1059例2型糖尿病人糖尿病肾病患病率及其相关危险因素

目的调查2型糖尿病病人糖尿病肾病患病率,并分析其相关危险因素.方法对中山医院1997～2000年间收治的1059例糖尿病病人进行临床分析.结果1059例2型糖尿病病人中糖尿病肾病的患病率为9.73%,终末期肾病的患病率为5.47%.高血压和以高甘油三酯、低HDL血症为特征的脂代谢紊乱是糖尿病肾病的重要危险因素.单次的HbAlc测定值与微量蛋白尿排泄率(UAER)水平间无显著相关.结论本研究所得的糖尿病肾病患病率较国外报道稍低,而危险因素与文献报道相似.当前大多数高危患者尚未进入临床蛋白尿期时,正是积极开展糖尿病肾病早期防治的有利时机.     

2型糖尿病致病危险因素的调查及其治疗对策

目的 研究糖尿病发病的危险因素，探求防治对策。方法 根据病史及体检结果分析217例病人发病的相关因素。结果 40岁以后人群发病率明显上升，父母双方或一方有糖尿病者患病率为10．93％，体型肥胖者患病率为13.08％，饮食结构不合理者患病率为9．45％，不常运动者患病率为13．92％。结论 2型糖尿病发病与年龄、遗传、肥胖、运动、饮食结构等有明显关系，与性别无关。     

上海市郊区2型糖尿病患者肾脏疾病及其危险因素研究

目的 了解上海市郊区2型糖尿病患者肾脏疾病的患病率、病因及其危险因素.方法 2008年11月至2009年3月以上海市郊区某社区2型糖尿病患者为研究对象,通过问卷调查、体格检查和实验室检查,采集研究对象的社会人口学特征、一般情况和肾脏疾病的相关证据.结果 共1487例符合入选标准的2型糖尿病患者进入研究,1421例资料完整,其中男579例(40.75％),女842例(59.25％),年龄37 ～86(61.33 ±9.65)岁,糖尿病病程0.25 ～43.92(7.85±6.34)年.43.42％患者并发糖尿病视网膜病变,21.18％有糖尿病周围神经病变;69.95％合并高血压,76.07％合并高脂血症,15.55％有高尿酸血症,23.65％有心血管事件病史.空腹血糖达标率57.71％,糖化血红蛋白达标率33.99％,血压达标率14.22％,血脂达标率2.46％.肾脏疾病总体患病率为41.31％,临床诊断糖尿病肾病、非糖尿病肾病和不明原因肾功能减退的患病率分别为18.51％、13.44％和9.36％.高龄、糖尿病病程较长、高尿酸血症、糖尿病视网膜病变和血压未达标是2型糖尿病患者肾脏疾病的独立危险因素;高龄和血压未达标是糖尿病肾病的独立危险因素;高龄和高尿酸血症是糖尿病肾病患者肾功能减退的独立危险因素.结论 尽管本组2型糖尿病患者的病程较短,但包括糖尿病肾病在内的各种糖尿病并发症的患病率较高,合并症控制率较低.2型糖尿病患者的非糖尿病肾病常见,进一步明确诊断对防治有重要意义.积极控制血糖、血压、血脂和血尿酸是降低2型糖尿病患者糖尿病肾病和慢性肾脏病发病率的关键.     

TGF-β_1基因启动子区-869C/T1多态性与2型糖尿病肾病尿蛋白的相关性

目的研究转化生长因子β1（TGF-β1）基因启动子区-869C/T1多态性与2型糖尿病肾病尿蛋白的关系。方法运用序列特异性引物聚合酶链反应方法检测232例2型糖尿病肾病患者（微量蛋白尿者117例,临床蛋白尿者115例）及126例正常对照者的TGF-β1基因型,采用ELISA法检测血清TGF-β1。结果 2型糖尿病肾病患者中的临床蛋白尿者CC基因型频率和C等位基因频率高于对照者及微量蛋白尿者（P均〈0.05）,C等位基因携带者患糖尿病肾病临床蛋白尿的风险是T等位基因的1.631倍（OR=1.631,95%CI：1.136～2.343）,临床蛋白尿者血清TGF-β1水平高于对照者（P〈0.01）。结论 TGF-β1基因-869C/T1多态性与2型糖尿病肾病尿蛋白相关,C等位基因可能是糖尿病肾病进展的一个危险因素。     

