糖尿病肾病死亡的临床危险因素分析

目的：分析糖尿病肾病死亡的主要相关因素,进而实施有效的防治措施,降低糖尿病肾病的死亡率。方法：回顾我院住院糖尿病肾病304例患者,其中33例死亡,对死亡原因进行分析,死亡与尿毒症、心血管事件、感染和脑卒中有关。结果：尿毒症39．3％,心肌梗塞9．1％,严重心律紊乱6．2％,猝死9．1％,急性左心衰12．1％,颅内血管事件6％,严重感染9．1％。死亡占首位尿毒症,其次心血管事件,最后是感染与脑卒中。结论：糖尿病肾病死亡仍以尿毒症占首位,其次是心血管事件,故防治糖尿病心肾损害是同等重要的,同时提高机体免疫能力,减少糖尿病感染的并发症,才能提高糖尿病肾病生存率。     

42例糖尿病死因分析

分析了42例糖尿病死亡原因，以心脑血管并发症占首位，共12例，占死亡人数的28．6％，糖尿病肾病占第2位，共10例，占23．8％，各种感染占第3位，共9例，占21．4％，糖尿病酮症酸中毒占第4位，共7例，占16．7％，高渗性非酮症糖尿病昏迷占第5位，共3例，占7．1％。为降低糖尿病死亡率，本文进行了探讨。     

慢性阻塞性肺疾病合并意识障碍43例原因分析

目的：分析慢性阻塞性肺疾病（COPD）患者意识障碍的原因。方法：对在我科住院的43例COPD合并意识障碍患者的临床资料进行回顾性分析。结果：由肺性脑病引起者17例,占有意识障碍人数的39．5%;低渗性脑病12例,占27．9％;脑梗死3例,占7．0％;药物引起者共6例,占14．0％;其他5例,共占11．6％。结论：慢性阻塞性肺疾病患者一旦出现意识障碍,并非都是肺性脑病所致,应积极寻找原因,对症治疗。     

住院糖尿病患者死亡原因分析

[目的]分析住院糖尿病患者的死亡原因,为糖尿病防治工作提供依据.[方法]对本院自2003年1月1日至2012年12月31日住院死亡的370例糖尿病病例临床资料进行回顾性分析.[结果]①10年间糖尿病病死率为2.09％(370/17683),占住院总死亡人数的13.4％(370/2762),死因构成比呈逐年增长趋势.②死亡主要原因依次排列为肿瘤39.19％(145/370)、心血管病19.19％、感染18.11％、脑血管病11.89％、肾病6.76％、急性并发症1.62％.③糖尿病合并症发生率由高到低依次为高血压59.73％(221/370)、心血管病50.54％(187/370)、肾病48.11％(178/370)、感染47.57％(176/370).[结论]肿瘤、心脑血管病、感染为糖尿病的主要死因,临床在防治过程中应予重视.     

老年维持性血液透析患者死亡原因分析

目的通过对老年尿毒症（CRF）维持性血液透析（MHD））患者死亡原因的分析，了解尿毒症患者的死亡情况，提高临床对死亡相关风险的认识，并及时预防和处理并发症的发生及对老年患者透析需要重视的问题。方法回顾性分析1994年1月至2004年10月开始在本院住院的尿毒症MHD患者透析的初始情况、原发病因与透析生存年限，找出其死亡病例，分析其死亡原因的相关性。结果心力衰竭是老年MHD患者最常见的死亡原因之一，占30．4％；多脏器功能衰竭占21．7％，为老年MHD患者死亡的第2个主要原因；糖尿病肾病占17．4％，严重的营养不良、低蛋白血症占15．2％；多数合并2种以上并发症占10．9％；各种严重感染占4．4％。结论对于老年MHD患者，心力衰竭、多脏器功能衰竭、糖尿病肾病、严重的营养不良和各种严重感染等均是老年MHD患者死亡的重要原因。因此老年MHD患者平时要注意保护心功能，减轻心脏负荷，防止高血钾、高血压、高血脂、高血糖，及时纠正高血压、高血脂、高血糖，积极控制和预防感染，加强营养，努力提高机体的免疫能力，按时进行透析治疗，减少并发症，避免死于各种并发症，降低死亡率。     

