背景:2型糖尿病肾功能不全患者血清1,5-脱水葡萄糖醇(1,5-AG)的可靠性仍存在争议。
目的:评价肾功能与血清1,5-AG,并评估肾功能对1,5-AG的影响程度。
方法:共纳入5337例2型糖尿病患者。使用99mTc-DTPA动态肾闪烁显像法测定测得的肾小球滤过率(mGFR)。根据mGFR将所有受试者分为五组(≥120[n=507],90-120[n=2015],60-90[n=2178],30-60[n=604],和<30mL/min/1.73m2[n=33])。
结果:总体而言,血清1,5-AG和mGFR水平分别为3.3(1.7-7.0)μg/mL和88.6±24.1mL/min/1.73m2。mGFR与1,5-AG水平呈负相关(r=-0.189,P<0.001)。多元线性回归分析显示,在调整包括HbA1c在内的协变量后,mGFR与血清1,5-AG呈独立负相关(P<0.001)。在mGFR≥30mL/min/1.73m2的亚组中,1,5-AG与HbA1c之间的相关系数,空腹血糖,餐后血浆葡萄糖,餐后血糖和空腹血糖之间的差异仍然显着(范围为-0.126至-0.743,均P<0.01)。然而,在mGFR<30mL/min/1.73m2的个体中,1,5-AG与传统血糖标志物之间的联系减弱.排除贫血患者后的敏感性分析显示,mGFR亚组的血清1,5-AG和HbA1c之间的关系相似。
结论:尽管我们在2型糖尿病中观察到mGFR与血清1,5-AG之间存在弱的负相关(r=-0.189),1,5-AG仍然是评估患有轻度或中度肾功能障碍的受试者的葡萄糖控制的有效标志物。
BACKGROUND: The reliability of serum 1,5-anhydroglucitol (1,5-AG) in type 2 diabetic patients with renal insufficiency remains controversial.
OBJECTIVE: To evaluate the relationship between renal function and serum 1,5-AG, and to assess the extent to which renal function influences 1,5-AG.
METHODS: A total of 5337 participants with type 2 diabetes were enrolled. The measured glomerular filtration rate (mGFR) was assayed using 99mTc-DTPA dynamic renal scintigraphy. All subjects were stratified into five groups based on mGFR (≥ 120 [n = 507], 90-120 [n = 2015], 60-90 [n = 2178], 30-60 [n = 604], and < 30 mL/min/1.73 m2 [n = 33]).
RESULTS: Overall, the serum 1,5-AG and mGFR levels were 3.3 (1.7-7.0) μg/mL and 88.6 ± 24.1 mL/min/1.73 m2, respectively. mGFR was found to be negatively correlated with 1,5-AG levels (r = -0.189, P < 0.001). Multiple linear regression revealed that mGFR was independently and negatively related to serum 1,5-AG after adjusting for covariates including HbA1c (P < 0.001). In subgroups with mGFR ≥ 30 mL/min/1.73 m2, the correlation coefficients between 1,5-AG and HbA1c, fasting plasma glucose, postprandial plasma glucose, and the differences between postprandial and fasting plasma glucose remained significant (range from -0.126 to -0.743, all P < 0.01). However, the link between 1,5-AG and traditional glycemic markers was attenuated in individuals with mGFR < 30 mL/min/1.73 m2. Sensitivity analysis after excluding anemic patients showed similar results regarding the relationship between serum 1,5-AG and HbA1c across the mGFR subgroups.
CONCLUSIONS: Although we observed a weak inverse correlation (r = -0.189) between mGFR and serum 1,5-AG in type 2 diabetes, 1,5-AG remains a valid marker for assessing glucose control in subjects with mild or moderate renal dysfunction.