初诊2型糖尿病患者微血管病变的患病率及相关危险因素分析

目的明确北京地区初诊2型糖尿病患者微血管病变(外周神经病变,视网膜病变,糖尿病肾病)的患病率,并对其相关危险因素进行分析。方法对402例新诊断的2型糖尿病患者进行眼底荧光造影和尿微量白蛋白、神经传导速度及相关指标测定,计算微血管病变的患病率,并对相关因素行Logistic回归分析。结果(1)初诊糖尿病的患者中糖尿病肾病的患病率为16.1%;糖尿病视网膜病变的患病率为18.7%;糖尿病神经病变的患病率为37.3%。(2)收缩压和糖化血红蛋白为糖尿病视网膜病变的独立危险因素。(3)年龄、收缩压、舒张压、空腹血糖、餐后两小时血糖及糖化血红蛋白为糖尿病外周神经病变的独立危险因素。(4)初诊2型糖尿病女性糖尿病视网膜病变、糖尿病肾病的患病率高于男性。结论北京地区初诊2型糖尿病微血管病变占一定比例,微血管病变的患病率存在性别差异,控制血压、血糖有利于改善糖尿病微血管病变。     

江津地区老年2型糖尿病患者皮肤病发病情况及相关因素分析

目的了解重庆江津地区老年2型糖尿病合并皮肤病的患病情况并分析其相关因素,为临床治疗提供依据。方法以重庆江津中心医院226例老年2型糖尿病住院病例为研究对象,分析其合并皮肤病的患病率及类型特征。并以其中无皮肤病患者为对照,分析糖尿病合并皮肤病相关因素。结果老年2型糖尿病患者皮肤病病变患病率为83．2％,其中前3位为皮肤真菌感染（占31．9％）、湿疹（11．9％）和皮肤瘙痒症（7．9％）。多凼素非条件Logistic回归分析显示,糖尿病并发症（OR=4．54）、高血压（OR=1．81）及血脂异常（OR=1．67）为老年糖尿病并发皮肤病的危险因素。结论重庆江津地区老年2型糖尿病患者常见皮肤病为皮肤感染和湿疹,可能与糖尿病患者糖尿病并发症、高血压及血脂异常有关。临床应重视对危险因素的控制,以降低老年糖尿病患者皮肤病的发生。     

糖尿病肾病患者如何合理选择降糖药物？

糖尿病肾病是糖尿病严重微血管并发症之一,国内外流行病学调查资料表明,2型糖尿病患者蛋白尿患病率约40-50％,其中微量白蛋白尿患病率为39％。这些数据表明,2型糖尿病合并肾损害是一个相当普遍的现象。我国目前的糖尿病患者已接近5000万人,若未予特殊干预,20-40％的微量白蛋白尿患者将发展为临床肾病,     

伴有微量蛋白尿的Ⅰ型糖尿病病人的血糖控制和预后

伴有微量蛋白尿的Ⅰ型糖尿病病人的血糖控制和预后［ＢｏｊｅｓｔｉｇＭ，ＤｉａｂｅｔｅｓＣａｒｅ，１９９６，４：３１３］在１型糖尿病病人中，死亡率相对高的主要发生在糖尿病肾病患者中。近１０年来糖尿病肾病的累积患病率有所下降（３０％→９％），可能是改善血糖...     

胰岛素依赖型糖尿病产生微白蛋白尿的危险因素──群体研究

０７８胰岛素依赖型糖尿病产生微白蛋白尿的危险因素──一群体研究［英］（英国微白蛋白尿协作组∥ＢＭＪ．－１９９３，３０６．１２３５～１２３９微白蛋白尿是胰岛素依懒型糖尿病发生明显肾病的一种早期标记，作者为调查胰岛素依赖型糖尿病病人发生持续性微白蛋白尿的...     