老年大肠癌患者围手术期死亡因素分析

目的探讨老年大肠癌患者围手术期死亡的原因及其预防措施：方法对我院1997年1月至2007年10月收治的大肠癌患者术后死亡的病例资料48例进行回顾性分析，根据患者年龄分为老年组32例和非老年组16例，比较两组死亡原因的差异结果老年组32例患者中死于心血管合并症28例（87、50％），其中心力衰竭19例（58．38％），心肌梗死5例（15．63％），恶性心律失常4例（12．50％）；死于肺部合并症2例（6．25％）；死于严重感染2例（6、25％）；而非老年组16例死于心血管合并症2例（12．50％），均为心肌梗死；死于肺部合并症3例（18．75％），死于严重感染8例（50．00％），死于麻醉意外2例（12．50％）；1例死亡因素不明。两组死亡因素具有显著不同，差异具有统计学意义（P〈0．05）。结论老年大肠癌患者围手术期死亡的主要原因为心血管合并症，熟悉老年人的病理生理特点、充分的术前准备、适当的手术时机与手术方式、完善的麻醉及心肺功能监测是减少并发症的有效方法。     

32例糖尿病肾病患者的规范化护理体会

糖尿病肾病（DN）是糖尿病最常见、最严重的慢j生并发症之一,糖尿病肾病既是糖尿病患者死亡的主要原因之一,也为这类疾病患者的护理提出了需要规范化的要求。据不完全统计,Ⅰ型糖尿病肾病的发病率为20％～40％,2型糖尿病肾病的发病率为10％～20％,糖尿病患者死于肾功能衰竭的占5％～10％。由于Ⅱ型糖尿病起病隐匿,有5％的患者在诊断糖尿病的时候就已合并肾脏损害。     

广州市某5家医院肿瘤化疗患者营养状况及其管理分析

目的调查住院肿瘤化疗患者的营养状况及其管理现状。方法对广州市5家医院400例住院肿瘤化疗患者进行营养现状调查,内容包括人口学资料、体质量、身高及营养管理情况。结果本组营养不良的总发生率为40．5％．其中轻度营养不足占12．7％．中度营养不足占6．蹴,重度营养不足占3．3％,超重或肥胖占17．7％;重度营养不足、中度营养不足、轻度营养不足、营养正常、超重或肥胖患者营养管理率分别为15．4％、74％、0、13．4％和7．0~4;营养正常的患者中,使用脂肪乳、氨基酸、维生素、白蛋白及血浆的概率分别为59％、20．6％、65．1％、4.2%和1.3％,而重度营养不良患者没有使用上述5种营养制品的概率分别为61．5％、46．2％、23．1％、9Z撕和100％。结论住院肿瘤化疗患者营养不良发生率高,营养管理现状差,营养支持存在不合理性。需要基于循证的营养支持指南加以改善。     

糖尿病肾病的早期诊断与糖尿病病程及糖化血红蛋白、血糖的关系探讨

目的：探讨糖尿病肾病与糖尿病病程、糖化血红蛋白及血糖的关系。方法：测定246例常规尿蛋白阴性糖尿病患者的晨尿微量白蛋白／尿肌酐，以大于2．5mg/mmol，为诊断糖尿病肾病标准，并比较不同病程、糖化血红蛋白、血糖的糖尿病肾病检查结果。结果：共检出糖尿病肾病59例，病程＞15年者与病程＜5年者比较，糖尿病肾病检出率有显著性差异（P＜0．01）；糖化血红蛋白＞11％者与糖化血红蛋白＜6．5％者比较，糖尿病肾病的检出率有高度显著性差异（P＜0．01）；空腹血糖＞11．1mmol/L者与＜7．8mmol/L者比较，糖尿病肾病的检出率有显著性差异（P＜0．05）。结论：测定晨尿微量白蛋白／尿肌酐来诊断糖尿病肾病方法简单可靠。糖尿病病程长及血糖、糖化血红蛋白控制越差者，其糖尿病肾病发生率越高。     

