驻昆部队离退休干部糖尿病糖化血红蛋白控制及影响因素分析

目的了解驻昆部队老干部2型糖尿病患者的血糖控制及并发症的情况及糖化血红蛋白相关因素分析。方法选择2012年2~8月成都军区昆明总医院体检且资料完整的2型糖尿病患者307例为研究对象,根据糖化血红蛋白（HbA1c）水平将其分为达标组（HbA1c〈7%）和未达标组（HbA1c≥7%）。采用横断面研究方法,以调查问卷形式收集患者年龄、病程、并发症、降糖药物及血糖监测的情况,留取血标本检测HbA1c、空腹血糖（FBG）、餐后2 h血糖（2hPBG）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、尿素氮、肌酐、尿酸等指标,对HbA1c进行相关因素分析。结果驻昆部队离退休老干部糖尿病患者HbA1c达标率为50.5%,达标组和未达标组的患者FBG（6.0±1.1）mmol/L比（7.7±1.5）mmol/L,t=11.60,P〈0.01）]、2hPBG（9.3±1.7）mmol/L比（11.3±2.2）mmol/L,t=9.00,P〈0.01）]和TG（1.8±1.2）mmol/L比（2.3±1.2）mmol/L,t=2.23,P〈0.05）]比较,差异均有统计学意义。达标组和未达标组心血管病变（68.9%比84.2%,χ2=5.335,P〈0.05）、脑血管病变（33.5%比48.0%,χ2=6.078,P〈0.05）、蛋白尿（18.1%比38.2%,χ2=14.385,P〈0.01）、周围神经病变（21.3%比40.1%,χ2=11.952,P〈0.01）和视网膜病变（30.3%比45.4%,χ2=6.789,P〈0.01）等糖尿病慢性并发症的发病率比较,差异均有统计学意义;HbA1c与FBG、2hPBG、TG呈正相关（r=0.75、0.63、0.25,P〈0.05或P〈0.01）,与血糖监测频率呈负相关（r=-0.53,P〈0.01）。结论驻昆部队离退休老干部2型糖尿病血糖控制现状较国内平均水平较好;血糖控制差的患者慢性并发症发生率高,HbA1c与FBG、2hPBG、TG和血糖监测频率密切相关。

The controlling and influencing factors of HbA1c in retired and veteran of military communities in Kunming

Objective To evaluate glycemic control, complication and influence factors of HbA1c in ageing cadres with type 2 diabetic in military communities of Kunming. Methods 307 cases of patients with type 2 diabetes and data in-tegrity from February to August 2012 in Kunming General Hospital of Chengdu Military Area Command were selected as study objects, they were divided into the standard group （HbA1c＆lt;7%） and substandard group （HbA1c≥ 7%） accord-ing to the level of HbA1c. The clinical data of age, course of the disease, complication, hypoglycemic agents and status of glucose controlling were collected by cross-sectional study and questionnaire methods, and HbA1c, FBG, 2hPBG, TC, TG, HDL-C, LDL-C, BUN, Cr, UA of the blood samples were tested. Relative factors of HbA1c were analyzed. Results The goal attainment rate of HbA1c in retired and veteran of military communities in Kunming was 50.50%. Between the standard and substandard groups, there were significant difference in the levels of fasting plasma glucose （6.0±1.1） mmol/L vs （7.7±1.5） mmol/L, t=11.60, P〈 0.01], postprandial plasma glucose （9.3±1.7） mmol/L vs （11.3±2.2） mmol/L, t=9.00, P〈 0.01] and triglycerides （1.8±1.2） mmol/L vs （2.3±1.2） mmol/L, t=2.23, P〈 0.05]. In addition, the preva-lence of diabetic chronic complications, such as the cardiovascular disease （68.9% vs 84.2%,χ2=5.335,P〈 0.05）, cerebrovascular disease （33.5% vs 48.0%, χ2=078, P〈 0.05）, proteinuria （18.1% vs 38.2%, χ2=14.385, P〈 0.01）, pe-ripheral neuropathy （21.3%vs 40.1%,χ2=1.952, P〈 0.01） and retinopathy （30.3% vs 45.4%, χ2=6.789, P〈 0.01） were significantly different between the two groups. There was a positive association between HbA1c level and FBG （r=0.75, P〈0.01）, 2hPBG （r=0.63, P〈0.01）, TG （r=0.25, P〈0.05）, and a negative association between the level of HbA1c and the frequency of glucose monitoring （r=-0.53, P〈0.01）. Conclusion The controlling of glucose level in retired and