Ⅱ型糖尿病所致终末期肾病患者并发脑卒中的分析

目的探讨Ⅱ型糖尿病(DM)患者所致终末期肾病(ESRD)脑卒中的发生率以及相关危险因素对其的影响。方法应用回顾性方法对我院肾内科Ⅱ型DM所致ESRD接受血透患者(Ⅰ组,n=36)进行了分析,对照组为年龄和性别匹配的Ⅱ型DM肾功代偿期尚不需透析患者(Ⅱ组,n=59)和非糖尿病肾病(DN)所致ESRD接受血透患者(Ⅲ组,n=50)。收集以上患者的年龄、性别、病程、透析龄、血糖、血肌酐、脉压差(PP)、脑卒中发生类型、周围血管病变、血清胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL)等临床资料,并进行多因素逐步回归分析。结果各组相比:Ⅰ组脑卒中总发生率最高,为22.2%,Ⅱ组为10.2%,Ⅲ组仅为4%;I组、Ⅱ组的脑梗塞发生率明显高于Ⅲ组(P<0.05);Ⅰ组脑出血发生率虽显著高于Ⅱ组(P<0.05),但该两组的脑梗塞发生率却相似。多因素逐步回归分析显示,脑梗塞发生的相关危险因素分别为PP、CHOL。结论Ⅱ型DM患者发生脑卒中的几率高于非DM所致ESRD患者,脑卒中发生的最危险因素为PP和CHOL,血液透析可能是导致Ⅱ型DM患者脑卒中几率增高的原因之一。

Analysis of End-stage Renal Disease Caused by Type 2 Diabetes Mellitus with Cerebral Apoplexy

Objective To explore the incident rate of cerebral apoplexy in the end-stage renal disease(ESRD) caused by type 2 diabetes mellitus(DM) and the effects of the correlated risk factors. Methods Retrospective method was used to analyze the data of type 2 DM patients those are divided into 3 groups: group 1, ESRD caused by type 2 DM with hemodialysis (n=36); group 2, control patients(matched in age and sex) with renal function compensated phase without hemodialysis (n=59) and group 3, ESRD with hemodialysis not caused by diabetic nephropathy(DN, n=50). The ages, sexes, course, hemodialysis ages, blood sugar, serum creatinine, pulse pressure(PP), category of cerebral apoplexy, peripheral angiopathy, blood serum cholesterol (CHOL), high density lipoprotein(HDL) and other clinical date of the patients were collected and analyzed by multiple factor stepwise regression. Results The incident rates of cerebral apoplexy were the highest in group 1 (22.2%), 10.2% in group 2 and only 4% in group 3. The incident rates of cerebral infarction in group 1 and 2 were higher than that in group 3 obviously (P<0.05), althongh the incident rate of cerebral hemorrhage was higher in group 1 than in group 2. Multiple factor stepwise regression analysis showed that the correlated risk factors of cerebral infarction were PP and CHOL. Conclusion The incident rate of ischemia apoplexy in type 2 DM patients was higher than that in ESRD patients not caused by DM, the highest risk factors of ischemia apoplexy were PP and CHOL. Hemodialysis may be one of the causes for the increase of the incident rate of hemorrhagic apoplexy in type 2 DM patients.