2型糖尿病患者合并卒中的相关危险因素分析

目的 探讨2型糖尿病患者合并卒中的相关危险因素。方法 采用回顾性分析的研究方法对连续选取自2003年1月至2010年6月于卫生部北京大学第五临床医学院内分泌科住院治疗的2099例2型糖尿病患者进行分析，依据患者是否合并卒中分为2型糖尿病合并卒中组和2型糖尿病不合并卒中组，比较两组患者一般资料及血糖、血脂、血尿酸等代谢指标，分析2型糖尿病患者合并卒中的危险因素。性别不同相应的危险因素略有差异，进一步按照性别进行分层，分别比较不同性别2型糖尿病患者合并卒中的危险因素。结果 2099例2型糖尿病患者中，212例（10.1%）合并卒中，年龄、腰臀比、糖尿病病程、空腹胰岛素、餐后2小时胰岛素、收缩压、尿酸以及颈动脉内中膜厚度和股动脉内中膜厚度在糖尿病合并卒中组均高于糖尿病不合并卒中组，差异具有显著性（P<0.05）。糖尿病合并高血压及合并冠状动脉粥样硬化性心脏病均较无相应并发症者卒中发病率明显增高（P均<0.01）。在男性患者中，合并卒中者130例（10.9%）。年龄、糖尿病病程、空腹胰岛素、2小时胰岛素、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、尿酸、收缩压、颈动脉内中膜厚度和股动脉内中膜厚度在合并卒中组均高于不合并卒中组，差异具有显著性（P<0.05）。糖尿病合并高血压及合并冠状动脉粥样硬化性心脏病均较无相应并发症者卒中发病率明显增高（P均<0.01）。在女性患者中，合并卒中者82例（9.04%）。年龄、腰臀比、糖尿病病程、收缩压、尿酸、高密度脂蛋白胆固醇、颈动脉内中膜厚度和股动脉内中膜厚度在合并卒中组均高于不合并卒中组，差异具有显著性（P<0.05）。在男性及女性患者中，糖尿病合并高血压或合并冠状动脉粥样硬化性心脏病病史的均较无相应并发症者卒中发病率明显增高（P均<0.01）。多因素Logistic回归分析表明，年龄［优势比（odds ratio，OR）为1.067，95%可信区间（confidence interval，CI）1.021～1.115，P=0.004］、股动脉内中膜厚度（OR 1.590，95%CI 1.041～2.431，P=0.032）、收缩压（OR 1.026，95%CI 1.008～1.044，P=0.004）、冠状动脉粥样硬化性心脏病病史（OR 2.342，95％CI 1.081～5.070，P=0.031）与2型糖尿病患者合并卒中具有相关性。结论 2型糖尿病患者合并卒中的相关危险因素为年龄、腰臀比、糖尿病病程、空腹胰岛素、餐后2小时胰岛素、收缩压和尿酸及颈动脉内中膜厚度和股动脉内中膜厚度。不同性别2型糖尿病患者合并卒中的危险因素略有差异。合并高血压及冠状动脉粥样硬化性心脏病可增加卒中的发生。

Risk Factors of the Type 2 Diabetic Patients Complicated with Stroke

Objective To explore the risk factors of the type 2 diabetic patients complicated with stroke. Methods In this retrospective study we enrolled 2099 patients hospitalized in the Department of Endocrinology, Beijing Hospital from 2003 to 2010. According to stroke, these patients were divided into two groups, type 2 diabetic patients complicated with stroke and the ones without stroke. The general state of health and related indicators were compared and the risk factors of type 2 diabetic patients complicated with stroke were analyzed in this study. Risk factors are slightly different in different gender, we further stratified according to gender, and the risk factors of type 2 diabetic patients complicated with stroke were analyzed respectively.without stroke in age, waist-hip ratio, duration of diabetes, fasting insulin, 2 hours postmeal insulin, systolic blood pressure, uric acid, the intima-media thickness of carotid artery and the intimamedia thickness of femoral artery. The differences were statistically significant（P〈0.05）. The rates of stroke in diabetic patients with hypertension and coronary heart disease were higher than those without the corresponding events（P〈0.05）. In male, 130 cases（10,9%）with stroke were higher than those without stroke in age, duration of diabetes, fasting insulin, 2 hours postmeal insulin, total cholesterol, triglycerides, low density lipoprotein cholesterol, uric acid, systolic blood pressure, the intima-media thickness of carotid artery and the intima-media thickness of femoral artery. The differences were statistically significant（P〈0.05）. In female, 82 cases（9.04%）with stroke were higher than those without stroke in age, waist-hip ratio, duration of diabetes, systolic blood pressure, uric acid, high density lipoprotein cholesterol, the intima-media thickness of carotid artery and the intima-media thickness of femoral artery. The differences were statistically significant（P〈0.05）. The rates of stroke in diabetic patients with hypertension and coronary heart disease were higher than those without the corresponding events（P〈0.05） in different gender. Logistic regression analysis showed that age（odds ratio, OR 1.067, 95% confidence interval, CI 1.021-1.115, P=0.004）, intima- media thickness of femoral artery thickness（OR 1.590, 95%CI 1.041-2.431, P=0.032）, systolic blood pressure（OR 1.026, 95%CI 1.008-1.044, P=0.004） and coronary heart disease（OR 2.342, 95%CI 1.081-5.070, P=0.031） were related with type 2 diabetic patients complicated with stroke. Conclusions The type 2 diabetic patients complicated with stroke is related with age, waist-hip ratio, duration of diabetes, fasting insulin, 2 hours postmeal insulin, systolic blood pressure and uric acid. The male type 2 diabetic patients complicated with stroke is related with age, duration of diabetes, fasting insulin, 2 hours postmeal insulin, total cholesterol, triglycerides, low density lipoprotein cholesterol, uric acid, systolic blood pressure, the intima-rnedia thickness of carotid artery and the intima-media thickness of femoral artery. The female type 2 diabetic patients complicated with stroke is related with age, waist-hip ratio, duration of diabetes, systolic blood pressure, uric acid, high density lipoprotein cholesterol, the intima-media thickness of carotid artery and the intima-media thickness of femoral artery. Hypertension and coronary heart disease can increase the risk of stroke in male and female oatients.