2型糖尿病合并早期糖尿病肾病的危险因素分析

目的 探讨2型糖尿病患者糖尿病肾病的危险因素.方法 回顾性分析解放军第四五一医院2010年1月至2013年5月收治的258例2型糖尿病患者的临床资料,根据尿白蛋白排泄率将糖尿病患者分为单纯糖尿病组（91例）、早期糖尿病肾病组（132例）和临床糖尿病肾病组（35例）,并对3组相关因素进行分析比较.采用葡萄糖糖化酶法检测空腹血糖,放射免疫法检测胰岛素,液相离子交换法检测糖化血红蛋白（HbA1c）,酶法检测定血清总胆固醇、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和极低密度脂蛋白胆固醇（VLDL-C）、三酰甘油,放射免疫法测定尿白蛋白定量.并以胰岛素、空腹血糖计算患者胰岛素抵抗指数.结果 单纯糖尿病组、早期糖尿病肾病组和临床糖尿病肾病组患者病程、体重指数、HDL-C、LDL-C、VLDL-C、空腹血糖、胰岛素、HbA1c单因素比较差异均有统计学意义分别为（5.5±1.3）、（7.0±1.6）、（8.5±2.1）年;（23±4）、（24±4）、（26±4） kg/m2;（1.75±0.46）、（1.48±0.82）、（1.15t±0.59） mmol/L; （2.46 ±0.76）、（2.86±0.62）、（3.12±0.58） mmol/L; （0.57±0.48）、（0.68±0.32）、（0.82±0.35） mmol/L;（9±3）、（10±4）、（10±3）mmol/L;（10±4）、（9±4）、（8±3） mU/L; （4.26±2.01）、（6.43±2.46）、（8.07±2.51）％]（P值分别为0.032、0.021、0.041、0.037、0.045、0.038、0.041、0.015）;年龄、收缩压、舒张压、尿酸、总胆固醇、三酰甘油、胰岛素抵抗指数因素间比较差异无统计学意义（P值分别为0.089、0.086、0.091、0.081、0.083、0.067、0.058）.Logistic回归分析显示,病程、体重指数、LDL-C、VLDL-C和HbA1c与糖尿病肾病密切相关（P值分别为0.032、0.027、0.002、0.035、0.021）.HDL-C、空腹血糖和胰岛素与糖尿病肾病无相关性（P值分别为0.062、0.058、0.054）.结论 病程、肥胖、高血糖和高血脂是2型糖尿病合并糖尿病肾病患者危险因素.

Risk factors of patients with type 2 diabetes complicated with nephropathy

Objective To explore the related risk factors of type 2 diabetic patients with diabetic nephropathy.Methods A retrospective research on 258 cases of type 2 diabetes mellitus was done.All of these patients were randomly divided into simple diabetes mellitus group （SDM）,early diabetic nephropathy group （EDN） and clinical diabetic nephropathy group（CDN） according to the urinary protein excretion rate（UAER）.The relevance of the related factors of the two groups was analyzed.Saccharifying enzyme hydrolysis of glucose was adopted to detect fasting plasma glucose ; radioimmunoassay method was adopted to detect insulin ; the liquid ion exchange method was used to detect glycosylated hemoglobin （HbA1 c）,enzymatic method was used to detect serum total cholesterol,high-density lipoprotein cholesterol （HDL-C）,low density lipoprotein cholesterol （LDL-C） and very low density lipoprotein cholesterol （VLDL-C） ; triglyceride and urinary albumin quantitative were determined by radioimmunity method.Insulin and fasting blood glucose were used to determine insulin resistance index （HOMA-IR）.Results The course of disease,body mass index,HDL-C,LDL-C,VLDL-C,fasting plasma glucose,insulin and HbA1 c were significantly different among the three groups （5.5 ± 1.3）,（7.0 ± 1.6）,（8.5 ± 2.1） years ; （23 ±4）,（24 ±47）,（26 ±4） kg/m2 ; （1.75 ±0.46）,（1.48 ±0.82）,（1.15 ±0.59） mmol/L; （2.46 ± 0.76）,（2.86 ±0.62）,（3.12 ± 0.58） mmol/L; （0.57 ±0.48）,（0.68 ±0.32）,（0.82 ±0.35）mmol/L ; （9 ±3）,（10 ± 4）,（10 ±3）mmol/L;（10 ±4）,（9 ±4）,（8 ± 3） mU/L; （4.26 ± 2.01）,（6.43 ± 2.46）,（8.07 ± 2.51）%] （P =0.032,0.021,0.041,0.037,0.045,0.038,0.041,0.015）.Regarding age,systolic pressure,diastolic blood pressure,uric acid,total cholesterol and three acyl glycerin,there were no statistically significant differences observed （P value were 0.089,0.089,0.091,0.081,0.083,0.081,0.083,respectively）.There were four factors including the course of disease,body mass indes,LDL-C,VLDL-C and HbAlc（P =0.032,0.027,0.002,0.035,0.021）affecting the outcomes.HDL-C,fasting blood glucose and insulin and diabetic nephropathy had no correlation with diabetic nephropathy （P value were 0.062,0.058,0.054,respectively）.Conclusion Course of the disease,obesity,hyperglycemia,hyperinsulinemia and hyperlipidemia are the risk factors of type 2 diabetic patients with diabetic nephropathy.