CKD) in elderly patients with type 2 diabetes mellitus(T2DM). MethodsA total of 1 311 elderly T2DM patients who were hospitalized in Shanghai Tenth Peoples Hospital were enrolled from August 2018 to January 2023. The patients were divided into four cohorts based on the FEMg quartiles. The renal functional indicators like estimated glomerular filtration rate(eGFR) and urinary albumin excretion(UAE) among the four groups were analyzed. Multivariable logistic regression model was used to analyze the correlation between FEMg and CKD. ResultsAfter adjusting for confounding factors, the CKD prevalence in the highest quartile group was markedly elevated when compared to those in the other three quartile groups(P<0.001); the prevalence of microalbuminuria and macroalbuminuria in the highest quartile group was also elevated(P<0.001). Meanwhile, the eGFR level showed a clearly decreasing trend with the increase of FEMg quartiles(P<0.001), and patients with moderate-to-severe decreases in eGFR levels(with cut of limits at 30-59, 15-30, and<15 mL/min/1.73 m2) were mostly found in the highest FEMg quartile group(P<0.001). Multivariable logistic regression analysis revealed that FEMg was associated with the prevalence of CKD(OR=6.97，95%CI: 3.54-13.71, P<0.001). ConclusionFEMg is independently associated with the CKD prevalence in elderly T2DM patients.