目的:糖尿病肾病是糖尿病(DM)患者的主要血管并发症。然而,血红蛋白(Hb)A1c水平之间的关联,特别是糖尿病前期的水平,肾脏病理变化尚不清楚。我们使用活体肾脏供体队列研究了无任何明显肾功能障碍的受试者中HbA1c水平与肾小动脉病变之间的关系。
方法:在2006年1月至2016年5月之间,393名活体肾脏捐献者在九州大学医院接受了“零时”活检。将患者分为四组(HbA1c水平<5.6%,5.6%-5.7%,5.8%-6.4%,且≥6.5%,或诊断为DM[DM组])。使用半定量分级评估肾小动脉的透明化和壁增厚。然后,我们研究了HbA1c水平与肾脏病理变化之间的关系。
结果:158例(40.2%)患者出现小动脉透明化,148例(37.6%)出现壁增厚。观察到HbA1c水平与壁增厚之间存在显著相关性(p为趋势<0.001)。根据多变量逻辑分析,在HbA1c水平为5.6%-5.7%和5.8%-6.4%的受试者中,HbA1c水平升高与壁增厚显着相关。和DM组,与HbA1c水平<5.6%的患者相比(比值比[OR],1.91;95%置信区间[CI]:5.6%-5.7%的[1.03-3.54],OR,1.96;95%CI:[1.09-3.53],5.8%-6.4%,或者,2.86;95%CI:DM组的[0.91-9.01]),而在非糖尿病HbA1c水平范围内,小动脉透明化没有增加.
结论:正常高HbA1c水平升高被认为是小动脉壁增厚的独立危险因素。糖尿病前期HbA1c水平患者可能发生亚临床肾小动脉硬化。
OBJECTIVE: Diabetic kidney disease is a major vascular complication in patients with diabetes mellitus (DM). However, the association between the hemoglobin (Hb)A1c levels, notably the prediabetic levels, and renal pathological changes remains unclear. We investigated the association between the HbA1c levels and renal arteriolar lesions in subjects without any apparent kidney dysfunction using a living kidney donor cohort.
METHODS: Between January 2006 and May 2016, 393 living kidney donors underwent a \"zero-time\" biopsy at Kyushu University Hospital. The patients were divided into four groups (HbA1c levels <5.6%, 5.6%-5.7%, 5.8%-6.4%, and ≥ 6.5%, or diagnosed with DM [DM group]). Renal arteriolar hyalinization and wall thickening were assessed using semi-quantitative grading. We then investigated the association between the HbA1c levels and renal pathological changes.
RESULTS: 158 (40.2%) patients had arteriolar hyalinization and 148 (37.6%) showed wall thickening. A significant correlation was observed between the HbA1c levels and wall thickening (p for trend <0.001). An elevated HbA1c level was significantly associated with wall thickening according to a multivariable logistic analysis in subjects with HbA1c levels of 5.6%-5.7% and 5.8%-6.4%, and the DM group, compared with those with HbA1c levels of <5.6% (odds ratio [OR], 1.91; 95% confidence interval [CI]: [1.03-3.54] for 5.6%-5.7%, OR, 1.96; 95% CI: [1.09-3.53] for 5.8%-6.4%, and OR, 2.86; 95% CI: [0.91-9.01] for the DM group), whereas arteriolar hyalinization did not increase within the nondiabetic HbA1c levels.
CONCLUSIONS: Elevated high-normal HbA1c levels are considered to be independent risk factors for arteriolar wall thickening. Subclinical renal arteriolar sclerosis may develop in patients with prediabetic HbA1c levels.