脑血管病患者医院感染的相关因素分析

目的：了解脑血管病住院患者医院感染危险因素,加强医院感染的防治。方法：采用回顾性方法调查2000年6月。2004年10月间神经内科脑血管病住院患者的临床资料。结果：脑血管病患者医院感染率为12．3％,例次感染率为16．4％。医院感染部位以下呼吸道感染最多见,占35．6％;其次是泌尿道和胃肠道,分别占24．6％与10．2％。年龄、住院天数、侵袭性操作、饮酒史、合并糖尿病、意识障碍程度、白细胞计数、应用H2-受体阻滞剂和抗菌药物等是医院感染发生的相关因素。结论：脑血管病患者医院感染发生率高,相关危险因素较多,应高度重视并加强防护。     

Mortality in childhood-onset type 1 diabetes: a population-based study

OBJECTIVE: To describe the age- and sex-specific mortality in a cohort of young type 1 diabetic patients and to analyze the causes of death with special focus on suicide, accidents, and unexplained deaths. RESEARCH DESIGN AND METHODS: A population-based incident childhood diabetes register, covering onset cases since 1 July 1977, was linked to the Swedish Cause of Death Register up to 31 December 2000. The official Swedish population register was used to calculate age- and sex-standardized mortality rates (SMRs), excluding neonatal deaths. To analyze excess risks for specific diagnoses, case subjects were compared with five nondiabetic control subjects, matched by age, sex, and year of death. Death certificates were collected for all case and control subjects. For case subjects with an unclear diagnosis, hospital records and/or forensic autopsy reports were obtained. RESULTS: Mean age- and sex-SMR was 2.15 (95% CI 1.70-2.68) and tended to be higher among females (2.65 vs. 1.93, P = 0.045). Mean age at death was 15.2 years (range 1.2-27.3) and mean duration 8.2 years (0-20.7). Twenty-three deaths were clearly related to diabetes; 20 died of diabetic ketoacidosis. Only two case subjects died with late diabetes complications (acute coronary infarction). Thirty-three case subjects died with a diagnosis not directly related to diabetes; 7 of them committed suicide, and 14 died from accidents. There was no significant difference in traffic accidents (odds ratio 1.02 [95% CI 0.40-2.37]). Obvious suicide tended to be increased but not statistically significantly so (1.55 [0.54-3.89]). Seventeen diabetic case subjects were found deceased in bed without any cause of death found at forensic autopsy. Only two of the control subjects died of similar unexplained deaths. CONCLUSIONS: In a well-developed health care system, there is still a significant excess mortality in young type 1 diabetic patients. We confirm a very large proportion of unexplained deaths in bed, which should be further studied. There is no clear excess death rate caused by suicide or traffic accidents among young diabetic subjects.     

Diabetic nephropathy is associated with an increased familial risk of stroke

OBJECTIVE: To test the hypothesis that genetic susceptibility to diabetic nephropathy is associated with an increased familial risk of vascular disease, we have examined the causes and rates of death of parents of individuals with type 1 diabetes complicated by diabetic nephropathy compared with the causes and rates of death of parents of control subjects with diabetes uncomplicated by nephropathy. RESEARCH DESIGN AND METHODS: Individuals with at least a 14-year duration of type 1 diabetes complicated by diabetic nephropathy were identified and matched for age, sex, and duration of diabetes to control subjects. A total of 118 patients and 118 matched control subjects were identified and approached to obtain information on parental age and cause of death. For parents who had died, the cause of death was ascertained from the death certificate. RESULTS: Kaplan-Meier curves showed that parents of subjects with nephropathy (PN) had reduced survival compared with parents of diabetic subjects without nephropathy (PC) (log rank test P < 0.05). There was an excess of all vascular deaths and, in particular, strokes in the parents of subjects with nephropathy (PN: 20 of 103 deaths, 19% vs. PC: 3 of 66 deaths, 4%; Fisher's exact test P < 0.01). CONCLUSIONS: Parents of diabetic patients with nephropathy have reduced survival. This seems to be largely explained by an increase in vascular deaths and, in particular, a four-fold increase in the number of strokes. This supports the hypothesis that a common hereditary risk factor predisposes to both vascular death and diabetic renal disease.     

