20182型糖尿病患者慢性并发症的患病率及相关因素分析

4174955

　　中图分类号：R587.1 文献标 识码：A 文章编号：1009_816X(2011)06_0428_03
http://
　　DOI:10.3969/j.issn.1009_816X.2011.06.05Prevalence and Risk Factors Analysis of Chronic Complications in the Inpatients with Type 2 Diabetes Mellitus. CHEN Ri_qiu， GUAN Chang_rong. Lishui People's Hospital，Zhejiang 3 23000，China
　　［Abstract］ Objective To study the prevalence and risk factors analysis of chronic complications in the inpatients with type 2 diabetes and to provide evidence for further prevent and treatment. Methods A total of 1372 cases, 651 men(47. 40%)and 721 women(52.60%), with type 2 diabetes were investigated. Their age wa s 7_88 years with average of 59.65±14.05 years and diabetes duration was 0_27 years with average of 6.89±5.59 years. The basic condition of patients，diab etes duration，therapeutic condition, metabolic index, diagnosis and treatment o f all kinds of diabetic chronic complications were investigated. Results The incidenc e of the chronic complications: cerebrovascular disease 8.16%, cardiovascular d i sease 13.78%, lower extremity arterial disease 4.88%, renal lesion 36.47%，ocu la r lesions 28.86%, peripheral neuropathy 63.92%, respectively. Multivariate Log is tic regression analysis showed that age, diabetes duration, fasting plasma gluco se, TC, HDL_C were independent risk factors for diabetes cerebrovascular disease . Multivariate Logistic regression analysis showed that age, systolic pressure, TC, HDL_C, 24 hours urinary protein were independent risk factors for diabetes c ardiovascular disease. Multivariate Logistic regression analysis showed that age , systolic pressure, diabetes duration, LDL_C were independent risk factors for diabetes lower extremity arterial disease. Multivariate Logistic regression anal ysis showed that age, diabetes duration, fasting plasma glucose, LDL_C were inde pendent risk factors for diabetes ocular lesions. Multivariate Logistic regressi on analysis showed that age, systolic pressure, sex, urinary albumin, 24 hours u rinary protein, TC, TG were independent risk factors for diabetic nephropathy. M ultivariate Logistic regression analysis showed that age, diabetes duration, 2hP G were independent risk factors for diabetic peripheral neuropathy. Conclusions Age, disease duration, sex, hypertension, hyperglyce mia, lipids disorder, HbA1c are risk factors of chronic complications in diabete s. Controlling these factors will help to prolong life, reduce the mortality and improve the quality of life.
　　［Key words］ Type 2 diabetes mellitus; Chronic complications; E pidemiology
　　
　　糖尿病是一组呈全球流行趋势的慢性代谢性疾病。随着经济的发展和人民生活方式的改变以 及人口老龄化，糖尿病患病率逐年增加是全球范围内的共同趋势。美国国家糖尿病委员会报 道糖尿病病人患心脏病、坏疽、肾病和失明者分别为非糖尿病病人的2、20、17和25倍 ［1］。在2型糖尿病初诊时，约有15％有糖尿病视网膜病变［2］，约有20.5％有 微量蛋白尿，22.8％有缺血性心脏病［3］。糖尿病慢性并发症是糖尿病患者致残、 致死的主要原因，其发病与许多危险因素相关。了解2型糖尿病患者合并慢性并发症的危 险因素，及早干预，防止或延缓各种并发症的发生、发展是糖尿病治疗中的重要问题。
　　1 资料与方法
　　 1.1 一般资料：以本院内分泌科2007年1月至2010年12月住院的2型糖尿病患者为调查对象 ，共入选1372例2型糖尿病患者均符合1999年WHO关于2型糖尿病的诊断标准。排除继发性高 血压及可能造成肾、眼、脑损害的原发性疾病。其中男651例，女721例；年龄7～88（59.6 5±14.05）岁，病程0～27（6.89±5.59）年。

  
  
       　　1.2 方法： 调查近3年住院的2型糖尿病患者的个人资料及辅助检查。包括：①个人资料：一般情况、糖 尿病病程、糖尿病家族史、治疗情况、既往病史、烟酒嗜好、有无糖尿病并发症，每例患者 测身高、体重、体重指数（BMI）、血压（收缩压及舒张压）。②辅助检查：测空腹血糖（F PG）、餐后2小时血糖（2hPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、甘油三酯（TG ）、低密度脂蛋白胆固醇（LDL_C）、高密度脂蛋白胆固醇（HDL_C）、尿微量白蛋白、24小 时尿蛋白等。慢性并发症的确定按中华医学会糖尿病学分会慢性并发症调查的实施细则进行 ［4］，分为脑血管病变、心血管病变、下肢血管病变、眼部病变、肾脏病变、周围 神经病变6种。
　　1.3 统计学处理：应用SPSS16.0分析软件处理，所有数据录入计算机，危险因素分析采 用Logistic逐步回归分析。P＜0.05为差异有统计学意义。
　　2 结果
　　2.1 基本情况：入院时入选者体重为（62.59±11.57）kg，体重指数为（23.76±3.4 8）kg/m2；空腹血糖为（10.08±3.83）mmol/L；餐后2h血糖为（19.69±6.78）mmol/ L；糖化血红蛋白为（10.43±2.51）%；收缩压为（135.30±20.27）mmHg；舒张压为（ 80.20±11.37）mmHg；血清总胆固醇为（4.71±1.32）mmol/L；高密度脂蛋白胆固醇为 （1.24±0.25）mmol/L；低密度脂蛋白胆固醇为（2.48±1.42）mmol/L；甘油三酯为（ 2.13±1.52）mmol/L。
　　2.2 慢性并发症患病率：近3年来我院2型糖尿病住院患者并发症的患病率与全国同期统计得到的数据基本一致［ 4］，肾脏病变及周围神经病变患病率稍高，眼部病变、大血管病变稍低，见表1。
　　2.3 慢性并发症的相关危险因素分析：用Logistic回归模型作了多因素筛选，得出对各并 发症具有统计学意义(P参考文献
　　［1］Mayer BD. Diabetes mellitus diagnosis and treatment［M］. 3rd ed. N ew York: Churehill Livingstone,1991:293.
　　［2］Tapp R, ShawJ, Harper C, et al. The prevalence of and factors associate d with diabetic retinopathy in the Australian population［J］. Diabetes Care,200 3,26(6):1731-1737.
　　 ［3］Klahulec B, Vozar J. Incidence of risk factors and vascular complications in patients with newly diagnosed type 2 diabetes mellitus［J］. Vnitr Lek,2002, 48(11):1031-1038.
　　［4］中华医学会糖尿病学分会糖尿病慢性并发症调查组.全国住院糖尿病患者慢性并发症 及其相关危险因素10年回顾性调查分析［J］.中国糖尿病杂志，2003，（11）：232-237.
　　［5］向红丁.1991～2000年全国住院糖尿病患者慢性并发症及相关大血管病变回顾性分析［ J］.中国医学科学院学报,2002,24(5)∶447-451.
　　［6］Mogensen CE. Microalbuminuria and hypertension with focus on type 1 and typ e 2 diabetes［J］. J Inter Med,2003,254(1):45-66.
　　［7］欧阳涓，姜镜.肾病的损伤性诊断［J］.中华检验医学杂志，2005，28（8）：877-880 .