2型糖尿病住院患者微血管病变危险因素分析  

Analysis of the correlated risk factors of microangiopathy in hospitalized type 2 diabetics

作　　者：李青[1] 张磊[1] 潘洁敏[1] 包玉倩[1] 张锋[1] 周健[1] 李鸣[1] 于浩泳[1] 贾伟平[1] 

机构地区：[1]上海市糖尿病临床医学中心-上海交通大学附属第六人民医院内分泌代谢科,上海200233

出　　处：《复旦学报（医学版）》2010年第2期211-215,共5页Fudan University Journal of Medical Sciences

基　　金：上海市市级医院新兴前沿技术联合攻关项目(SHDC12006101)

摘　　要：目的分析2型糖尿病住院患者视网膜病变和肾脏病变相关危险因素,为临床糖尿病微血管并发症的防治工作提供理论基础。方法对2002年7月—2008年9月在本院内分泌科住院的2338例2型糖尿病患者测定24h尿白蛋白定量。按照尿白蛋白定量结果,将其分为正常白蛋白尿组(NA)和糖尿病肾病组(DN),后者又分为微量白蛋白尿组(MAU)和大量白蛋白尿组(CAU)。全部患者均由眼科医生眼底摄片,按照眼底摄片结果,将其分为正常眼底组(NR)和糖尿病视网膜病变组(DR),后者又分为背景型糖尿病视网膜病变组(BDR)和增殖型糖尿病视网膜病变组(PDR)。结果(1)本研究人群中有673例(28.8%)伴有视网膜病变(DR),671例(28.7%)伴有肾脏病变(DN)。男性和女性发生DR、DN的比例之间的差异均无统计学意义(27.8%vs30.0%;29.6%vs27.6%,P均>0.05)。(2)NA组中23.1%的患者伴有DR;MAU组中37.7%的患者伴有DR;CAU组中56.6%的患者伴有DR。不同蛋白尿组患者伴有DR的比例之间的差异有统计学意义(P<0.01)。(3)NR组23.1%的患者伴有DN;BDR组41.1%的患者伴有DN;PDR组59.3%的患者伴有DN。不同DR组患者伴有DN的比例之间的差异有统计学意义(P<0.01)。(4)发生DR、DN的影响因素的Logistic回归分析结果:合并DN、糖尿病病程、收缩压、糖化血红蛋白分别与DR独立相关;合并DR、收缩压、糖化血红蛋白、三酰甘油分别与DN独立相关。结论2型糖尿病患者微血管并发症的发生及其严重程度与糖化血红蛋白、收缩压有关;糖尿病视网膜病变和肾脏病变密切相关。Objective To analyze the risk factors of retinopathy and nephropathy in hospitalized patients with type 2 diabetics. Methods 24 h-urinary albumin was measured in 2 338 patients with type 2 diabetic hospitalized from July, 2002 to Sep, 2008 in our hospital. All the subjects were divided into normalbuminuria group （NA） and diabetic nephropathy group （DN）, the latter consisted of microalbuminuria group （MAU） and macroalbuminuria group （CAU）. All the patients were divided into normal retina group （NR） and diabetic retinopathy group （DR）, the latter consisted of background diabetic retinopathy group （BDR） and proliferative diabetic retinopathy group （PDR） according to fundus photography. Results （1） The percentages of DR and DN of this cohort were 28.8% and 28.7%, respectively.The percentage of DR and DN had no statistical difference between male and female （27.8% vs 30.0%; 29.6% vs 27.6%, P0.05）. （2） The percentage of DR was 23.1%, 37.7% and 56.6% in NA, MAU and CAU group, respectively. There was significant difference among different albuminuria group （P0.01）. （3） The percentage of DN was 23.1%, 41.1% and 59.3% in NR, BDR and PDR group, respectively. There was significant difference among different DR group （P0.01）. （4） Combined with DN, diabetes duration, systolic pressure, hemoglobin A1C, triglyceride were independently associated with DR by Logistic regression analysis. Meanwhile, combined with DR, systolic pressure, hemoglobin A1C, and triglyceride were all independently associated with DN. Conclusions The onset and progression of microvascular complications in type 2 diabetic patiens are correlated with hemoglobin A1C and systolic pressure. Diabetic retinopathy is closely correlated with diabetic nephropathy.

关 键 词：糖尿病视网膜病变 糖尿病肾脏病变 影响因素 

分 类 号：R587.1[医药卫生—内分泌]