59 740例住院糖尿病患者病死率及其危险因素

目的了解住院糖尿病患者的病死率,分析死亡相关因素。 方法回顾分析1998~2009年北京某医院内分泌科住院糖尿病患者的资料,并分析不同性别、住院次数、住院时间以及糖尿病类型的病死率。 结果59740例住院糖尿病患者中,死亡1283例,总体病死率为2.1%（男性2.2%,女性2.0%）。死亡组患者的人均住院次数和住院时间均大于存活组患者。不同类型的糖尿病患者的病死率也存在较明显差异。其中急性并发症糖尿病患者病死率2.8%,其次是2型糖尿病患者的病死率2.4%,病死率最低的是1型糖尿病患者（1.1%）。 结论住院次数、住院时间及糖尿病类型反映患者病情严重程度,是住院糖尿病患者病死相关因素。      

Mortality and causes of death in a national sample of diabetic patients in Taiwan

OBJECTIVE: To determine the mortality rate, causes of death, and standardized mortality ratio (SMR) in Taiwanese diabetic patients. RESEARCH DESIGN AND METHODS: A cohort of 256036 diabetic patients (118855 men and 137181 women, aged 61.2 +/- 15.2 years) using the National Health Insurance were assembled during the years 1995-1998 and followed up to the end of 2001. Deaths were verified by indexing to the National Register of Deaths. Underlying causes of death were determined from death certificates coded according to the ninth revision of the International Classification of Diseases. The general population of Taiwan was used as reference for SMR calculation. RESULTS: With a total of 1124348.4 person-years of follow-up, 43888 patients died and the crude mortality rate was 39.0/1000 person-years. Mortality rates increased with age, and diabetic men had a significantly higher risk of death than women. However, mortality rate ratio for men versus women attenuated with increasing age. The overall SMR was 1.63 (1.62-1.65), and SMRs also attenuated in the elderly. Causes of death ascribed to diabetes; cancer; cardiopulmonary disease; stroke; disease of arteries, arterioles, and capillaries; nephropathy; infection; digestive diseases; accidents; and suicide were 28.8, 18.5, 9.0, 10.5, 0.3, 4.8, 6.4, 7.9, 3.2, and 0.8%, respectively. CONCLUSIONS: Approximately 71.2% of the diabetes-related deaths would not be ascribed to diabetes on death certificates in Taiwan. The diabetic men have higher risk of dying than women, and diabetic patients have excess mortality when compared with the general population. For underlying causes of death not listed as diabetes, total cardiovascular death, including cardiopulmonary disease, stroke, and disease of arteries, arterioles, and capillaries, is the most common cause of death, followed by cancer.     

Diabetes duration and cause-specific mortality in the Verona Diabetes Study

OBJECTIVE: To examine the 10-year mortality and effect of diabetes duration on overall and cause-specific mortality in diabetic subjects in the Verona Diabetes Study (VDS). RESEARCH DESIGN AND METHODS: Records from diabetes clinics, family physicians, and a drug consumption database were used to identify 5,818 subjects > or =45 years of age with type 2 diabetes who were alive and residing in Verona, Italy on 31 December 1986. Vital status of each subject was ascertained on 31 December 1996. Underlying causes of death were determined from death certificates. Death rates and death rate ratios (DRRs) were computed and standardized to the population of Verona in 1991. RESULTS: During the study, 2,328 subjects died; 974 deaths were attributable to cardiovascular disease, 517 to neoplasms, 324 to diabetes-related diseases, 134 to digestive diseases, 250 to other natural causes, and 48 to external causes. There were 81 subjects who died of unknown causes. Death rates from natural causes were higher in men than in women (DRR 1.4, 95% CI 1.2-1.5) and rose in both sexes with increasing duration of diabetes (P = 0.001). Among the natural causes of death, those for diabetes-related diseases were strongly related to diabetes duration (P = 0.001). a modest relationship with duration was also found for ischemic heart disease in men (P = 0.07). CONCLUSIONS: Cardiovascular disease was the principal cause of death among people with type 2 diabetes in the VDS. Rates for natural causes of death rose with increasing duration of diabetes. Deaths from diabetes-related diseases in both sexes and from ischemic heart disease in men were largely responsible for this increase.     

