影响2型糖尿病患者糖尿病肾病的多因素分析

目的 研究2型糖尿病(T2DM)患者糖尿病肾病(DN)有关的危险因素，并分析各因素在DN发病中各自独立作用及相对影响大小。方法 采用多元逐步回归的统计方法对122例T2DM患者的临床及生化指标进行分析。结果 (1)DN的患者占总病例数39.3％；(2)T2DM患者DN组48例和非DN组(NDN组)74例与健康对照组45例相比较，前组年龄，病程、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、血浆内皮素(ET)水平、空腹胰岛素(FINS)、甘油三酯(TG)、载脂蛋白apoB100均显著高于后两组，而ISI显著低于后两组，提示年龄大、病程长、超体重、血脂异常、ET水平升高和胰岛索抵抗(1R)与DN的发病有关。(3)与DN相关的危险因素依次为ET，apoB100、DBP、SBP、FBG、BG2h、病程、C-P2h、年龄和餐后2h胰岛素(INS2h)。结论 ET升高、血脂异常，高血压、高血糖、1R是ND发病的主要危险因素。积极维护体内正常代谢，尽早纠正血脂异常．有效控制血压、血糖以及改善1R状态是预防和延缓DN发生发展的关键措施。

The multiple regression analysis of the faotors influencing diabetic nephropathy in type 2 diabetu patients

Objective To study the risk factors influencing diabetic nephropathy (DN) in type 2 diabetic mellitus (T2DM), and analyze the action and impact of each factor in DN Methods The clinical and biochemical data of 122 type T2DM were collected and analyzed with multivariable steopwise regression statisical method. Results:(1) The DN was 39.3%;(2)48 cases with DN, 74 cases with non diabetic nephropathy (non-DN) and 45 control were observed. It showed that the factors such as age, diabetic course, body mass index (BMI), systolic blood pressure (SBP), rliastolic blood pressure (DBF), the lever of endothelin (ET), fasting insulin (FINS), triglyceride (T(J),apoB100 in the first group were significant higher than in the latter two groups, but insulin sensitivity index (ISI) was significant lower. It implied that DN had relationship with elder, long diabetic course. Overweight ,dyslipidemia, the high lever of ET and insulin resistance (IR). (3)The factors associated with DN were ET, apoB100,DBP, SBP, sasling blood glucose (FBG), postprandical 2h blood glucose (BG2h),diabetic courses, postprandial 2h C-peptide (C-p2h), age and postprandial 2h insulin (INS 2h). Conclusion The main risk factors of DN were the high lever of ET, dyslipidemia, hypertension, hyperglycemia, IR. It implied that the following methods were useful in preventing and postponing DN, including staying actively in normal metabolism, normalizing dyslipidemia, controlling blood pressure, justifying blood glucose and improving IR.