上海市华漕社区1851例>60岁糖尿病患者周围神经病变患病情况及影响因素分析

Analysis of the prevalence and influencing factors of peripheral neuropathy in 1 851 patients with diabetes >60 years old in Huacao community of Shanghai

目的了解华漕社区糖尿病患者周围神经病变(DPN)患病情况,分析其影响因素,为预防DPN提供科学依据。方法2020-06-01-2020-12-31对华漕社区1851例>60岁糖尿病患者进行足部检查,检查完用密西根周围神经病筛查表(MNSI)进行评分;清晨抽空腹血检查糖化血红蛋白(HbA1c)、血糖、血脂、血肌酐(Cr),化验患者尿液中尿微量白蛋白与尿肌酐比值(UACR),测定肾小球滤过率(GFR)。结果1851例糖尿病患者中共发现DPN患病人数350例,患病率为18.91%。不同年龄(χ^(2)=47.29,P<0.01)、病程(χ^(2)=5.45,P=0.02)、HbA1c(χ^(2)=5.19,P=0.02)、UACR(χ^(2)=10.79,P<0.01)、GFR(χ^(2)=7.44,P=0.02)DPN患病率差异有统计学意义;随着年龄的增大、病程的增加,DPN患病率有升高趋势,随着GFR升高有下降趋势。多因素logistic回归分析结果显示,影响DPN的因素有年龄(≥80岁:OR=3.70,95%CI为2.29~5.99,P<0.01;75~岁:OR=1.76,95%CI为1.12~2.75,P=0.01;70~岁:OR=1.88,95%CI为1.21~2.94,P<0.01;65~岁:OR=1.29,95%CI为0.80~2.09,P=0.30)、病程(OR=1.37,95%CI为1.03~1.81,P=0.03)、HbA1c(OR=1.31,95%CI为1.03~1.66,P=0.03)、UACR(OR=1.36,95%CI为1.07~1.74,P=0.01)以及GFR(OR=1.32,95%CI为0.96~1.82,P=0.08)。结论上海市华漕社区糖尿病患者DPN患病率较高,影响DPN主要因素是年龄、病程、肾功能以及血糖控制情况。社区家庭医生可采取综合干预措施,如血糖监测、用药指导、积极治疗肾病及足部护理技能的传授等,预防DPN的发生发展。

Objective To understand the prevalence of diabetes peripheral neuropathy(DPN)in Huacao community,and analyze its influencing factors,so as to provide scientific basis for the prevention of DPN.Methods From June 1 to December 31,2020,1851 patients with diabetes>60 years old in Huacao community underwent foot examination.After the examination,the Michigan neuropathy screening instrument(MNSI)was used for scoring.In the morning,the fasting abdominal blood was taken to check the glycosylated hemoglobin A1 c(HbA1 c),blood sugar,blood lipid and blood creatinine,and the urinary albumin/creatinine ratio(UACR)in the patient was tested,and the glomerular filtration rate(GFR)was measured.Results A total of 350 cases of DPN were found in 1851 patients with diabetes,with a prevalence rate of 18.91%.The prevalence of DPN in different age(χ^(2)=47.29,P<0.01),disease course(χ^(2)=5.45,P=0.02),HbA1 c(χ^(2)=5.19,P=0.02),UACR(χ^(2)=10.79,P<0.01),GFR(χ^(2)=7.44,P=0.02)was statistically significant.With the increase of age and course of disease,the prevalence of DPN increased,and decreased with the increase of GFR.Multivariate logistic regression analysis showed that the factors affecting DPN were age(≥80 years old:OR=3.70,95%CI was 2.29-5.99,P<0.01;75-years old:OR=1.76,95%CI was 1.12-2.75,P=0.01;70-years old:OR=1.88,95%CI was 1.21-2.94,P<0.01;65-years old:OR=1.29,95%CI was 0.80-2.09,P=0.30),course of disease(OR=1.37,95%CI was 1.03-1.81,P=0.03),HbA1 c(OR=1.31,95%CI was 1.03-1.66,P=0.03)UACR(OR=1.36,95%CI was 1.07-1.74,P=0.01)and GFR(OR=1.32,95%CI was 0.96-1.82,P=0.08).Conclusion The prevalence of DPN in diabetes patients in Huacao community is high.Focus on diabetes patients with poor blood glucose control,renal function damage and long course of disease.Community family doctors can take comprehensive intervention measures,such as blood glucose monitoring,medication guidance,active treatment of kidney disease and teaching of foot care skills,to prevent the occurrence and development of DPN.