2型糖尿病患者中陈旧性脑梗死的流行状况和相关因素分析

Analysis on prevalence and related factors of old cerebral infarction in patients with type 2 diabetes mellitus

目的分析2型糖尿病(T2DM)患者陈旧性脑梗死的流行状况,并探索T2DM患者脑梗死的相关因素,为其预防和控制提供科学依据。方法回顾性查阅2008年1月1日至2013年3月1日天津医科大学代谢病医院(现更名为天津医科大学朱宪彝纪念医院)住院的2525例糖尿病患者的病历资料,收集相关信息,排除其他类型糖尿病以及未做脑部电子计算机断层扫描(CT)或磁共振成像(MRI)检查的T2DM患者,最终纳入2169例T2DM患者作为研究对象,分析T2DM患者陈旧性脑梗死的患病情况和分布特点。采用SPSS 19.0统计软件进行t检验、χ^2检验及秩和检验,脑梗死患病影响因素采用单因素和多因素非条件logistic回归进行分析。结果在2169例T2DM住院患者中,178例(8.2%)有陈旧性脑梗死,男性T2DM患者陈旧性脑梗死患病率(9.6%)高于女性(6.5%),差异有统计学意义(P<0.01);并且脑梗死的患病率随年龄的增长呈递增的趋势(P<0.01)。陈旧性脑梗死组平均年龄、糖尿病病程、体质指数(BMI)、收缩压(SBP)、纤维蛋白原(FIB)和血尿酸(SUA)水平均高于无脑血管疾病组,差异均有统计学意义(P<0.05);并且男性以及糖尿病足、骨质疏松、周围神经病变、冠心病、高血压、高纤维蛋白原血症的比例高于无脑血管疾病组,差异均有统计学意义(P<0.05,P<0.01);而糖化血红蛋白(HbA1C)水平低于无脑血管疾病组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,高龄、男性、糖尿病病程长、高BMI和高血压史与脑梗死患病有关[OR值(95%CI)分别为1.782(1.438~2.209)、1.897(1.293~2.782)、1.894(1.486~2.416)、1.495(1.155~1.935)和2.017(1.368~2.974)]。结论T2DM患者中脑梗死的患病率较高,特别是高龄、病程长的男性患者,控制体重和血压有利于降低脑梗死的患病率。

Objective To analyze the prevalence and the related factors of old cerebral infarction in the patients with type 2 diabetes mellitus(T2 DM),and to provide the scientific basis for prevention and treatment.Methods After excluding those patients with other types of diabetes and without data on computerized tomography(CT)or magnetic resonance imaging(MRI)of the brain from 2525 diabetic inpatients of Metabolic Disease Hospital(renamed as Chu Hsien-I Memorial Hospital now),Tianjin Medical University from January of 2008 to March of 2013,a total of 2169 T2 DM inpatients served as the subjects in the present study.Information of medical records was retrospectively collected.The prevalence and the distribution characteristics of cerebral infarction in T2 DM patients were analyzed.The t test,χ^2 test and rank-sum test were used to analyze the data.Univariate and multivariate unconditional logistic regression methods were used to analyze the influencing factors of old cerebral infarction in T2 DM patients.The used software was SPSS 19.0.Results In 2169 T2 DM inpatients,the number of old cerebral infarction was178 cases(8.2%),the prevalence(9.6%)of old cerebral infarction in male T2 DM patients was significantly higher than that(6.5%)in female T2 DM patients,P<0.01;the prevalence of old cerebral infarction increased significantly with age(P<0.01).The levels of average age,diabetes duration,body mass index(BMI),systolic blood pressure(SBP),fibrinogen(FIB),serum uric acid(SUA)in old cerebral infarction group were significantly higher than those in group without cerebral diseases,P<0.05;the proportions of males,diabetic foot,osteoporosis,diabetic peripheral neuropathy,coronary heart disease,hypertension and hyperfibrinogenemia in old cerebral infarction group were significantly higher than those in group without cerebral diseases,P<0.05;but the level of hemoglobin A1 C(HbA1 C)in old cerebral infarction group was significantly lower than that in group without cerebral diseases,P<0.05.Results of multivariate non-conditional logistic regression analysis showed that the elder,males,longer diabetes duration,higher BMI and hypertension history were related to cerebral infarction in T2 DM patients.The ORs(95%CI)were 1.782(1.438-2.209),1.897(1.293-2.782),1.894(1.486-2.416),1.495(1.155-1.935)and 2.017(1.368-2.974),respectively.Conclusion The prevalence of old cerebral infarction in T2 DM patients was higher.,especially,in male T2 DM patients with elder and long disease duration;and the weight and hypertension control is useful to reduce the prevalence of old cerebral infarction in T2 DM patients.