肾周脂肪与 2 型糖尿病慢性肾病：传入动脉阻力的中介作用。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism Pub Date : 2024-10-09 DOI:10.1016/j.diabet.2024.101583

Xiangjun Chen , Yao Qin , Jinbo Hu , Yan Shen , Yun Mao , Lianghua Xie , Jia Li , Jie Wang , Shumin Yang , Qifu Li , John Cijiang He , Zhihong Wang

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引用次数: 0

摘要

目的：肾周脂肪（PRF）是 2 型糖尿病（T2DM）患者慢性肾脏疾病（CKD）的独立预测因子。以前的研究推测，肾周脂肪可能通过影响肾血流动力学促进肾功能不全。为了验证这一假设，我们研究了 PRF 与 T2DM 患者肾血流动力学之间的关系。方法：纳入 91 例 T2DM 患者，通过磁共振成像测量 PRF 厚度（PRFT）。肾动态成像测定肾小球滤过率（GFR）和有效肾血浆流量（ERPF）。肾血管阻力（RVR）、肾小球静水压（PGLO）、传入（RA）和传出（RE）动脉阻力由戈麦斯方程计算得出。多元线性回归用于确定 PRFT 与肾脏血液动力学之间的关系。进行中介分析以估计肾血流动力学对 PRFT 与 CKD 关系的中介效应：根据 PRFT 的分层将所有患者分为三组。与分层 1 的患者相比，分层 3 的患者的 GFR 和 ERPF 明显下降，而 RVR 和 RA 则明显上升。在对性别、年龄、内脏脂肪组织以及 ACE 抑制剂/血管紧张素受体阻滞剂和钠-葡萄糖共转运蛋白-2 抑制剂的治疗进行调整后，PRFT 与 GFR、ERPF 和 PGLO 呈负相关，而与 RVR 和 RA 呈正相关。此外，RVR和RA介导了PRF对GFR的影响，介导比例分别为29.1%和41.4%：结论：在 T2DM 患者中，PRF 与 GFR 呈负相关，与 RA 呈正相关。RA 在 PRF 与 CKD 的关系中起中介作用。

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Perirenal fat and chronic kidney disease in type 2 diabetes: The mediation role of afferent arteriolar resistance

Aim

Perirenal fat (PRF) is an independent predictor for chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) patients. Previous studies speculated that PRF may promote renal dysfunction through affecting renal hemodynamics. To verify this hypothesis, we studied the relationship between PRF and renal hemodynamics in T2DM.

Methods

91 T2DM patients were included. PRF thickness (PRFT) was measured by magnetic resonance imaging. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined by renal dynamic imaging. Renal vascular resistance (RVR), glomerular hydrostatic pressure (P_GLO), afferent (R_A) and efferent (R_E) arteriolar resistance were calculated by Gomez equations. Multiple linear regression was used to determine the relationship between PRFT and renal hemodynamics. Mediation analysis was conducted to estimate the mediation effects of renal hemodynamics on the relationship between PRF and CKD.

Results

All patients were divided into three groups according to the tertiles of PRFT. Compared with patients in tertile 1, GFR and ERPF were significantly decreased in patients in tertile 3, while RVR and R_A were significantly increased. PRFT was negatively correlated with GFR, ERPF and P_GLO, and positively correlated with RVR and R_A after adjustment for sex, age, visceral adipose tissue and treatments with ACE inhibitors/angiotensin receptor blockers and sodium-glucose cotransporter protein-2 inhibitors. Moreover, RVR and R_A mediated the effect of PRF on GFR, with a mediated proportion of 29.1 % and 41.4 % respectively.

Conclusion

In T2DM patients, PRF was negatively correlated with GFR, and positively correlated with R_A. R_A mediated the relationship between PRF and CKD.

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来源期刊

Diabetes & metabolism 医学-内分泌学与代谢

CiteScore

12.00

自引率

4.20%

发文量

审稿时长

13 days

期刊介绍： A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.