皖南地区2型糖尿病住院患者微血管病变及其相关危险因素分析

目的:分析2型糖尿病住院患者糖尿病肾病和视网膜病变危险因素,为糖尿病微血管并发病的防治提供依据。方法:选取2011年10月²012年12月在我院内分泌科住院的603例2型糖尿病患者,通过测定尿微量白蛋白及24 h蛋白定量将患者分为正常糖尿病组及糖尿病肾病组(DN),其中DN组又分为微量(MIAU)、大量白蛋白尿组(MCAU)。通过眼科检查将患者分为正常眼底组及糖尿病视网膜病变组(DR),完善临床资料,检测分析糖尿病微血管病变的发病危险因素。结果:正常糖尿病组DR的发生率最低,仅为5.23%,而MCAU组DR发生率最高,为35.57%,组间比较差异具有统计学意义(P<0.01)。与正常蛋白尿组比较,DN组中(MCAU组)患者的糖尿病病程、血肌酐水平均明显升高(P<0.05或P<0.01),GFR水平则显著减低(P<0.01)。对糖尿病微血管病变危险因素的logistic回归分析表明,合并DR(OR:6.127,P<0.000 1),糖尿病病程(OR:1.123,P<0.000 1)是影响糖尿病患者DN发生的独立危险因素;而合并DN(OR:6.299,P<0.000 1),糖尿病病程(OR:1.085,P<0.000 1)是影响糖尿病患者DR发生的独立危险因素。结论:糖尿病病程是2型糖尿病患者微血管并发症发生的重要独立危险因素,糖尿病患者视网膜病变和肾脏病变密切相关。

Analysis of the risk factors for type 2 diabetic in patients complicated with microvascular disease in population from south Anhui areas

Objective：To investigate the prevalence and risk factors for diabetic nephropathy and retinopathy in hospitalized patient with type 2 diabetes mellitus（DM） for evidence to prevent the incidence of such diabetic microvascular complications.Methods：603 patients with type 2 DM undergone treat-ment on hospitalization basis in our endocrinology department between Oct .2011 and Dec.2012 were included,and allocated to either normal diabetics and diabetic nephropathy group （DN）,which were sub-divided into groups of microalbuminuria（MIAU） and macroalbuminuria（MCAU） by the laboratory findings of urinary albumin and protein level in 24-hour or normal fundus and diabetic retinopathy（DR） group by ophthalmology examination results.The clinical data were thoroughly examined for the risk factors of microvascular complications .Results：Lower incidence of DR（5.23%） was found in the nor-mal diabetics group,while that was higher in MCAU group（35.57%）,and the two groups were statistically different（P〈0.01）.As compared with cases with normal albuminuria level,the sub-group of MCAU in DN had significantly longer duration of diabetes and elevated blood creatinine level （P〈0.05 or P〈0.01）,whereas the GFR levels were markedly decreased（P〈0.01）.Logistic regression analysis showed that independent risk factors for incidence of DN was associated with presence of DR （OR=6.127,P〈0.000 1）and duration of diabetes （OR=1.123,P 〈0.000 1）,and associated DN （OR =6.299,P〈0.000 1） and duration of diabetes （OR=1.085,P 〈0.000 1） were independent risk factors incidence of DR in patients with type 2 DM. Conclusion：Our findings suggest that the duration of diabetes is the key risk factors for the type 2 diabetic microvascular complications ,and the diabetic retinopathy is the close renal involvement .