2型糖尿病肾病住院患者心血管疾病的发生情况

目的通过分析2型糖尿病肾病住院患者既往心血管疾病(cardiavascular disease,CVD)发生史、颈动脉粥样硬化及左心室肥厚的情况,探讨2型糖尿病肾病患者CVD的发生情况。方法入选上海交通大学医学院附属仁济医院肾脏科住院治疗的2型糖尿病肾病患者共2 4 5例,根据肾小球滤过率(glomerular filtration rate,GFR)水平分为早中期组[GFR30 ml/(min·1.73m~2)]、中晚期非透析组[GFR≤30 ml/(min·1.73m~2)]、透析组。收集入选患者CVD的发生情况、颈动脉多普勒超声及心脏彩超检查结果,并与临床相关资料进行比较分析。结果 245例入选患者,其中男性146例,女性99例,平均年龄64岁(55～70岁)。共有150例患者进行了颈动脉多普勒超声检查,其中88例(58.3%)发现颈动脉斑块,在33例早中期患者中,即有21例(63.6%)发现斑块。与正常参考值相比,各组患者的颈动脉内中膜厚度(intima-media thickhess,IMT)、颈总动脉阻力指数均显著增加。153例患者进行了心脏超声检查,其中120例(78.4%)存在左心室肥厚(left ventricular hypertrophy,LVH),在36例早中期患者中,即有21例(58.3%)有LVH。245例2型糖尿病肾病患者中,共147例既往发生CVD(60.0%),远高于普通人群的CVD发生率(36.3%)。各组患者CVD发生率均明显高于普通人群(36.3%),早中期患者的CVD发生率已达47.8%,中晚期患者CVD的发生率(67.9%)比早中期组显著性升高,差异有统计学意义(P=0.01 1)。结论 2型糖尿病肾病患者普遍存在颈动脉粥样斑块和LVH,其CVD发生率较普通人群明显升高,在早中期阶段CVD的发生率即存在增高趋势。

The prevalence of cardiovascular disease in inpatients with type 2 diabetic kidney disease

Objective To evaluate the prevalence of cardiovascular disease （CVD） in inpatients with type 2 diabetic kidney disease （DKD） by analyzing their CVD history, carotid atherosclerosis and left ventricular hypertrophy （LVH）. Methods We recruited 245 inpatients with type 2 DKD, and assigned them based on GFR into earlymedium stage group （GFR〉30 ml/min/1.73m^2）, medium-advanced stage without dialysis group （GFR=30 ml/min/ 1.73m^2）, or dialysis group. Results A total of 245 cases were enrolled, of which 146 cases were males and 99 were females. The average age was 64 （55-70） years. Carotid artery examination was conducted by Doppler ultrasonography in 150 cases, of which 88 cases （58.3%） were found to have carotid artery plaques. In the 33 cases in early-medium stage group, 21 （63.6%） cases already had the arterial plaques. All patients exhibited increased intima-media thickness （IMT） of carotid artery and increased common carotid artery resistance index, as compared with the normal reference values. Cardiac ultrasonography was performed in 153 patients, of which 120 cases （78.43%） showed left ventricular hypertrophy （LVH）. In the 36 cases in early-medium stage group, 21 cases （58.33%） already had LVH. A total of 147 cases had a history of CVD （60%）, much higher than the prevalence rate in general population in USA （36.3%）, and the higher CVD history rate was present in all of the 3 groups. In early-medium stage group, the prevalence rate of CVD already reached to 47.8%. With the progress of diabetic kidney disease, the prevalence rate of CVD became higher in medium-advanced stage group （67.9%, P =0.011, as compared with the rate in early-medium stage group）. Conclusion Carotid atherosclerosis and LVH are very frequently found in patients with type 2 DKD. The prevalence rate of CVD is significantly higher in these patients than in general population. CVD occurs earlier even in the early-medium stage of the disease.