上海市社区2型糖尿病患者糖尿病周围神经病变现况调查  

Existing Circumstances Research of Diabetic Peripheral Neuropathy of Type 2 Diabetes Mellitus Patients Based on Community Population in Shanghai

作　　者：杨辉[1] 施榕[1] 朱静芬[1] 贾丽丽[2] 娄洁琼 龙雯[1] 冯易[1] 梁辰[1] 张胜冰[3] 宋道平 蒋玉立[5] 顾文娟[6] 彭云[7] 程慧琴 秦飞[1] 

机构地区：[1]上海交通大学公共卫生学院,上海市200025 [2]上海市第六人民医院,200233 [3]上海市浦东新区花木社区卫生服务中心,201204 [4]上海市浦东新区金杨社区卫生服务中心,200120 [5]上海市杨浦区殷行社区卫生服务中心,200433 [6]上海市杨浦区四平社区卫生服务中心,200433 [7]上海市浦东新区三林社区卫生服务中心,200120 [8]上海市杨浦区大桥社区卫生服务中心,200433

出　　处：《中国全科医学》2017年第5期579-585,共7页Chinese General Practice

基　　金：上海市公共卫生重点学科(全科医学)建设项目(12GWZX1002)

摘　　要：目的了解上海市社区2型糖尿病患者糖尿病周围神经病变(DPN)患病率及其影响因素。方法采用整群随机抽样的方法,于2014年10月—2015年4月,对上海市浦东新区、杨浦区的6个社区的5 053例2型糖尿病患者进行问卷调查、体格检查及实验室检查,采用多伦多临床评分系统(TCSS)对患者进行DPN筛查,分为不存在DPN、轻度、中度及重度DPN。采用多因素Logistic回归分析影响DPN患病的因素。结果 DPN筛查的阳性率为16.0%(810/5 053),其中612例(12.1%)为轻度DPN,158例(3.1%)为中度DPN,40例(0.8%)为重度DPN。不同性别、腹型肥胖、吸烟者DPN患病率比较,差异均无统计学意义(P>0.05);不同年龄、病程、体质指数(BMI)者DPN患病率比较,差异均有统计学意义(P<0.001)。不同空腹血糖(FPG)水平、是否合并高血压者DPN患病率比较,差异均无统计学意义(P>0.05);不同餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平、尿微量清蛋白与肌酐比值(ACR)以及不同糖尿病视网膜病变(DR)严重程度者DPN患病率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥65岁、病程≥15年、Hb A1c≥8.5%、HDL-C≤0.9 mmol/L、并发中度或重度DR是2型糖尿病患者DPN的危险因素(P<0.05)。结论上海市社区2型糖尿病患者DPN患病率低,且以轻度病变为主。年龄≥65岁、病程≥15年、Hb A1c≥8.5%、HDL-C≤0.9 mmol/L、并发中度或重度DR是社区2型糖尿病患者DPN的危险因素。Objective To investigate the prevalence of diabetic peripheral neuropathy （DPN） of patients with type 2 diabetes mellitus in Shanghai community and its influencing factors. Methods With duster random sampling method, 5 053 patients with type 2 diabetes mellitus of six communities in Pudong New Area and Yangpu District in Shanghai accepted questionnaires survey, physical examination and laboratory tests from October 2014 to April 2015, DPN was screened by Toronto Clinical Scoring Scale （TCSS） , and divided into nonexistent DPN, mild DPN, moderate DPN, and severe DPN. Multivariate Logistic regression analysis was used to analyz6 the influence factors of developing DPN. Results The positive rate of DPN screening was16.0% （810/5053）, of which612 （12. 1%） were mild DPN, 158 （3.1%） were moderate DPN, and40 （0. 8% ） were severe DPN. There were no significant differences in the prevalence of DPN among subjects of different gender, subjects with or without abdominal obesity and subjects smoking or not （ P 〉 O. 05 ） ; there were significant differences in the prevalence of DPN among subjects with different ages, disease durations, body mass index （BMI） （P 〈 0. 001 ）. There were no significant differences in the prevalence of DPN among subjects of different FPG levels and subjects combined with or without hypertension （P 〉 O. 05 ） ; there were significant differences in the prevalence of DPN among subjects of different levels of 2 - hour postprandial blood glucose （2 hPG）, glycosylated hemoglobin （HbAlc）, low density lipoprotein cholesterin （LDL-C）, high density lipoprotein cholesterol （ HDL-C ）, urinary albumin to creatinine ratio （ ACR ） and different severity degree of diabetic retinopathy （DR） （P 〈 0. 05）. Multivariate Logistic regression analysis showed that age≥65, disease duration≥ 15 years, HbA1c ≥8.5%, HDL-C ≤0. 9 mmol/L, combining with moderate or severe DR were the risk factors of type 2 diabetes mellitus patients＇ DPN being pos

关 键 词：糖尿病 2型 糖尿病神经病变 患病率 筛查 影响因素分析 

分 类 号：R587.1[医药卫生—内分泌]