2型糖尿病糖化血红蛋白控制率及其与并发症的关系

Association of glycosylated hemoglobin A1c control with the complications in type 2 diabetic patients

目的探讨2型糖尿病(NIDDM)患者糖化血红蛋白的控制情况及其与合并症、并发症的关系。方法对来我院内分泌科就诊的676例2型糖尿病患者进行糖化血红蛋白(GHbA1c)检测,同时进行有关合并症、并发症的问卷调查。根据GHbA1c测定将患者分为观察组(GHbA1c>7%)和对照组(GHbA1c≤7%)。结果(1)糖化血红蛋白控制良好者(GHbA1c≤7%)占35.1%(237/676),控制不佳者(GHbA1c>7%)占64.9%(439/676)。(2)观察组合并高血压病和脑血管事件的比率显著高于对照组[分别为69.9%vs55.7%,21.8%vs8.9%](均P<0.001)。但两组合并冠心病的比率无显著性差异[18.7%vs17.3%](P>0.05)。(3)观察组并发周围神经病变和脂肪肝的比率明显高于对照组[分别为46.0%vs35.0%,36.9%vs25.3%](均P<0.01)。但两组并发肾病、视网膜病变和糖尿病足的比率无显著性差异[分别为18.7%vs16.5%,30.8%vs27.4%,5.0%vs3.8%](均P>0.05)。结论2型糖尿病患者糖化血红蛋白控制良好率低,糖化血红蛋白控制与合并症、并发症有关,应加强健康教育和糖化血红蛋白监测。

Objective To investigate the status ofglycosylated hemoglobin Alc （GHbA1c） control in type 2 diabetic patients and its relation to diabetic complications. Methods A total of 676 patients with type 2 diabetes were investigated for GHbA1c level and the diabetic complications. The patients were divided into two groups with GHbA1c 〉7% and GHbA1c ≤ 7%, and the relation of GHbA1c with the complications was analyzed. Results The rate of good GHbA1c control （GHbA1c ≤ 7%） was 35.1% （237/676） in these patients, and 64.9% （439/676） of the patients showed poor GHbA1c control （GHbA1c〉7%）. The rates of hypertension and cerebralovascular complications were significantly higher in patients with GHbA1c〉7% than in those with GHbA1c≤7% （69.9% vs 55.7%, and 21.8% vs 8.9%, respectively, P〈0.001）, but the rate of coronary heart disease was comparable between the two groups （18.7% vs 17.3%, P〉0.05）. The patients with poor GHbAloControl had significantly higher incidences of diabetic peripheral neuropathy and fatty liver than those with good GHbA1c control （46.0% vs 35.0%, and 36.9% vs 25.3%, respectively, P〈0.01）, but no significant differences were found in the incidences of diabetic nephropathy （18.7% vs 16.5%）, diabetic retinopathy （30.8% vs 27.4%） or diabetic feet （5.0% vs 3.8%） between the two groups （P〉0.05）. Conclusion Type 2 diabetic patients have generally low rate of successful GHbA1ccontrol, which can be associated with the occurrence of diabetic complications, suggesting the necessity of more rigorous diabetic health education and GHbA1c monitoring in these patients.