早发2型糖尿病临床特征及慢性并发症相关因素的分析

Clinical characteristics of early-onset type 2 diabetes and risk factors associated with its chronic complications

目的研究早发2型糖尿病(T2DM)的临床特征,探讨其慢性并发症的相关危险因素。方法 2713例病程皆在10年之内的 T2DM 患者,根据发病年龄是否大于40岁分为早发(EOD)和晚发组(LOD)。比较两组的临床资料,分析 EOD 患者的临床特征及慢性并发症的相关危险因素。结果(1)与 LOD 组相比,EOD 组吸烟者比例较高(29.2%vs22.0%,P<0.01),糖尿病家族史阳性率增高(28.6%vs13.1%,P<0.01),血糖(FPG 及 HbAlc)控制不佳者比例高(分别为80.8%vs74.6%及77.3%vs72.7%,均 P<0.05),血 TG(2.5±2.4mmol/L vs 1.9±1.5 mmol/L,P<0.01)及 BMI(24.4kg/m^2±4.6 kg/m^2vs 23.6 kg/m^2±3.7 kg/m^2,P<0.01)水平高。EOD 组代谢综合征(MS)的患病率高于 LOD 组(18.9%vs10.7%,P<0.01)。(2)EOD 组患者的微血管及神经并发症发生率高于其大血管并发症,且早发患者的疼痛(10.6%vs7.10%,P<0.05),感觉缺失(6.20%vs2.80%,P<0.01),腹泻(6.00%vs3.70%,P<0.05)等神经并发症发生率及早期肾病发生率(13.00%vs8.00%,P<0.01)高于 LOD 组。多因素 Logistic 回归分析提示,年龄、病程、高血压、吸烟、阳性家族史、高 TG 血症是慢性并发症发生发展的重要相关因素。结论 EOD 患者表现有更严重的代谢紊乱,相对易早期并发各种微血管、神经的损害,而晚发 T2DM 患者更易并发心脑血管病、高血压病等大血管病变。多因素综合防治策略是防治其慢性并发症发生发展的重要措施。

Objective To investigate the clinical characteristics of early-onset type 2 diabetes （EOD） and the risk factors associated with its chronic complications. Methods A total of 2713 T2DM patients were recruited and divided into two groups： early-and late-onset groups EOD group （diagnosed at the age ≤ 40 ） and late-onset type 2 diabetes （LOD） group （diagnosed at the age 〉 40 ）. The clinical characteristics were compared between two groups, and the risk factors were analyses within the early-onset group. Results （1） The EOD patients were characterized by significantly higher levels of triglycerides （ 2. 5 ± 2.4 mmol/L vs 1.9 ± 1.5 mmol/L, P 〈 0.01 ） and BMI （ 24.4 kg/m^2 ± 4.6 kg/m^2 vs 23.6 kg/m^2 ± 3.7 kg/m^2, P 〈 0.01 ）, higher rates of smoking （29.2% vs 22.0%, P 〈 0.01 ）, family history of diabetes （28.6% vs 13.1%, P 〈0.01 ）, and higher prevalence of metabolic syndrome （ 18.9% vs 10.7% , P 〈 0. 01）, higher proportion of patients with unacceptable HbAlc （ 〉7.0% ） （77.3% versus 72.7%, P 〈 0. 05 ） and fasting blood glucose ≥7.0 mmol/L, （80.8 % versus 74.6%, P 〈 0. 05 ）. （2） The prevalence rates of microvascular complications were higher than those of macrovascular complications in the EOD group, and the prevalence rates of pain, anesthesia, diarrhea, and nephropathy were 10.6% , 6.20%, 6. 00%, and 13.00% respectively, all significantly higher than those of the LOD group （7.10% , 2.80%, 3.70%, and 8.00% respectively, P 〈 0.05, 〈 0.01, 〈 0.05, and 〈 0.01 ）. Linear regression analysis showed that certain subsets of chronic complications were associated with onset age, diabetes duration, hypertension, family history and high level of triglyceride. Conclusion Early-onset DM patients present the clinical features of poorer metabolic profiles, which may contribute to the development of certain subsets of microvascular complications. Late-onset patients tend to be complicated with macmvascular diseases, such as cerebrovascular disease, angiocardiopathy, etc. Multiple factor comprehensive control is important for the prevention of the complications.