2型糖尿病肾病78例临床分析

糖尿病肾病（DN）是糖尿病并发症患死亡的主要原因，以微量自蛋白尿作为DN的临床诊断标准，DN发生率为2型DM患的40％左右。为了总结DN发生、发展规律，达到预防和治疗此病的目的．现将我院2002年以来的78例2型DN分析报道如下。     

Explorative study on diabetes neuropathy among type II diabetic patients in Universiti Sains Malaysia Hospital

ObjectiveThe aim of this study was to determine risk factors and prevalence of diabetic neuropathy (DN) among type II diabetic patients in Malaysian hospital setting.Subjects and methodsa observational prospective longitudinal follow up study design was selected, total no of respondents were 1077 type 2 diabetes mellitus outpatients recruited via attended the diabetes clinics at Hospital Universiti Sains Malaysia (HUSM) in Kelantan. The diagnosis of neuropathy was confirmed by nerve conduction studies. Logistic regression analysis was used to assess the independent variables that affect the development of neuropathy.ResultsThe prevalence of nephropathy is 54.3%. Longitudinal logistic regression identified four predictive variables on the development and progression of diabetic neuropathy that are: duration of diabetes, retinopathy, HbA1c at second visit, and creatinine clearance third visit.ConclusionFindings of this study show high prevalence of diabetic neuropathy. HbA1c and creatinine clearance are two modifiable risk factors for the development of diabetic neuropathy.     

Leukocyte-endothelial cell adhesion molecule 1 (LECAM-1) polymorphism is associated with diabetic nephropathy in type 2 diabetes mellitus

BACKGROUND/AIMS: Glomerular infiltration with monocytes/macrophages has been implicated in the pathogenesis of diabetic nephropathy. In this study, we evaluated the relationship between the genetic polymorphism in leukocyte-endothelial adhesion molecule-1 (LECAM-1) and diabetic nephropathy in patients with type 2 diabetes mellitus. METHODS: We determined the frequency of the LECAM-1 P213S genotype in 102 diabetic patients with diabetic nephropathy, 90 diabetic patients with no evidence of diabetic nephropathy, and 200 healthy control individuals. RESULTS: The frequency of the LECAM-1 213PP genotype and P allele in patients with diabetic nephropathy was significantly higher than that in patients without nephropathy (genotype 68% vs. 53%, chi(2)=6.78, P=.034; allele 83% vs. 72%, chi(2)=6.26, P=.012). The LECAM-1 P213 genotype was associated with a 1.86-fold increased risk for nephropathy independently of other risk factors. CONCLUSION: The data suggest that the LECAM-1 213PP genotype is a genetic risk factor for the development of nephropathy in type 2 diabetes mellitus.     

Epidemiology of diabetic nephropathy

The epidemiology of diabetic nephropathy (DN) should be approached from two angles: a) incidence of diabetic nephropathy in patients with diabetes, and b) epidemiology of chronic renal failure (CHRF) in diabetic patients. According to data from different sources, DN affects, in all its stages, about one third of patients irrespective of the type of diabetes they suffer from, with the peak rate of incidence after 15 years of duration of the illness. It is estimated that the rate of DN prevalence is 4-8% of patients monitored in diabetes centres. In addition, a significant portion of diabetics, especially the type 2 diabetic patients, are affected by the non-diabetic type nephropathy of primarily atherosclerotic etiology. Currently, DN is the principal cause of CHRF in advanced industrial countries (Western Europe, USA,Japan). A similar trend has been recorded in the Czech Republic which has one of the highest incidences of DN among the former Eastern Block countries. Most affected patients are type 2 diabetes patients. The cause of the above increase is the growing prevalence and incidence of type 2 diabetes, and, primarily, better care for type 2 diabetes patients who live long enough to develop severe macro and microvascular complications including DN. The principal factors influencing the risk of a diabetic patient developing DN are long-term monitoring ofglycaemia, control of hypertension, genetic (ethnic) factors, age and sex. Metabolic control has an effect on the risk of diabetic nephropathy developing in type 1 and 2 diabetes, yet it is blood pressure control which is critical for the progression of chronic renal insufficiency in DN patients. In view of the high number of diabetic patients with CHRF which, in addition, associates with their high polymorbidity and extensive demands put on medical and nursing care which is not directly associated with CHRF therapy, we have to do with a serious medical and economic problem.     

