新诊断2型糖尿病的代谢和慢性并发症分析  

Metabolic changes and diabetic complications in patients with newly-diagnosed type 2 diabetes

作　　者：史琳涛[1] 许樟荣[1] 王玉珍[1] 杨小平[1] 王爱红[1] 冯新星[1] 曹明君[1] 

机构地区：[1]中国人民解放军第306医院全军糖尿病诊治中心、内分泌科,北京100101

出　　处：《中华内分泌代谢杂志》2010年第12期1045-1049,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：基金项目：首都医学发展科研基金自主（2002-1013）

摘　　要：目的 研究1994年至2008年期间筛查的新诊断2型糖尿病患者的代谢控制指标及糖尿病慢性并发症患病率的变化.方法 采取集约患者、不同学科联合门诊的方法,进行糖尿病并发症筛查和数据采集.结果 2085例患者中男性1189例,女性896例.患者的发病年龄由1994年的（54.6±7.9）岁下降到2008年的（51.6±13.1）岁.1994年没有20～29岁年龄组的患者,30～39岁的患者占5%,而2008年此比例分别是2%和16%.体重指数从1994年的（24.48±4.15）kg/m2增加到2008年的（26.03±3.63）kg/m2,体重指数≥25 kg/m2、腰臀比≥0.90（男性）或≥0.85（女性）的异常率分别从1994年的63.6%、75.0%和71.4%增加到79.6%、95.2%和93.8%.以1994年的血压为基线,1995年至2008年各年筛查的血压分别与其比较,均无显著的统计学差异.空腹血糖、餐后血糖和HbA1c分别由1994年的10.3 mmol/L、15.2mmol/L和11.1%降低到2008年的9.0 mmol/L、14.3 mmol/L和8.6%.总胆固醇、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）无明显的变化.1994年糖尿病视网膜病变患病率为28.2%,至2008年下降至3.9%,有显著的统计学差异.肾病患病率由1994年的17.7%上升至2008的24.1%,但无显著的统计学差异.心血管并发症由1994年的14.3%增加至2008年的24.1%,有显著的统计学意义.有微血管并发症的患者收缩压、舒张压、HbA1c均明显高于无微血管并发症组[分别是136/78对130/77mm Hg（1 mm Hg=0.133 kPa）、9.41%对9.11%],有统计学差异.有大血管并发症的患者年龄、收缩压、血总胆固醇、甘油三酯明显高于无大血管并发症组（53.4对50.0岁,132对129 mm Hg,5.3对5.1 mmol/L和2.6对2.1 mmol/L）.结论 在1994年至2008年期间新诊断的糖尿病患者,肥胖人群呈现逐年增多,血糖、血压、总胆固醇水平有所下降,而甘油三酯上升;微血管并发症,尤其是视网膜病变明显下降,肾病无明显变化,心血管并发症患病率明显增加.Objective To evaluate biochemical characteristics and the trend of diabetic complications in patients with newly-diagnosed type 2 diabetes from 1994 to 2008. Methods We utilized the database of the diabetes complications assessment and analyzed the metabolic disorder and the diabetic complications in the patients with newly diagnosed diabetes. Results 2 085 cases were collected, including 1189 males and 896 females. The average age of onset of diabetes was 51.6±13.1 and 54.6±7.9 yrs respectively in 2008 and 1994. During 1994,no case was found in subjects aged 20-29 yrs and 5% of the patients were aged 30-39; but 2% of patients aged 20-29 and 16% aged 30-39 yrs were found in 2008. BMI was increased from 24.48±4.15 in 1994 to 26.03±3.63 in 2008. Percentage of patients with abnormal BMI （ ≥25 kg/m2 ）, WHR [≥0.90 （male） or ≥0.85 （female）]increased significantly from 63.6%, 75.0%, and 71.4% in 1994 to 79.6%, 95.2%, and 93.8% in 2008,respectively. Both SBP and DBP were not significantly changed. The fasting blood and postprandial blood glucose,HbA1c decreased from 10.3 mmol/L, 15.2 mmol/L, 11.1% in 1994 to 9.0 mmol/L, 14.3 mmol/L, and 8.6% in 2008, respectively. The average TG level increased from 1.7 mmol/L in 1994 to 2. 1 mmol/L in 2008,however, TC and HDL level were not significantly changed. The prevalence of diabetic retinopathy decreased from 28.2% in 1994 to 3.9% in 2008. The prevalence of diabetic nephropathy increased from 17.7% in 1994 to 24.6% in 2008. The prevalence of diabetic cardiovascular disease increased from 14.3% in 1994 to 24. 1% in 2008. Compared with the patients without microvascular complications, the patients with microvascular complications had higher SBP, DBP, and HbA1c（ 136/78 vs 130/77 mm Hg, 9.41% vs 9.11% ）. The patients with macrovascular complications had older age, higher SBP, TC, and TG than those without macrovascular complications （53.4 vs 50.0 yrs; 132 vs 129 mm Hg ; 5.3 vs 5.1 mmol/L and 2.6 vs 2.1 mmol/L）. Conclusions In the studied newly-diagnosed

关 键 词：糖尿病 血糖 血脂 血压 糖尿病并发症 

分 类 号：R686[医药卫生—骨科学]