胫前黑斑与糖尿病微血管病变关系的研究

目的探讨2型糖尿病（T2DM）患者胫前黑斑（PPP）的发生情况和危险因素，及与糖尿病微血管病变之间的关系。方法2011年2月至2012年2月间住院资料完整的T2DM患者1134例中，其中伴PPP者364例（32．1％），PPP者在男性患者中的比例为37．7％（203／539）、女性患者中的比例为27．1％（161／595）（x2=4．34，P〈0．05）。比较各组微血管病变的百分比及生化指标，采用logistic多元回归分析PPP的危险因素；分析急性时相蛋白、白细胞介素-18与PPP的关系。结果87．1％（317／364）的PPP患者年龄在50岁以上；与非PPP患者相比，伴PPP患者的糖尿病视网膜病变、糖尿病肾病及糖尿病周围神经病变百分比增高，分别为21．7％（167／770）与64．0％（233／364），19．5％（150／770）与54．9％（200／364），17．3％（133／770）与52．7％（192／364）；同时发生以上3种微血管病变的百分比达31．0％（113／364），显著高于非PPP患者的7．8％（60／770）（均P〈0．01）；PPP与血糖控制情况、病程及C反应蛋白水平独立相关，糖化血红蛋白≥7％、≥9％、≥11％者的OR值分别为3．21、12．68和13．65；糖尿病病程≥10年者OR=1．18；C反应蛋白≥3g／L者OR=2．90。结论PPP是糖尿病常见慢性并发症，可视为糖尿病微血管病变的识别标志之一；血糖控制水平、糖尿病病程及C反应蛋白水平是PPP发生的独立危险因素。

Association between pigmented pretibial patches and diabetic microangiopathy

Objective To investigate the association of pigmented pretibial patches （PPP） with diabetic mieroangiopathy in type 2 diabetic （T2DM） patients. Method One thousand one hundred and thirty four T2DM patients admitted from February 2011 to February 2012 were enrolled in the study. The association of PPP with diabetic microangiopathy, serum C-reactive protein and IL-18 levels and other disease parameters was analyzed with logistic regression method. Results The overall prevalence of PPP was 32. 1% （364/1134） with 37.7% （203/539） for males and 27. 1% （ 161/595 ） for females. The prevalence of diabetic retinopathy, diabetic nephropathy and diabetic neuropathy in patients with or without PPP were 64. 0% （233/364）, 54. 9% （200/364） , 52. 7% （192/364） and 21.7% （ 167/770）, 19. 5% （150/770） , 17.3% （133/770） respectively; the prevalence of all three mierovascular complications in patients with PPP was significantly higher than that in patients without PPP E31.0% （113/364） vs. 7.8% （60/770） , P 〈 0. 05 ]. Logistic analysis indicated that the levels of glycosylated hemoglobin, duration of diabetes≥10 years and C-reactive protein ≥3 g/L were associated with prevalence of PPP. Conclusions PPP is a common sign in diabetic patients and may be used as a indicator for diabetic microvascular complications. The prevalence of PPP is also associated with the levels of blood glucose, C-reactive protein and course duration of the disease.