[1]周小海,安晔,王小玲,等.1型糖尿病合并非酒精性脂肪性肝病与慢性肾脏病的关系[J].国际内分泌代谢杂志,2021,41(04):339-344.[doi:10.3760/cma.j.cn121383-20200713-07032]
　Zhou Xiaohai,An Ye,Wang Xiaoling,et al.Relationship between nonalcoholic fatty liver disease and chronic kidney disease in patients with type 1 diabetes mellitus[J].International Journal of Endocrinology and Metabolism,2021,41(04):339-344.[doi:10.3760/cma.j.cn121383-20200713-07032]
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1型糖尿病合并非酒精性脂肪性肝病与慢性肾脏病的关系()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
41
期数:
2021年04期
页码:
339-344
栏目:
论著
出版日期:
2021-07-20

文章信息/Info

Title:
Relationship between nonalcoholic fatty liver disease and chronic kidney disease in patients with type 1 diabetes mellitus
作者:
周小海; 安晔; 王小玲; 苏青; 陈寒蓓
上海交通大学医学院附属新华医院内分泌科 200092
Author(s):
Zhou Xiaohai;  An Ye;  Wang Xiaoling;  Su Qing;  Chen Hanbei.
Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
关键词:
1型糖尿病;  非酒精性脂肪性肝病;  慢性肾脏病
Keywords:
Type 1 diabetes mellitus;  Non-alcoholic fatty liver disease;  Chronic kidney disease
DOI:
10.3760/cma.j.cn121383-20200713-07032
摘要:
目的 探讨1型糖尿病(T1DM)患者中非酒精性脂肪性肝病(NAFLD)与慢性肾脏病(CKD)的关系。方法 选取自2010年1月至2019年12月上海交通大学医学院附属新华医院内分泌科住院的T1DM患者334例,根据是否合并NAFLD分为T1DM合并NAFLD组(146例)和T1DM未合并NAFLD组(188例),比较两组尿白蛋白/肌酐比值(ACR)、估算的肾小球滤过率(eGFR)、CKD比例等,采用多因素logistic回归分析T1DM患者中NAFLD与CKD的关系。结果 与T1DM未合并NAFLD相比,T1DM合并NAFLD组白蛋白尿比例(42.5%比22.9%,χ2=14.637,P<0.001)和CKD比例(45.9%比23.9%,χ2=17.771,P<0.001)更高,eGFR水平更低(Z=-1.967,P=0.049); logistic回归分析显示,NAFLD是CKD的独立危险因素(OR=2.227,95% CI:1.186～4.181)。进一步按年龄、病程和体重指数(BMI)中位数分层进行logistic回归分析,在年龄<47.5岁,年龄≥47.5岁,病程≥6年,BMI<21 kg/m2,BMI≥21 kg/m2的T1DM患者中,NAFLD仍是CKD的独立危险因素,OR(95% CI)分别为2.861(1.342～6.099)、2.705(1.171～6.246)、3.951(1.701～9.176)、2.589(1.235～5.426)、3.022(1.245～7.338); 而在病程小于中位数的T1DM患者中,NAFLD不是CKD的独立危险因素。结论 在病程较长的T1DM患者中,NAFLD是CKD的独立危险因素。
Abstract:
Objective To explore the relationship between non-alcoholic fatty liver disease(NAFLD)and chronic kidney disease(CKD)in patients with type 1 diabetes mellitus(T1DM).Methods A total of 334 patients with T1DM who were hospitalized in the Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2010 to December 2019 were enrolled in this study. The subjects were divided into T1DM with NAFLD group(146 cases)and T1DM without NAFLD(188 cases)according to whether they had NAFLD. Urine albumin/creatinine ratio(ACR), estimated glomerular filtration rate(eGFR), percentage of CKD, etc. in two groups were compared, and multiple variable logistic regression was used to analyze the correlation between NAFLD and CKD in T1DM patients.Results Compared with T1DM without NAFLD, T1DM with NAFLD had a higher proportion of albuminuria(42.5% vs. 22.9%,χ2=14.637,P<0.001)and CKD(45.9 vs. 23.9,χ2=17.771,P<0.001), lower eGFR level(Z=-1.967,P=0.049); logistic regression analysis showed that NAFLD was an independent risk factor of CKD(OR=2.227, 95% CI:1.186-4.181). The logistic regression analysis was further stratified by median values of age, diabetes duration and BMI, in T1DM patients with age<47.5 years, age≥47.5 years, diabetes duration≥6 years, BMI<21(kg/m2), BMI≥21(kg/m2),NAFLD was still an independent risk factor of CKD in different groups, with OR(95% CI)were 2.861(1.342-6.099), 2.705(1.171-6.246),3.951(1.701-9.176), 2.589(1.235-5.426),3.022(1.245-7.338), respectively; but NAFLD was not an independent risk factor of CKD in lower median of diabetes duration group.Conclusion In patients with long-term T1DM, NAFLD is an independent risk factor for CKD.

