血压控制不佳是痛性糖尿病周围神经病变的危险因素:前瞻性队列研究  

Poorly-controlled blood pressure is a risk factor for painful diabetic peripheral neuropathy:a prospective cohort study

作　　者：张琦 孙婉婉 张元品 朱小明 季立津 郑杭萍 金雯婕 熊茜 叶红英 李益明 鹿斌 张烁 Zhang Qi;Sun Wanwan;Zhang Yuanpin;Zhu Xiaoming;Ji Lijin;Zheng Hangping;Jin Wenjie;Xiong Qian;Ye Hongying;Li Yiming;Lu Bin;Zhang Shuo(Department of Endocrinology,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;Shanghai Gonghui Hospital,Shanghai 200041,China)

机构地区：[1]复旦大学附属华山医院内分泌科,上海200040 [2]上海市公惠医院,上海200041

出　　处：《中华糖尿病杂志》2022年第1期68-74,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：三诺糖尿病公益基金会·甜蜜医生培育项目(2019SD03);国家自然科学基金面上项目(81770807)。

摘　　要：目的通过前瞻性研究设计明确血压控制不佳是否为痛性糖尿病周围神经病变(DPN)发病的危险因素。方法本研究为前瞻性研究。自2014年起从上海5家社区卫生中心纳入年龄≥18岁未诊断DPN的患者。记录所有患者在基线纳入和随访结束时的基本资料、实验室检查和密西根神经病变筛查量表检查结果,并在随访结束时接受神经病理性疼痛问卷评估和神经传导功能检查。根据痛性DPN标准,将患者分为非DPN组、痛性DPN组和无痛性DPN组。比较非DPN组、痛性DPN组和无痛性DPN组患者基线及随访时临床资料,分析痛性DPN组和无痛性DPN组患者基线(收缩压、舒张压)、随访(收缩压、舒张压)以及随访和基线时血压差值的差异,并采用χ^(2)检验比较血压控制不佳组(≥130/80 mmHg,1 mmHg=0.133 kPa)和血压控制良好组(<130/80 mmHg)痛性DPN发生率的差异,采用多因素logistic回归模型进一步分析血压控制不佳与痛性DPN之间的关系。结果最终纳入315例T2DM患者,随访(5.06±1.14)年,将患者分为非DPN组152例、痛性DPN组74例和无痛性DPN组89例。与非DPN组患者相比,痛性DPN组和无痛性DPN组患者基线的年龄、腰围和空腹血糖明显升高,差异有统计学意义(P<0.05);痛性DPN组患者基线时的糖尿病病程、收缩压和舒张压明显高于非DPN组患者(P<0.05)。痛性DPN组患者随访时的收缩压(P=0.030)和舒张压(P=0.007)明显高于无痛性DPN组,差异有统计学意义(P<0.05)。基线血压控制不佳组患者132例,血压控制良好组患者30例,基线血压控制不佳组痛性DPN的发生率49.24%(65/132)高于基线血压控制良好组26.67%(8/30),差异有统计学意义(P=0.025)。校正体重指数、糖化血红蛋白、年龄、性别、吸烟、饮酒、T2DM病程、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、服用血管紧张素转化酶抑制剂、其他降压药及二甲双胍后,血压控制不佳仍然与痛性DPObjective To explore whether poorly-controlled blood pressure is a risk factor of painful diabetic peripheral neuropathy(DPN).Methods This study was a prospective study.Diabetic patients aged≥18 years with undiagnosed DPN were recruited from 5 community health centers in Shanghai since 2014.Demographic data,laboratory tests and Michigan Neuropathy Screening Instrument examination were recorded at baseline and follow-up visit.And Douleur Neuropathique en 4 Questions screening and nerve conduction studies were assessed at follow-up visit.According to the criteria of painful DPN,the patients were divided into non-DPN group,painful-DPN group and painless-DPN group.The differences of systolic and diastolic blood pressure at baseline and follow-up between painful-DPN group and painless-DPN group were analyzed.And the incidence of painful-DPN were compared between poorly-controlled blood pressure group(≥130/80 mmHg,1 mmHg=0.133 kPa)and well-controlled blood pressure group(<130/80 mmHg)by using Chi-squared test.Multivariate logistic regression model was used to explore the relationship between poorly-controlled blood pressure and painful-DPN.Results Finally,315 patients with type 2 diabetes mellitus(T2DM)were included and followed up for(5.06±1.14)years.The patients were divided into non-DPN group(n=152),painful-DPN group(n=74)and painless-DPN group(n=89).Compared with non-DPN group,the patients in painful-DPN group and painless-DPN group had older age,higher waist circumference and fasting plasma glucose at baseline(P<0.05).In addition,systolic blood pressure,diastolic blood pressure and diabetic duration at baseline were higher in patients with painful-DPN than the patients with painless-DPN(P<0.05).And the systolic blood pressure(P=0.030)and diastolic blood pressure(P=0.007)at follow-up visit in painful-DPN group were significantly higher than those in painless-DPN group.The incidence of painful-DPN was significantly higher in patients with poorly-controlled blood pressure(≥130/80 mmHg,n=132)than that in patien

关 键 词：糖尿病 2型 痛性糖尿病周围神经病变 血压 危险因素 

分 类 号：R587.2[医药卫生—内分泌]