2型糖尿病下肢血管病变发生率及相关因素调查

目的调查2型糖尿病患者下肢血管病变发生率及其相关因素.方法于北京地区5所医院对随机选择所在医院随诊1年以上,发病年龄≥40岁,病程≥5年的2型糖尿病患者393例,进行病史回顾,体格检查,生化检查和下肢血管多普勒超声检查.结果393例患者中下肢坏疽8例(2.0%),间歇性跛行28例(7.1%).超声多普勒检查提示有不同程度下肢血管病变者357例(90.8%),其中以68例(17.8%)踝/肱动脉压比值＜1.0者与以下临床情况相关明显糖尿病肾病和视网膜病变发生率高(P＜0.05),FBS和HbAlc水平高(P＜0.05),HDL-ch水平低(P＜0.05),舒张压高0P＜0.01).且踝/肱比值与FBS、HbAlc、Tg、纤维蛋白原、血压呈负相关,与HDL-ch呈正相关0P＜0.05).结论 2型糖尿病患者下肢血管病变常见,与血糖、血脂、血压以及血凝多种因素有关.超声多普勒检查能较早地发现病变,而踝/肱比值是下肢血管病变的一种方便可行和可靠的检测指标.     

History of obesity as a risk factor for both carotid atherosclerosis and microangiopathy

As a westernized lifestyle becomes widespread in Japan, the number of individuals with obesity, as well as type 2 diabetes, is rapidly increasing. In this investigation, we studied the prevalence of obesity and its association with the development of diabetic macroangiopathy and microangiopathy. The clinical records of 634 patients in our hospital with type 2 diabetes were surveyed. The relationship between obesity and diabetic retinopathy and nephropathy and macroangiopathy (carotid artery intima-media thickness, IMT) was examined using univariate and multivariate analysis. A body mass index (BMI) > or = 25 kg/m2 was used as the diagnostic criterion for obesity. The prevalence of obesity at the time of the survey was 35% and a history of obesity was reported in 70% of the survey population. Multiple regression analysis revealed that the maximum BMI was significantly correlated with IMT thickening. The prevalence of nephropathy in previously obese patients was significantly higher than in non-obese patients. The maximum BMI was significantly associated with the development of retinopathy and nephropathy, as shown by logistic regression analysis. This suggests that a history of obesity may be an important risk factor for the development of micro- and macroangiopathy in Japanese with type 2 diabetes.     

Prevalence and risk factors of chronic complications of type 2 diabetic inpatients in Hubei Province of central China: results from a multiple-hospital study

The aims of this study are to investigate the prevalence of chronic complications in hospitalized patients with type 2 diabetes mellitus (T2DM) in Hubei Province of central China and identify its risk factors. The retrospective study was conducted in eight hospitals from four cities in Hubei Province from January 1, 2013 to December 31, 2014. All participants’ medical records were collected, and the demographic characteristics, clinical features, metabolic parameters, and the occurrence of chronic complications associated to T2DM were analyzed. The risk factors of T2DM-associated chronic complications were identified using multivariate logistic stepwise regression analysis. A total of 3469 subjects with T2DM were enrolled. Among the subjects included, 28.9 % developed diabetic retinopathy, 39.2 % developed diabetic nephropathy, 53.0 % developed diabetic neuropathy, 25.8 % developed coronary heart disease (CHD), 17.4 % developed cerebral vascular diseases (CVD), and 10.4 % developed vascular disease of the lower extremities. The prevalence of chronic complications varied significantly among the four cities (P?<?0.01). Multivariate logistic regression analysis showed that systolic blood pressure >125 mmHg and diabetes duration >5 years were common risk factors for microvascular (nephropathy and retinopathy) and macrovascular (CHD and CVD) complications. Meanwhile, family history of diabetes was risk factor for retinopathy, HbA1c >7.0 % was risk factor for retinopathy and CHD, LDL-C level >3.12 mmol/L was risk factor for nephropathy and CHD, triglyceride level >1.7 mmol/L was risk factor for nephropathy and CVD, and age at admission >45 years was risk factor for CHD and CVD. Chronic complications are highly prevalent in inpatients with T2DM in Hubei Province of central China. Future efforts directed at blood glucose control and management of hypertension and lipid disorders are required to prevent and reduce the occurrence of chronic complications of T2DM.     

