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投稿时间：2024-10-24 网络发布日期：2025-09-19
投稿时间：2024-10-24 网络发布日期：2025-09-19
中文摘要: 目的 探讨预后营养指数（PNI）在预测2型糖尿病（T2DM）患者肾功能变化中的作用。方法 回顾性选取2015年1月至2021年1月于芜湖市第一人民医院就诊的366例T2DM患者作为研究对象，治疗后进行随访，随访截至2024年8月。收集患者的临床资料，并计算患者估算肾小球滤过率（eGFR）年下降值，将患者分为肾功能快速下降（RKFD）组（n=109）和非RKFD组（n=257），RKFD定义为eGFR年下降值＞3mL/（min· 1.73 m2 ）。采用Spearman相关性分析探究T2DM患者的PNI与各指标的相关性；通过多因素logistic回归分析T2DM患者RKFD的影响因素；运用受试者工作特征（ROC）曲线分析PNI的预测价值。结果 366例T2DM患者的中位随访时间为5年，共有109例（29.78%）患者发生RKFD。RKFD组基线糖化血红蛋白（HbA1C）水平高于非RKFD组［9.40%（7.33%，10.85%） vs 8.20%（6.70%，9.95%），Z= 3.240，P= 0.001］，白蛋白、eGFR、淋巴细胞计数、红细胞计数、血小板计数、血红蛋白和PNI均低于非RKFD组（P＜0.05）。Spearman相关性分析结果显示，T2DM患者PNI分别与尿酸、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、白蛋白、空腹C肽、白细胞计数、淋巴细胞计数、红细胞计数、血小板计数、血红蛋白、eGFR呈正相关（P＜0.05），与HbA1C呈负相关（r=-0.163，P= 0.002）。多因素logistic回归分析显示，PNI（OR= 0.846，95%CI:0.798~0.898，P＜0.01）和HbA1C（OR= 1.121，95% CI< ：1.009~1.247，P= 0.034）为发生RKFD的独立影响因素。ROC曲线分析显示，PNI预测T2DM患者发生RKFD的曲线下面积为0.752，截断值为49.33，灵敏度为0.658，特异度为0.789。结论 PNI较低的T2DM患者发生RKFD的风险更高，PNI可作为评估T2DM患者肾功能预后风险的重要指标。
Abstract:Objective To investigate the role of the prognostic nutritional index (PNI) in predicting renal function changes in patients with type 2 diabetes mellitus (T2DM). Methods A retrospective study was conducted with 366 T2DM patients who visited the First People’s Hospital of Wuhu from January 2015 to January 2021. Follow-up was performed after treatment, with the final follow-up in August 2024. Clinical data were collected, and the annual decline in the estimated glomerular filtration rate (eGFR) was calculated. Patients were divided into two groups the rapid kidney function decline (RKFD) group (n=109) and the non-RKFD group (n=257), with RKFD defined as an annual eGFR decline over 3 mL/ (min· 1.73 m2 ). Spearman correlation analysis was used to explore the relationship between PNI and various indicators in T2DM patients. Multivariate logistic regression analysis was performed to identify the factors influencing RKFD in T2DM patients. The predictive value of PNI was evaluated using receiver operating characteristic (ROC) curves. Results The median follow-up period for the 366 T2DM patients was 5 years, with 109 (29.78%) patients experiencing RKFD. The baseline level of glycated hemoglobin (HbA1C) in the RKFD group was higher than that in the non-RKFD group [9.40% (7.33%, 10.85%) vs 8.20% (6.70%, 9.95%), Z= 3.240, P= 0.001]. Compared with non-RKFD group, the albumin, eGFR, lymphocyte count, red blood cell count, platelet count, hemoglobin, and PNI were lower in the RKFD group (P＜0.05). Spearman correlation analysis showed that PNI in T2DM patients was positively correlated with uric acid, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, albumin, fasting C-peptide, white blood cell count, lymphocyte count, red blood cell count, platelet count, hemoglobin, and eGFR, respectively (P＜0.05), and was negatively correlated with HbA1C (r=-0.163, P= 0.002). Multivariate logistic regression analysis indicated that independent factors influencing RKFD included PNI (OR= 0.846, 95%CI: 0.798-0.898, P＜0.01) and HbA1C (OR= 1.121, 95%CI: 1.009-1.247, P= 0.034). ROC curve analysis showed that the area under the curve for PNI in predicting RKFD in T2DM patients was 0.752, with an optimal cut-off value of 49.33, sensitivity of 0.658, and specificity of 0.789. Conclusion T2DM patients with lower PNI are at higher risk of RKFD, and PNI can be served as an important indicator for assessing the renal function prognosis inT2DM patients.
keywords: Prognostic nutritional index Type 2 diabetes mellitus Rapid kidney function decline Diabetic kidney disease Glomerular filtration rate Glycated hemoglobin
文章编号： 中图分类号：R587.1 文献标志码：A
基金项目:安徽省高校自然科学重点科研项目（2022AH050752）；安徽省高校自然科学研究项目
（KJ2020A0341）
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引用文本：
李小勤,崔凡,张平平,等.预后营养指数对2型糖尿病患者肾功能快速下降的预测价值[J].中国临床研究,2025,38(9):1355-1359.
李小勤,崔凡,张平平,等.预后营养指数对2型糖尿病患者肾功能快速下降的预测价值[J].中国临床研究,2025,38(9):1355-1359.