基于健康体检分析2型糖尿病患者发生糖尿病肾脏疾病的影响因素研究

背景　综合管理对降低2型糖尿病人群糖尿病肾脏疾病的发病具有重要意义。因此，分析2型糖尿病患者发生糖尿病肾脏疾病的危险因素，便于社区全科医师更好地管理糖尿病患者。目的　探究2型糖尿病患者发生糖尿病肾脏疾病的影响因素，为社区全科医师综合管理糖尿病患者提供一定的理论依据。方法　收集2018年3-8月在嘉定区江桥镇社区卫生服务中心体检的既往病史中明确诊断为2型糖尿病人群（n=1 627）的体检资料。依据《中国糖尿病肾脏疾病防治临床指南》中糖尿病肾脏疾病诊断标准，将患者分为单纯糖尿病组〔估算肾小球滤过率（eGFR）≥60 ml?min-1?（1.732）-1〕和糖尿病肾脏疾病组〔eGFR<60 ml?min-1?（1.732）-1〕。比较两组患者年龄、性别、吸烟史、血压、体质指数（BMI）、腰围、高血压史、高脂血症史、血脂指标〔总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）〕、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、血尿酸（SUA）、尿蛋白定量（UP）。采用多因素Logistic回归分析探究2型糖尿病患者发生糖尿病肾脏疾病的影响因素。结果　1 627例患者中，糖尿病肾脏疾病104例（糖尿病肾脏疾病组），占6.39%。糖尿病肾脏疾病组患者年龄、腰围大于单纯糖尿病组，收缩压（SBP）、BMI及高血压史发生率、高脂血症史发生率高于单纯糖尿病组，舒张压（DBP）低于单纯糖尿病组（P<0.05）。糖尿病肾脏疾病组患者LDL-C、HDL-C低于单纯糖尿病组，SUA、UP阳性率高于单纯糖尿病组（P<0.05）。年龄〔OR=1.171，95%CI（1.133，1.211）〕、高血压史〔OR=1.892，95%CI（1.070，3.344）〕、高脂血症史〔OR=1.719，95%CI（1.077，2.742）〕、SUA〔OR=8.962，95%CI（5.490，14.629）〕、UP〔OR=8.087，95%CI（4.145，15.779）〕、中心型肥胖〔OR=2.457，95%CI（1.616，3.736）〕是2型糖尿病患者发生糖尿病肾脏疾病的影响因素（P<0.05）。结论　高龄、高血压史、高脂血症史、SUA、UP、中心型肥胖是2型糖尿病患者发生糖尿病肾脏疾病的独立危险因素，提示社区卫生服务中心全科医师要加强对高龄2型糖尿病患者的综合管理；同时建议将UP检测纳入2型糖尿病患者管理监测指标体系中，及时发现和治疗糖尿病肾脏疾病。

Analysis of Risk Factors Related to Type 2 Diabetic Kidney Disease based on Physical Examination

Background　The management of type 2 diabetes played a significant role in decreasing the incidence of diabetic kidney disease within type 2 diabetes mellitus patients.Thus，risk factors analyses of diabetic kidney disease in type 2 diabetes patients could promote patients management for community general practitioners.Objective　To explore the risk factors related to diabetic kidney disease in type 2 diabetes patients，and provide certain theoretical basis for community general practitioners to manage diabetes patients.Methods　Patients diagnosed as type 2 diabetes（n=1 627） between March and August 2018 in Jiangqiao Town Health Service Center，Jiading District were collected，and their physical examination results were gathered.According to the diabetic kidney disease diagnostic criteria in China Clinical Guideline of Diabetic Kidney Disease Treatment and Control，patients were separated into only-type 2 diabetes group 〔eGFR≥60 ml?min-1?（1.732）-1〕 and diabetic kidney disease group 〔eGFR<60 ml?min-1?（1.732）-1〕.General information，including age，gender，smoking history，blood pressure，BMI，waistline，hypertension history，hyperlipidemia history，serum lipid parameters（TC，LDL-C，HDL-C，TG），FPG，HbA1c，SUA，UP，were collected and compared between the two groups.Multivariate Logistic regression analyses were conducted to explore the related risk factors of diabetic kidney disease incidence in type 2 diabetes patients.Results　Among 1 627 diabetes patients，104 were diagnosed as diabetic kidney disease，with a 6.39 percent.Patients in diabetic kidney disease group had higher age，waistline，SBP and BMI than patients in only-type 2 diabetes group；while they had lower DBP than patients in only-type 2 diabetes group；they also had more frequent hypertension history and hyperlipidemia history than patients in only-type 2 diabetes group（P<0.05）.In addition，compared with only-type 2 diabetes group，patients in diabetic kidney disease group had lower LDL-C，HDL-C and higher SUA，UP positive rate（P<0.05）.Age〔OR=1.171，95%CI（1.133，1.211）〕，hypertension history〔OR=1.892，95%CI（1.070，3.344）〕，hyperlipidemia history〔OR=1.719，95%CI（1.077，2.742）〕，SUA〔OR=8.962，95%CI（5.490，14.629）〕，UP〔OR=8.087，95%CI（4.145，15.779）〕，and central obesity 〔OR=2.457，95%CI（1.616，3.736）〕 were the risk factors of diabetic kidney disease incidence in type 2 diabetes patients（P<0.05）.Conclusion　Aging，hypertension history，hyperlipidemia history，SUA，UP and central obesity were independent risk factors for diabetic kidney disease within type 2 diabetes patients，suggesting that community general practitioners should improve the management of aged type 2 diabetes patients.Urinary protein test should be included in surveillance system of type 2 diabetes patients to early detect and treat diabetic kidney disease.