An explanation for the increase in heart disease mortality rates in diabetic Pima Indians: effect of renal replacement therapy

OBJECTIVE: Diabetic nephropathy (DN) became the leading cause of death in diabetic Pima Indians in the 1970s, but was superseded by ischemic heart disease (IHD) in the 1980s. This study tests the hypothesis that the rise in the IHD death rate between 1965 and 1998 is attributable to access to renal replacement therapy (RRT). RESEARCH DESIGN AND METHODS: Underlying causes of death were determined among 2,095 diabetic Pima Indians > or = 35 years old during four 8.5-year time intervals. To assess the effect of access to RRT on IHD death rates, trends were reexamined after subjects receiving RRT were classified as if they had died of DN. RESULTS: During a median follow-up of 11.1 years (range 0.01-34), 818 subjects died. The age- and sex-adjusted DN death rate decreased over the 34-year study (P = 0.05), whereas the IHD death rate increased from 3.3 deaths/1,000 person-years (95% CI 1.4-5.2) to 6.3 deaths/1,000 person-years (95% CI 4.5-8.0; P = 0.03). After 151 subjects on RRT were reclassified as if they had died of DN, the death rate for DN increased from 4.8 deaths/1,000 person-years (95% CI 2.6-7) to 11.3 deaths/1,000 person-years (95% CI 9-13.6; P = 0.0007), whereas the increase in the IHD death rate disappeared (P = 0.57). CONCLUSIONS: The incidence rate of renal failure attributable to diabetes has increased rapidly over the past 34 years in Pima Indians. IHD has emerged as the leading cause of death due largely to the availability of RRT and to changes in the pattern of death among those with DN.     

Relationship between diabetes and mortality: a population study using record linkage

OBJECTIVE: To determine patterns and causes of mortality for patients with diabetes in a district health authority RESEARCH DESIGN AND METHODS: The study used cross-sectional record linkage, combining an electronic death register with a diabetic patient register constructed from a variety of routine health data sources collected from 1991 to 1997. The study was conducted in Cardiff and the Vale of Glamorgan, Wales, U.K., and included all diabetic deaths between 1993 and 1996. RESULTS: Of 1,694 deaths in patients with known diabetes, only 674 (39.8%) had diabetes recorded as an immediate or antecedent cause of death. Mortality rates were 41.8 per 1,000 for the diabetic population and 10.1 per 1,000 for the nondiabetic population. The standard mean ratio for the diabetic population was 1.24 (95% CI 1.12-1.35), with the risk of mortality relative to the nondiabetic population decreasing with age. Males with diabetes lost an average of 7.0 years from the year of diagnosis, and females with diabetes lost an average of 7.5 years. The most common cause of death was cardiovascular disease, which accounted for 49.1% of deaths in the diabetic population. CONCLUSIONS: Diabetes is recorded as a cause of death on a minority of death certificates for patients with diabetes. Using death certificates in isolation, therefore, is a poor method of estimating diabetic mortality, but results can be improved with the use of record linkage techniques. Patients with diabetes have an excess risk of mortality compared with the nondiabetic population. Life-years lost for patients with diabetes is strongly related to age at diagnosis and is a means of expressing mortality without relying on accurate prevalence data.     

