基于多因素Cox回归模型的糖尿病肾病进展的危险因素分析

Analysis of risk factors for progression of diabetic kidney disease based on multivariate Cox regression model

摘要

目的 本研究基于多因素 Cox 模型，探讨糖尿病肾病患者肾功能衰竭的危险因素。方法 收集2013年1月—2024年10月多次就诊于兰州大学第二医院的糖尿病肾病患者临床资料，通过时间分段方法，利用多因素Cox回归模型，分析糖尿病肾病患者肾功能衰竭的危险因素。结果 第1年、第2～4年、第4～11年肾衰竭发生率分别为0、20%、42.95%，多因素COX分析表明血糖控制不佳(HR=13.15，95%CI:[3.03，57.02]，P＜0.001)、高血压 (HR=12.01，95%CI:[2.83，51.01]，P＜0.001）、老龄（HR=3.22，95%CI:[1.35，7.66]，P=0.008）、较长的糖尿病病程（HR=1.08，95%CI:[1.00，1.17］，P=0.046）、较高的尿白蛋白与肌酐比值（HR=1.03，95%CI:[1.01，1.06]，P=0.019）、较高的收缩压（HR=1.02，95%CI:[1.00，1.03]，P=0.024) 为糖尿病肾病进展的危险因素；较高的血红蛋白质量浓度（HR=0.99，95%CI:[0.98，1.00]，P=0.021）、较高的估算肾小球滤过率（HR=0.96，95%CI:[0.94，0.97]，P＜0.001）、较高的白蛋白质量浓度(HR=0.95，95%CI:[0.92，0.99]，P=0.008)、糖尿病诊断年龄高（HR=0.94，95%CI:[0.91，0.96]，P＜0.001）、早期胰岛素治疗（HR=0.91，95%CI:[0.86，0.97]，P=0.001）为糖尿病肾病进展的保护因素。结论 通过多因素 Cox 回归模型，明确了糖尿病肾病进展的危险因素及保护因素，提示临床中应采取＂早期发现、全面评估、积极干预、多靶点管理＂的综合策略。

Abstract

Objective To investigate the risk factors of renal failure in diabetic kidney disease patients by us- ing the multivariate Cox model．Methods Clinical data of diabetic kidney disease patients were collected from the Second Hospital of Lanzhou University from January 2013 to October 2024．The risk factors of renal failure in diabetic kidney disease patients were analyzed by the time-segmented method and multivariate Cox regression model．Results The rates of renal failure in the first year，the second to fourth year and the fourth to eleventh year were 0%，20% and 42.95%，respectively．Multivariate Cox analysis showed poor glycemic control (HR=13.15，95%CI:[3.03，57.02]，P＜0.001)，hypertension (HR=12.01，95%CI:[2.83，51.01]，P＜0.001)，advanced age (HR=3.22，95%CI:[1.35，7.66]，P=0.008)，longer duration of diabetes (HR=1.08，95%-0.050.019)，and higher systolic blood pressure（HR=1.02，95%CI:[1.00，1.03]，P=0.024）were risk factors for renal function progression．On the other hand，a higher hemoglobin concentration（HR=0.99，95%CI：[0.98， 1.00]，P=0.021)，higher estimated glomerular filtration rate（HR=0.96，95%CI:[0.94，0.97]，P＜0.001），high- er albumin (HR=0.95，95%CI:[0.92，0.99]，P=0.008)，older age of diabetic diagnosis (HR=0.94，95%CI：[0.91，0.96]，P＜0.001)，and early insulin therapy（HR=0.91，95%CI:[0.86，0.97]，P=0.001）were protective factors against renal function progression．Conclusion Multivariate Cox regression analysis identified the risk and protective factors，highlighting that a comprehensive strategy of＂early detection，comprehensive assess- ment，proactive intervention，and multi-target management＂should be implemented in clinical practice to delay the progression of diabetic kidney disease．

关键词

糖尿病肾病 / 肾功能衰竭 / 危险因素 / 保护因素 / 多因素Cox模型

Key words

diabetic kidney disease / renal failure / risk factors / protective factors / multifactor Cox model

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基金资助

甘肃省科技计划（创新基地和人才计划）项目(21JR7RA436)

甘肃省高等学校创新基金项目(2022B-050)

兰州市人才创新创业项目(2021-RC-94)

兰州大学第二医院＂萃英科技创新＂计划项目(CY2021-QN-B01)