北京地区13家医院门诊2型糖尿病患者周围神经病变危险因素分析和筛查方法评估  

Evaluation of risk factors and screening method of diabetic peripheral neuropathy in type 2 diabetic outpatients in 13 hospitals of Beijing

作　　者：潘琦 李洪梅[2] 邢小燕[3] 李全民 齐林 马力[6] 黄薇[7] 邓微[8] 李玉凤[9] 吕肖锋 赵冬[11] 姚合斌[12] 王爱红[13] 郭立新[14] Pan Qi;Li Hongmei;Xing Xiaoyan;Li Quanmin;Qi Lin;Ma Li;Huang Wei;Deng Wei;Li Yufeng;Lyu Xiaofeng;Zhao Dong;Yao Hebin;Wang Aihong;Guo Lixin(Graduate School,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院研究生院,100730 [2]煤炭总医院内分泌科 [3]中日友好医院内分泌科 [4]火箭军总医院内分泌科 [5]北京燕化医院内分泌科 [6]中国中医科学院广安门医院(南区)内分泌科 [7]北京市海淀医院内分泌科 [8]北京积水潭医院内分泌科 [9]北京市平谷区医院内分泌科 [10]陆军总医院内分泌科 [11]首都医科大学附属北京潞河医院内分泌科 [12]海军总医院内分泌科 [13]解放军第306医院内分泌科 [14]北京医院内分泌科国家老年医学中心

出　　处：《北京医学》2018年第11期1009-1014,共6页Beijing Medical Journal

基　　金：国家重点研发计划"重大慢性非传染性疾病防控研究"专项(2017YFC1309800)

摘　　要：目的探讨北京地区医院门诊2型糖尿病周围神经病变(diabetic peripheral neuropathy, DPN)的相关危险因素和评估筛查方法。方法本研究为多中心随机横断面研究,对北京市城区和郊区的13家医院门诊1 975例2型糖尿病患者进行问卷调查、体格检查及实验室检查,采用中华医学会糖尿病学分会(Chinese Diabetes Society, CDS)推荐的5项体征检查对患者进行DPN筛查,分为确诊DPN组、疑似DPN组及非DPN组。采用多因素logistic回归分析影响DPN患病的因素,分析各项检查单用及其组合用于DPN筛查的灵敏度、特异度、约登指数和ROC曲线下面积,进而选出最佳组合。结果 1 975例患者中,698例(35.3%)为确诊的DPN患者,508例(25.7%)为疑似DPN患者,非DPN患者769(38.9%)例。3组年龄、家庭收入、病程、糖化血红蛋白(HbA1c)、低血糖、血脂异常、高血压差异均有统计学意义(P <0.001),是否使用二甲双胍、二甲双胍服用剂量和长时间使用者DPN患病率比较,差异均有统计学意义(P <0.001),DPN患病率在是否合并脑梗死、冠心病、外周血管病变、糖尿病视网膜病变(diabetic retinopathy, DR)、糖尿病肾脏病变间比较,3组间差异均有统计学意义(P <0.001)。多因素logistic回归分析显示,年龄、病程、合并DR是2型糖尿病患者DPN的危险因素(P <0.05)。筛查方法上联合应用踝反射、振动觉、温度觉3项检查,灵敏度为94.1%,特异度为75.6%,约登指数为0.698。结论北京市13家医院门诊2型糖尿病患者DPN患病率高,年龄、病程、合并DR是2型糖尿病患者DPN的危险因素,建议加强对高危人群的DPN筛查和管理。联合应用踝反射、振动觉、温度觉3项体征检查的筛查方法,简便、快速且可靠,可以在门诊和基层医院推广。Objective To investigate the risk factors and the screening methods for diabetic peripheral neuropathy(DPN) in diabetic outpatients in Beijing. Methods This research was a multi-center, randomized, cross-sectional study.Questionnaires, physical examinations, and laboratory tests were performed on diabetic outpatients at 13 hospitals in urban and rural areas of Beijing. Patients were screened for DPN using 5 physical examinations recommended by Chinese Diabetes Society(CDS). They were divided into confirmed DPN group, suspected DPN group, and non-DPN group. Multivariate logistic regression was used to analyze risk factors for DPN. The sensitivity, specificity, Youden index, and area under the receiver operating characteristic(ROC) curve were calculated and used for evaluating each test and their combinations in screening DPN and for choosing the optimal test combination. Results 1 975 patients with type 2 diabetes were included in the study, and divided into confirmed DPN group(n=698, 35.5%), suspected DPN group(n=508, 25.8%)and non-DPN group(n=769, 39.1%). The differences in age, family income, duration of diabetes, glycated hemoglobin(HbA1c), hypoglycemia, dyslipidemia and hypertension among three groups were statistically significant(all P<0.001).The comparison of DPN prevalence in whether or not to initiate metformin therapy, metformin doses and long-term metformin therapy showed statistically differences among three groups(all P<0.001). The differences in the prevalence of cerebral infarction, coronary heart disease, peripheral vascular disease, diabetic retinopathy and diabetic nephropathy among three groups were statistically significant(all P<0.001). Multivariate logistic regression analysis suggested that age, duration of diabetes and whether or not with diabetic retinopathy were risk factors for DPN in type 2 diabetes(all P<0.05).The combined methods of ankle reflex, vibratory sensation, and temperature sensation used for screening DPN showed the best results with a sensitivity of 94.1%, specificity of 7

关 键 词：糖尿病 2型 糖尿病神经病变 患病率 筛查 

分 类 号：R587.2[医药卫生—内分泌]