2型糖尿病发生蛋白尿的危险因素配对病例对照研究

目的　探讨 2型糖尿病 (DM)患者发生蛋白尿的危险因素。方法　回顾性分析了按年龄、性别、种族、居住地匹配的两组 2型DM患者 ,其中一组为非蛋白尿组 (尿蛋白 <30 0mg/2 4h ,n =10 6 ) ,另一组为蛋白尿组 (尿蛋白≥ 5 0 0mg/2 4h ,n =10 6 )。资料处理使用条件logistic回归分析。结果　职业、DM病程、血糖控制情况、高血压史、高血压病程、患DM后蔬菜摄入量均分别与蛋白尿的发生有统计学关联。相应的比值比及 95 %的可信区间分别为 2 .4 2 9(1.2 99～ 4 .5 4 2 )、1.0 78(1.0 2 9～ 1.131)、2 .316 (1.341～ 3.998)、1.810 (1.0 5 9～ 3.0 92 )、1.0 4 3(1.0 12～ 1.0 74 )和 0 .5 5 1(0 .334～ 0 .90 7)。但未发现DM家族史、高血压家族史、吸烟、其他饮食习惯与 2型DM发生蛋白尿有统计学联系。拟合多变量logistic回归模型 ,应变量为发生蛋白尿 ,自变量包括DM病程、血糖控制情况和高血压史。结论　对于 2型DM患者 ,体力劳动者发生蛋白尿的危险性较脑力劳动者大 ;糖尿病病程长 ,血糖控制差 ,有高血压史均可独立增加其发生蛋白尿的危险性 ;而患DM后 ,日蔬菜摄入量多则可减少发生蛋白尿的危险性

A case control study on the risk factors of proteinuria in patients with type 2 diabetes

OBJECTIVE: To assess factors predisposing to proteinuria in patients with type 2 diabetes mellitus (DM). METHODS: A case-control study was conducted on two groups of patients with type 2 diabetes without proteinuria (urine protein < 300 mg/24 h, n = 106) and with proteinuria (urine protein >or= 500 mg/24 h, n = 106). The two groups were matched by age (+/- 3 years), sex, race and place of residence. Information on these subjects including demography, history of disease, family history of diseases, lifestyle and behavioral variables, were obtained through questionnaire. Variables including blood pressure, fasting blood glucose (FBG), quantity of protein in 24-h urine were measured. Cox's proportional hazards regression analysis was then performed. RESULTS: Factors that were independently associated with the development of proteinuria, would include occupation, diabetic duration, glycemic control, hypertension, duration of hypertension and daily intake of vegetable after diagnosis of DM. Their corresponding odds ratios (OR) with 95% confidence intervals (CI) were 2.429 (1.299 - 4.542), 1.078 (1.029 - 1.131), 2.316 (1.341 - 3.998), 1.810 (1.059 - 3.092), 1.043 (1.012 - 1.074) and 0.551 (0.334 - 0.907), respectively, while the presence of proteinuria was not associated with family history of DM, family history of hypertension, certain dietary habits and smoking habit. Multivariate logistic regression model was then fitted with three variables, including diabetic duration, glycemic control and hypertension. CONCLUSION: The prevalence of proteinuria in labor workers was higher than that in intellectuals. Longer history of diabetic duration, poor glycemic control, hypertension and longer duration of hypertension all independently contributed to the development of proteinuria. The risk of proteinuria decreased with increasing daily intake of vegetables after the patients being diagnosed as having DM.