2型糖尿病肾病影响因素病例对照研究

Influential factors of diabetic nephropathy among type 2 diabetes patients

目的探讨与2型糖尿病肾病相关的影响因素。方法采用1∶1配对的病例对照研究,对139对研究对象进行2型糖尿病肾病(DN)相关危险因素的问卷调查;应用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)技术对亚甲基甲氢还原酶(MTHFR)多态性基因型进行检测,采用SPSS 13.0统计软件进行分析。结果条件Logistic回归分析表明:携带MTHFR基因667T型基因、糖尿病病程长、并发糖尿病视网膜病变、白/球蛋白比值过低和纤维蛋白原过高均可增加DN的危险性;文化程度高、体育锻炼、患病后盐摄入控制、蔬菜摄入量多可降低DN发生的危险;交互作用分析表明,基因型与病程之间有相乘交互作用,患病后蔬菜摄入量及锻炼、白/球蛋白比值之间存在相乘交互作用。结论 DN的发生是多因素综合作用的结果。

Objective To explore the influencing factors of diabetic nephropathy.Methods A 1∶1 sex and age matched case-control study was conducted among 139 type 2 diabetic nephropathy（DN） patients.Information was collected through interview for demographic data,disease history,family disease history,dietetic habit,behavior pattern,social psychologic character,clinical data and laboratory data.Polymorphism of methylenetetrahydrofolate（MTHFR） gene was assessed with polymerase chain reaction（PCR） and restriction fragment length polymorphism（RFLP）.The effects of risk factors on DN in type 2 diabetes patients and the potential interaction between the risk factors were analyzed with conditional logistic regression model.Results Univariate conditional logistic regression analysis showed that 667T allele of MTHFR gene,long diabetes history,diabetic retinopathy,lower ratio of albumm/globulin（A/G）,higher fibrinogen were associated with higher risk of DN incident.Higher education,more exercise,control of sugar intake,higher vegetable intake after DM incident were associated with lower risk of DN incident.The interaction existed between duration of DM and genotype,vegetable intake and exercise,vegetable intake after DM.Conclusion The incidene of DN of type 2 diabetes patient is associdted with multiple risk factors.