Higher mortality of patients on haemodialysis with pancreatic diabetes compared to type 2-diabetes

ABSTRACT: In rare cases (1-8%) diabetic patients with end-stage renal disease (ESRD) suffer from diabetic nephropathy (dNP) due to pancreatic diabetes mellitus (PDM). Aim of this study was to investigate differences in the outcome of patients with PDM and those with type 2 diabetes.In a retrospective study we evaluated 96 diabetic patients, who started hemodialysis (HD) in our dialysis centre (1997-2005). In 12 patients PMD was diagnosed, and 84 patients had type 2 diabetes. In both groups we compared vascular risk factors and prevalence of vascular diseases at the start of dialysis. We also evaluated incidence of malnutrition, and 5-year survival in both patient groups.The vascular risk factors were similar in both patient groups, also the prevalence of vascular diseases at the initiation of HD was similar in both groups. In the patients with PDM the mean BMI (kg/m2) was lower (22 + 3 versus 25 + 3), and also their serum albumin was lower (2.7 + 0.3 versus 3.4 + 0.3 g/dl, p < 0.05). Four of these patients (33%) developed malnutrition (BMI < 18.5). In the patients with PDM the age adjusted 5-year survival was significantly lower (8% versus 27%, p < 0.05) than in the type 2 diabetic patients.Conclusions in HD-treated patients with type 2 diabetes or PDM the prevalence of vascular diseases was not significantly different. The lower survival of PDM patients can be related to poor nutrition status.     

A 63bp deletion in the promoter of rage correlates with a decreased risk for nephropathy in patients with type 2 diabetes.

Several polymorphisms have been identified in the RAGE-promoter region that might modulate the outcome of disease. Here we analyse the association of a 63bp deletion (delta63) spanning from bp - 407 to bp - 345 with diabetic nephropathy. The deletion was determined using the polymerase chain reaction (PCR) in a cross-sectional study with 1087 patients with type 1 diabetes (n = 559) and type 2 diabetes (n = 528). 475 patients with osteoporosis served as disease independent control. The prevalence of the heterozygous genotype did not significantly differ between the three groups (type 1: 2.15 %, type 2: 2.27 %, controls: 1.47 %), indicating that heterozygous delta63 is not related to the manifestation of diabetes. Homozygous carriers were not identified in this study. The heterozygous delta63 genotype, was associated with a reduced prevalence of diabetic nephropathy in patients with type 2 diabetes (OR = 0.06; 95 % CI: [0.05, 0.07]), but not in patients with type 1 (OR = 1.49; 95 % CI: [1.14, 1.94]). We conclude, that patients with type 2 diabetes and the 63bp deletion in the promoter of RAGE seem to be protected from diabetic nephropathy. The observed difference between type 1 and type 2 diabetes might point to diverse pathomechanisms of nephropathy in both types of diabetes.     

2型糖尿病患者参考范围甲状腺激素与糖尿病肾病的相关性分析

目的:探讨甲状腺功能正常的2型糖尿病患者甲状腺激素与血糖控制及糖尿病肾病(diabetic kidney disease,DKD)的关系。方法:收集240例年龄≥45岁甲状腺功能正常的2型糖尿病患者临床及实验室资料,分析甲状腺激素与血糖控制及DKD的关系。结果:糖化血红蛋白(hemoglobin A1c,HbA1c)分别与总三碘甲状腺原氨酸(total triiodothyronine,TT3)(r=-0.183,P<0.01)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)(r=-0.221,P<0.01)呈显著负相关。将TT3、FT3、总甲状腺素(total thyroxine,TT4)、游离甲状腺素(free thyroxine,FT4)以四分位法分为4组,以促甲状腺激素(thyroid stimulating hormone,TSH)2.5 mU/L为界分为2组,发现FT3-Q1(2.94~3.52)、FT3-Q2(3.53~3.84)组DKD的患病率分别显著高于FT3-Q4(4.11~4.81)组(FT3-Q1比FT3-Q4χ^2=9.636,P<0.01;FT3-Q2比FT3-Q4χ^2=5.227,P<0.05)。TT3-Q1(0.33~1.27)组DKD的患病率显著高于TT3-Q4(1.54~1.94)组(χ^2=7.557,P<0.01)。多元Logistic回归分析显示,与FT3-Q4组相比,FT3-Q1、FT3-Q2组发生DKD的危险性显著升高[优势比(odds ratio,OR)=5.132,95%可信区间(confidence interval,CI):1.561~16.872,P<0.01;OR=3.775(95%CI:1.131~12.596),P<0.05]。结论:甲状腺功能正常的2型糖尿病患者体内FT3可反映血糖控制情况。参考范围内低水平的FT3与DKD的高患病率显著相关,为DKD的危险因素。