2型糖尿病肾病患者发生颈动脉粥样硬化危险因素分析  

Analysis of risk factors for carotid atherosclerosis in patients with type 2 diabetic nephropathy

作　　者：王焕[1] 崔凯[2] 尤冠巧[3] 郭利芹 徐可[1] 布海霞[1] WANG Huan;CUI Kai;YOU Guanqiao;GUO Liqin;XU Ke;BU Haixia(Department of Nephrology,Xinxiang Central Hospital,Xinxiang 453000,Henan Province,China;Department of General Tumor Surgery,Xinxiang Central Hospital,Xinxiang 453000,Henan Province,China;Department of Nephrology,Henan Provincial People′s Hospital,Zhengzhou 450000,Henan Province,China)

机构地区：[1]新乡市中心医院肾内科,河南新乡453000 [2]新乡市中心医院普瘤外科,河南新乡453000 [3]河南省人民医院肾内科,河南郑州450000

出　　处：《新乡医学院学报》2021年第6期531-533,539,共4页Journal of Xinxiang Medical University

基　　金：河南省科技攻关计划项目(编号:201503150)。

摘　　要：目的探讨2型糖尿病肾病患者发生颈动脉粥样硬化的危险因素。方法选择2015年1月至2020年1月新乡市中心医院收治的2型糖尿病肾病患者共214例为研究对象。所有患者常规行颈动脉彩色多普勒超声检查,根据检查结果将患者分为非动脉粥样硬化组(n=40)和动脉粥样硬化组(n=174)。所有患者常规行多导睡眠监测,判断是否存在阻塞性呼吸睡眠暂停(OSA);常规监测并记录所有患者的血压、糖化血红蛋白(HbA1c)、血糖、血脂、血尿素氮、血肌酐、24 h尿蛋白定量,计算体质量指数(BMI)及估算的肾小球滤过率(eGFR)。比较2组患者上述各指标的差异,将差异有统计学意义的指标进一步行logistic回归分析筛选颈动脉粥样硬化发生的危险因素。结果214例2型糖尿病肾病患者中共有174例发生颈动脉粥样硬化,发生率为81.3%。2组患者的年龄、性别分布、HbA1c、eGFR比较差异无统计学意义(P>0.05),2组患者的BMI、收缩压、舒张压、三酰甘油、胆固醇、低密度脂蛋白、24 h尿蛋白定量及OSA发生比例比较差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,收缩压、舒张压、三酰甘油、合并OSA是2型糖尿病肾病患者发生颈动脉粥样硬化的危险因素(P<0.05)。结论高血压、高血脂及合并OSA是2型糖尿病肾病患者发生颈动脉粥样硬化的危险因素,积极控制血压、血脂及治疗OSA可预防或改善颈动脉粥样硬化的发生、发展。Objective To explore the risk factors of carotid atherosclerosis in patients with type 2 diabetic nephropathy.Methods A total of 214 patients with type 2 diabetic nephropathy admitted to Xinxiang Central Hospital from January 2015 to January 2020 were selected as the research objects.All patients underwent routine carotid artery color Doppler ultrasonography examination and were divided into non-atherosclerosis group(n=40)and atherosclerosis group(n=174)according to the examination results.All patients underwent routine polysomnography to determine whether there was obstructive sleep apnea(OSA).Blood pressure,glycosylated hemoglobin(HbA1c),blood glucose,blood lipid,blood urea nitrogen,serum creatinine,24-hours urinary protein,body mass index(BMI)and estimated glomerular filtration rate(eGFR)of all patients were monitored and recorded.The difference of the above indexes between the two groups were compared,and the statistically significant indexes were further analyzed by logistic regression to screen the risk factors of carotid atherosclerosis.Results There were 174(81.3%)cases of carotid atherosclerosis in the 214 patients with type 2 diabetic nephropathy.There was no significant difference in age,gender distribution,HbA1c and eGFR between the two groups(P>0.05);there was significant difference in BMI,systolic blood pressure,diastolic blood pressure,triglyceride,cholesterol,low-density lipoprotein,24-hours urinary protein and the incidence of OSA between the two groups(P<0.05).Logistic regression analysis showed that systolic blood pressure,diastolic blood pressure,triglyceride and combination of OSA were risk factors of carotid atherosclerosis in patients with type 2 diabetic nephropathy(P<0.05).Conclusion Hypertension,hyperlipidemia and combination of OSA are risk factors of carotid atherosclerosis in patients with type 2 diabetic nephropathy.Active treatment of blood pressure,blood lipid and OSA may prevent or improve the occurrence and development of carotid atherosclerosis.

关 键 词：糖尿病肾病 阻塞性呼吸睡眠暂停 颈动脉粥样硬化 

分 类 号：R587.2[医药卫生—内分泌]