糖尿病肾病患者贫血的相关因素分析

Associated factors of anemia in patients with diabetic nephropathy diagnosed by renal biopsy

摘要:

目的 探讨糖尿病肾病（DN）贫血的相关因素。方法 选取201 例在该院经病理确诊为DN 的患者， 分为贫血组和非贫血组。采用回归性分析贫血与临床表现、实验室指标，以及DN 病理分型和肾小管损伤评 分的关系；二分类Logistic 回归分析不同性别DN 患者贫血的影响因素。结果 ①非贫血组肾小球滤过率估 算值（eGFR）、糖化血红蛋白（HbA1c）、白蛋白（ALB）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、 血清铁（SI）、转铁蛋白（TRF）、促红细胞生成素（EPO）高于贫血组（P <0.05），超敏C 反应蛋白（hs-CRP）、 尿微量白蛋白/ 肌酐（UACR）、糖尿病病程（DD）低于贫血组（P <0.05）。②男性患者中，非贫血组DD、 Scr、BUN、UACR、hs-CRP 低于贫血组（P <0.05），HbA1c、ALB、TG、eGFR、SI、TRF、总铁结合率高 于贫血组（P <0.05）；女性患者中，非贫血组UACR、hs-CRP 低于贫血组（P <0.05），eGFR、ALB、HbA1c 高于贫血组（P <0.05）。③ Logistic 回归分析发现，男性患者eGFR、ALB、DD、hs-CRP 与贫血相关（P <0.05）； 女性患者ALB、hs-CRP 与贫血相关（P <0.05）。④Ⅱ a 型患者的Hb 水平高于其余病理分型患者（P <0.05）。 ⑤非贫血组肾小管损伤评分低于贫血组（P <0.05）。结论 DN 患者贫血的相关因素包括DD、肾功能恶化、 铁代谢紊乱、微炎症状态等，肾小管及间质损伤可能是肾功能异常导致贫血的重要原因。

Abstract:

Objective To investigate the related factors of anemia in the patients with diabetic nephropathy (DN) diagnosed by renal biopsy. Methods In this retrospective study, 201 patients with DN diagnosed by renal biopsy were included. They were divided into an anemia group and a non-anemia group. The relationships of anemia with clinical manifestations, laboratory findings, pathological classification of DN and renal tubular injury scores were analyzed. Binary logistic regression analysis was used to evaluate the related factors in the DN patients of different genders. Results In 201 cases with DN, diabetes duration (DD), eGFR, urinary albumin/creatinine (UACR), glycosylated hemoglobin (HbA1c), albumin (ALB), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), serum iron (SI), transferrin (TRF), hypersensitive C reactive protein (hs-CRP) and erythropoietin (EPO) were significantly different between the anemia group and the non-anemia group (P < 0.05). There were significant differences in DD, eGFR, UACR, HbA1c, ALB, TG, SI, TRF, hs-CRP, Scr, BUN and total iron binding rate between the anemia group and the non-anemia group of the male patients (P < 0.05); in the female cases, eGFR, ALB, HbA1c, UACR and hs-CRP were significantly different between the two groups (P < 0.05). Logistic regression analysis showed that eGFR, ALB, DD and hs-CRP were related to anemia in the male patients (P < 0.05); while ALB and hs-CRP were correlated with anemia in the female patients (P < 0.05). The tubulointerstitial damage score in the anemia group was significantly higher than that in the non-anemia group (P < 0.05), and the significant difference in the Hb level between the patients in pathological stage IIa and those in other stages was also detected (P < 0.05). Conclusions The related factors of anemia in DN patients include duration of diabetes, renal function deterioration, disorder of iron metabolism, microinflammation and so on. Tubulointerstitial damage might be an important mechanism of renal function deterioration-associated anemia.