Apolipoprotein E polymorphisms and mortality in Italian type 2 diabetic patients

AIMS: To determine if apolipoprotein E polymorphism is associated with cardiovascular or all-cause mortality in Italian Type 2 diabetic patients. METHODS: A prospective study of mortality in Type 2 diabetic patients (n = 433) as a function of apolipoprotein E phenotype, which was assessed at entry into the study. During follow up (10 years), 110 (25.4%) patients died of which 66 (15.2%) were the result of cardiovascular causes. Cause of death was established from death certificates and clinical records. The clinical status of the survivors was determined at the end of the study. RESULTS: Apolipoprotein E polymorphisms were not associated with excess cardiovascular or all-cause mortality in the Italian Type 2 diabetic patients either in univariate or multivariate analyses. Age, duration of diabetes and glycated haemoglobin levels at entry were the primary determinants of premature mortality in the diabetic population. CONCLUSIONS: Apolipoprotein E polymorphisms are not markers for premature mortality in Italian Type 2 diabetic patients. The impact of apolipoprotein E mutations may be attenuated by environmental factors, notably a healthier diet, in Italian patients.     

Cause-specific mortality in type 2 diabetes. The Verona Diabetes Study.

OBJECTIVE: This population-based study, carried out in the framework of the Verona Diabetes Study, investigated mortality from specific causes in known type 2 diabetic patients. RESEARCH DESIGN AND METHODS: A cohort of 7,148 known type 2 diabetic patients (3,366 men and 3,782 women) was identified on 31 December 1986 and followed up for 5 years (1987-1991). Underlying causes of death were obtained from death certificates and were coded according to the International Classification of Diseases, Ninth Revision. Cause-specific death rates of diabetic subjects were compared with those of the inhabitants of Verona. By 31 December 1991, 1,550 diabetic subjects (744 men and 806 women) had died. RESULTS: The standardized mortality ratio (SMR) for all causes of death was 1.42 (95% CI 1.35-1.50). The highest SMRs were for the following specific causes: diabetes (SMR 4.47 [3.91-5.10]), gastrointestinal diseases (1.83 [1.50-2.21])--particularly liver cirrhosis (2.52 [1.96-3.20])--and cardiovascular diseases (1.34 [1.23-1.44]), particularly cerebrovascular (1.48 [1.25-1.73]) and ischemic heart diseases (1.41 [1.24-1.62]). A significantly higher than expected risk of mortality for cardiovascular causes was already present in the first 5 years after diagnosis and decreased with age. Type 2 diabetic patients treated with insulin had a higher risk of dying than those treated orally or by diet. CONCLUSIONS: The highest SMRs in the diabetic cohort were for diabetes and liver cirrhosis. The mortality risk for cardiovascular diseases, although significantly higher than expected, was much lower in Italian type 2 diabetic patients than that reported for American patients. The evidence of an early effect on mortality suggests that prevention, early diagnosis, and treatment should be improved.     

Temporal trends in BMI among adults with diabetes

OBJECTIVE: Increasing obesity within the general population has been accompanied by rising rates of diabetes. The extent to which obesity has increased among people with diabetes is unknown, as are the potential consequences for diabetes outcomes. RESEARCH DESIGN AND METHODS: Community medical records (hospital and ambulatory) of all Rochester, Minnesota, residents aged > or =30 years who first met standardized research criteria for diabetes from 1970 to 1989 (n = 1,306) were reviewed to obtain data on BMI and related characteristics as of the diabetes identification date (+/-3 months). Vital status as of 31 December 1999 and date of death for those who died were obtained from medical records, State of Minnesota death tapes, and active follow-up. RESULTS: As of the identification date, data on BMI were available for 1,290 cases. Of the 272 who first met diabetes criteria in 1970-1974, 33% were obese (BMI > or =30), including 5% who were extremely obese (BMI > or =40). These proportions increased to 49% (P < 0.001) and 9% (P = 0.012), respectively, for the 426 residents who first met diabetes criteria in 1985-1989. BMI increased significantly with increasing calendar year of diabetes identification in multivariable regression analysis. Analysis of survival revealed an increased hazard of mortality for BMI > or =41, relative to BMI of 23-25 (hazard ratio 1.60, 95% CI 1.09-2.34, P = 0.016). CONCLUSIONS: The prevalence of obesity and extreme obesity among individuals at the time they first met criteria for diabetes has increased over time. This is disturbing in light of the finding that diabetic individuals who are extremely obese are at increased risk of mortality compared with their nonobese diabetic counterparts.