糖尿病合并大血管病变的危险性研究——4845例糖尿病患者合并慢性并发症及治疗现状调查

A survey on the diabetic macrovascular complications and related risk factors in the 4845 Chinese diabetic patients

目的调查和分析糖尿病患者合并慢性并发症和治疗现状以及采用1997年ADA糖尿病诊断标准前后5年的糖尿病大血管危险因素的变化。方法分析1993～2003年期间参与糖尿病并发症筛查的4845名患者资料,并比较了1993～1997年(A组)和1998～2003年(B组)两个时间段筛查患者的糖尿病并发症和体重、血压以及血糖等变化。结果60.5%的患者HbA1c超过8.5%;近一半的患者治疗的依从性比较差或差;38.3%的患者合并心、脑和(或)下肢血管病变病;2.0%的患者有足(趾)坏疽;54.5%的患者合并高血压。B组与A组比较,视网膜病变、体位性低血压、心率大于90次/min、Cr>133μmol/L的患者比例及高血压的检出率明显减少;BMI大于28kg/m2的比例由18%增加至26%、腰围由86±10cm增加至88±10cm。结论糖尿病合并大血管危险因素应该受到高度重视。

Objective To investigate the prevalence of diabetic macroangiopathy and its risk factors change before and after 1997,diabetes diagnostic criteria. Methods The 4845 patients were divided into two groups according to complication screening time： group A （1993- 1997） and group B （1998-2003）. Results The hyperglycemic treatment compliance was poor in nearly half of DM patients, including 17.5% of them out of diet control. 12.4% were treated with insulin. There were patients with ischemic heart disease （31.9 % ）, cerebral vascular disease （11.1%）, un-palpabilities of dorsalis pedis pulse and/or posterior tibial pulse（26.3 % ）, gangrene（2.0 % ）, hypertension（ 54.5 % ）. Group B showed lower detection rates of DN（6.1% vs 30.4%）, postual hypotension （6.4% vs 22.9%）, the increased seram creatinine （〉 133 μmol/L） （1.5% vs 3.0%）, and HbA1c （8.4% vs 9.0%）（all P〈0.01） as compared with group A, and showed the similar detection rates of DN （26.6% vs 25.4%）, hypertension （36.9% vs 40.5%）,tachycardia （15.6% vs 17%） to the group A. Group B had higher rate of central obesity （high WC） in both male （70.1% vs 60.8%） and female （72.5% vs 58.1%） versus group A（all P〈0.01）. Conclusions The patients screened for diabetic complications from 1998-2003 shows a lower blood glucose level, lower prevalence of microvascular complications, but more severe cluster of macrovascular risk factors.