关键词: 2型糖尿病, 糖尿病肾病, 室间隔厚度, 左室内壁厚度, 影响因素分析

Abstract: Background　20% to 40% of patients with diabetes clinically develop diabetic kidney disease（DKD）.The main clinical manifestations of DKD are trace proteinuria and negative changes in renal function.The glomerular filtration rate（GFR） is an indicator of kidney function.In diabetic patients，the relationship of renal function with interventricular septal thickness（IVST） has been confirmed，but its relationship with left ventricular wall thickness（LVWT） is not clear.Objective　To investigate the development of DKD in patients with type 2 diabetes mellitus.Methods　A retrospective analysis was performed on the clinical and laboratory data of patients with type 2 diabetes mellitus who received treatment in 2008 and 120-month follow-up（as of December 31，2018） from Chengdu Fifth People's Hospital.Those with significantly increased albuminuria 〔defined as 24-hour urinary albumin excretion>500 mg/d and GFR<50 ml/min〕 and those without during the study period were assigned to DKD group，and non-DKD group，respectively.Kaplan-Meier method was used for survival analysis.Log-rank test was used to compare the survival status.Multivariate Logistic regression analysis was used to analysis the influencing factors associated with DKD.ROC analysis was conducted to estimate the value of IVST and LVWT in predicting the development of DKD.Results　A total of 178 were included and 48 of them（26.9%） developed DKD.Compared with those without DKD，those with DKD showed similar sex ratio，mean age，BMI，total cholesterol，LDL，BUN，Scr，sUA，hemoglobin，and HbA1c（P>0.05），but had longer mean duration of diabetes，higher mean systolic blood pressure，fasting blood glucose，LVWT and IVST，and mean lower HDL（P<0.05）.The result of multivariate Logistic regression analysis suggested that IVST 〔OR=4.577，95%CI（2.280，9.188）〕，and LVWT 〔OR=3.805，95%CI（1.917，7.553）〕 were independently associated with the occurrence of DKD（P<0.05）.Log-rank test results showed that increased IVST was associated with higher incidence of DKD either in those with hypertension （n=47）or in those without hypertension （n=131）（P<0.05），and so was increased LVWT（P<0.05）.Correlation analysis showed that LVWT and IVST were positively correlated with 24-hour urinary albumin excretion（P<0.001），and were negatively correlated with GFR（P<0.001）.ROC curve analysis showed that the AUC of IVST in the prediction of the development of DKD was 0.824，with 70.00% sensitivity and 73.64% specificity when the optimal cutoff value was determined as 12.5 mm.And the AUC of LVWT was 0.721，with 60.91% sensitivity and 67.27% specificity when the optimal cutoff value was determined as 11.5 mm.Conclusion　Longer duration of diabetes，elevated systolic blood pressure and fasting blood glucose，decreased HDL，increased LVWT and IVST were found to be associated with the development of DKD in type 2 diabetes，among which increased LVWT and IVST may be independent predictors for DKD in type 2 diabetes mellitus.

Key words: Diabetes mellitus, type 2；Diabetic kidney disease；Interventrieular septum thickness；Left wall thickness；Root cause analysis