糖尿病肾病患者糖尿病慢性并发症合并情况的分析

Chronic complications in patients of type 2 diabetes with diabetic nephropathy

目的:分析不同阶段2型糖尿病肾病(DN)患者合并糖尿病慢性并发症的发生率。方法:临床或肾活检确诊的2型DN患者774例,根据尿蛋白及血清肌酐水平分为白蛋白尿期、临床蛋白尿期及血清肌酐升高期,分析不同时期患者并发症的发生率及代谢指标差异。结果:774例DN患者平均年龄(56.6±11.3)岁,糖尿病病程中位时间为96个月,肾病病程中位时间为12个月。白蛋白尿者210例,蛋白尿者246例,肾功能不全者318例。DN患者视网膜病变的发生率随病程进展逐渐上升,肾功能不全者较肾功能正常者升高显著;周围神经病变占49.5%,以浅感觉障碍为主,自主神经病变以胃肠功能紊乱、性功能障碍最多见,肾功能不全的患者大部分出现神经病变;各期DN患者心绞痛和心肌梗死的发生率无明显差异,肾功能不全者心肌缺血的发生率明显升高,达40.3%;DN患者随病程进展,心肌舒张功能逐渐下降;脑血管病变中以缺血性脑血管病变为主;糖尿病足的发生率较低(1.4%),间歇性跛行达7.5%;80.6%DN患者存在高血压,以肾功能不全者尤著;白蛋白尿组患者糖化血红蛋白达标率明显高于蛋白尿组及肾功能不全组,与蛋白尿组比较达统计学差异;白蛋白尿组患者的空腹及餐后血糖均较后两组患者控制更好;DN患者脂质代谢异常以三酰甘油和低密度脂蛋白升高为主。结论:2型DN患者同时存在糖尿病其它大小血管并发症,肾功能损害严重者,并发症多且严重。视网膜病变不能作为DN早期诊断的必备条件;神经病变的发生率亦随病程进展呈明显上升趋势,并进一步促进疾病的进展;随着DN的进展,心肌缺血比例增加,心肌舒张功能下降,可能增加DN患者心血管的死亡率。我国DN患者代谢控制达标率低,因此,强调DN患者综合治疗是改善患者远期预后,减少并发症,提高患者生活质量的关键。

Objective：To analyze the incidence of complications in different stage patients with diabetic nephropathy （DN）. Methodology：Seven hundred and seventy four patients with clinical or biopsy-proven 2 type DN were enrolled. They were divided into microalbuminuria （n=210）,proteinuria （n=246） and renal dysfunction group （n=318） according to the level of urine protein and serum creatinine. We calculated the complication incidence in patients in different stage and compared the difference of their metabolic parameters. Results：The mean age of these patients was （56.6±11.3） years old,and the median duration of diabetes mellitus was 96 months,and 12 months for DN. Hypertension presented in 80.6% patients with DN,most of whom with impaired renal function. Retinopathy was gradually increasing with the progression of DN. The prevalence of retinopathy in patients with impaired renal function was statistically higher than that in patients with normal renal function. The incidence of peripheral neuropathy was 49.5%,most of which was superficial sensation disorder. Gastrointestinal dysfunction and impotence were predominant in autonomic neuropathy. The neuropathy occurred in majority of patients with impaired renal function. The difference of prevalence of angina and myocardial infarct wasn＇t distinguished among the patients in different stages. Myocardium ischemia was more common in patients with elevated serum creatinine,counting for 40.3%. Myocardium diastolic function decreased with the development of DN. Cerebral ischemia was predominant in cerebral vessels diseases. Diabetic foot was scarce in these patients. The prevalence of intermittent claudication was 7.5 percent. The qualification rate of glycosylated hemoglobin was higher in microalbuminuria group than those in proteinuria and renal dysfunction group. There was statistically difference between microalbuminuria and proteinuria group. Fasting and postprandial blood glucose were controlled better in microalbuminuria group compared with the other two groups. Abnormal lipid metabolism presented predominantly with hypertriglyceridemia and elevated low-density lipoprotein cholesterol. Conclusion：Diabetic other macro-and micro-vascular complications occurred simultaneously in patients with type 2 DN. The complications were diverse and severe in patients with severe renal dysfunction. It was emphasized that comprehensive treatment is necessary for the patients with DN. Intensive controlling of blood glucose,blood lipid and blood pressure and preventing microalbuminuria were the key for improving the prognosis,reducing complications and ameliorating the life quality of DN patients.