参考文献/References:

[1] Wang FS,Fan JG,Zhang Z,et al.The global burden of liver disease:the major impact of China[J].Hepatology,2014,60(6):2099-2108.DOI:10.1002/hep.27406.
[2] Byrne CD,Targher G.NAFLD as a driver of chronic kidney disease[J].J Hepatol,2020,72(4):785-801.DOI:10.1016/j.jhep.2020.01.013.
[3] Ma YC,Zuo L,Chen JH,et al.Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease[J].J Am Soc Nephrol,2006,17(10):2937-2944.DOI:10.1681/ASN.2006040368.
[4] 李红,时立新.1型糖尿病诊断和治疗的研究进展[J].中华糖尿病杂志, 2016,8(10):587-590.DOI:10.3760/cma.j.issn.1674-5809.2016.10.004.
[5] 中华医学会内分泌学分会.非酒精性脂肪性肝病与相关代谢紊乱诊疗共识(第二版)[J].临床肝胆病杂志,2018,34(10):2103-2108.DOI:10.3969/j.issn.1001-5256.2018.10.010.
[6] Targher G,Pichiri I,Zoppini G,et al.Increased prevalence of chronic kidney disease in patients with type 1 diabetes and non-alcoholic fatty liver[J].Diabet Med,2012,29(2):220-226.DOI: 10.1111/j.1464-5491.2011.03427.x.
[7] Alberti KG,Zimmet P,Shaw J.The metabolic syndrome—a new worldwide definition[J].Lancet,2005,366(9491):1059-1062.DOI:10.1016/S0140-6736(05)67402-8.
[8] Targher G,Bertolini L,Padovani R,et al.Prevalence of non-alcoholic fatty liver disease and its association with cardiovascular disease in patients with type 1 diabetes[J].J Hepatol,2010,53(4):713-718.DOI:10.1016/j.jhep.2010.04.030.
[9] Teupe B,Bergis K.Epidemiological evidence for "double diabetes"[J].Lancet,1991,337(8737):361-362.DOI:10.1016/0140-6736(91)90988-2.
[10] Luk AOY,So WY,Ma RCW,et al. Hong Kong Diabetes Registry.Metabolic syndrome predicts new onset of chronic kidney disease in 5,829 patients with type 2 diabetes:a 5-year prospective analysis of the Hong Kong Diabetes Registry[J].Diabetes Care,2008,31(12):2357-2361.DOI:10.2337/dc08-0971.
[11] Mende C.Management of chronic kidney disease:the relationship between serum uric acid and development of nephropathy[J].Adv Ther,2015,32(12):1177-1191.DOI 10.1007/s12325-015-0272-7.
[12] Siu YP,Leung KT,Tong MK,et al.Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level[J].Am J Kidney Dis,2006,47(1):51-59.DOI:10.1053/j.ajkd.2005.10.006.
[13] 聂秀玲,李明珍,孙丽荣.高尿酸血症与非酒精性脂肪性肝病[J].国际内分泌代谢杂志,2016,36(02):89-91.DOI:10.3760./cma.j.issn.1673-4157.2016.02.004.
[14] Targher G,Mantovani A,Pichiri I,et al.Nonalcoholic fatty liver disease is independently associated with an increased incidence of chronic kidney disease in patients with type 1 diabetes[J].Diabetes Care,2014,37(6):1729-1736.DOI:10.2337/dc13-2704.
[15] Targher G,Bertolini L,Rodella S,et al.Non-alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and proliferative/laser-treated retinopathy in type 2 diabetic patients[J].Diabetologia,2008,51(3):444-450.DOI 10.1007/s00125-007-0897-4.
[16] Targher G,Chonchol M,Zoppini G,et al.Risk of chronic kidney disease in patients with non-alcoholic fatty liver disease:is there a link?[J].J Hepatol,2011,54(5):1020-1029.DOI:10.1016/j.jhep.2010.11.007.
[17] Musso G,De Michieli F,Bongiovanni D,et al.New pharmacologic agents that target inflammation and fibrosis in nonalcoholic steatohepatitis-related kidney disease[J].Clin Gastroenterol Hepatol,2017,15(7):972-985.DOI:10.1016/j.cgh.2016.08.002.
[18] Zimmermann E,Anty R,Tordjman J,et al.C-reactive protein levels in relation to various features of non-alcoholic fatty liver disease among obese patients[J].J Hepatol,2011,55(3):660-665.DOI:10.1016/j.jhep.2010.12.017.
[19] Targher G,Byrne CD.Non-alcoholic fatty liver disease:an emerging driving force in chronic kidney disease[J].Nat Rev Nephrol,2017,13(5):297-310.DOI:10.1038/nrneph.2017.16.
[20] 张宇恒,丁素英.转氨酶水平与非酒精性脂肪肝的关系[J].郑州大学学报(医学版),2019,54(6):916-918.DOI:10.13705/ j.issn.1671-6825.2019.02.065.
[21] Stadler M,Bollow E,Fritsch M,et al.Prevalence of elevated liver enzymes in adults with type 1 diabetes:a multicentre analysis of the German/Austrian DPV database[J].Diabetes Obes Metab,2017,19(8):1171-1178.DOI:10.1111/dom.12929.

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备注/Memo

备注/Memo:
基金项目:上海市自然科学基金(19ZR1433200)
通信作者:陈寒蓓,Email:chenhanbei@xinhuamed.com.cn
更新日期/Last Update: 1900-01-01