2型糖尿病肾病的危险因素分析

Analysis of risk factors for diabetic nephropathy in patients with type-two diabetes mellitus

目的探讨糖尿病肾病(diabetic nephropathy,DN)发生的危险因素。方法对381例2型糖尿病患者根据尿白蛋白排泄率(urinary albumin excretion rate,UAER)分为3组:正常白蛋白尿(normal albuminuria,NA)组、微量白蛋白尿(microalbuminuria,MA)组、临床白蛋白尿(clinical proteinuria,CP)组。比较3组患者年龄、糖尿病病程、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、腰臀比(waist-to-hip ratio,WHR)、体质量指数(body mass index,BMI)、空腹血糖(fasting plasmaglucose,FPG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、三酰甘油(triglyceride,TG)、胆固醇(total cholesterol,TC)、高密度脂蛋白(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白(low density lipoprotein cholesterol,LDL-C)、尿酸(uric acid,UA)以及空腹C肽(fasting blood C-peptide,C-P)等指标。采用Logistic回归分析DN与各因素的相关性。结果年龄、病程、WHR、SBP、DBP、LDL-C、TC、HbA1c、C肽、UA等指标在各组间的差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,病程、SBP是DN的独立危险因素(OR值分别为1.029、1.088,P值均小于0.05)。结论 DN的发生及其严重程度与糖尿病病程及SBP独立相关,重视对DN相关因素的监测与评价有助于DN的预防和治疗。

Objective To study the relationship between diabetic nephropathy（DN） and its risk factors.Methods A total of 381 type-2 diabetic patients were divided into three groups： normal albuminuria（NA）,microalbuminuria（MA） and clinical proteinuria（CP）,depending on the levels of urinary albumin excretion rate（UAER）.The differences of the 3 groups in terms of age,duration of diabetes,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,waist-to-hip ratio（WHR）,body mass index（BMI）,fasting plasma glucose（FPG）,glycosylated hemoglobin A1c（HbA1c）,triglyceride（TG）,total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,uric acid（UA） and C-peptide.Logistic regression analysis was used to analyze the possible factors that might affect the DN.Results There were statistically significant differences in age,duration of diabetes,WHR,SBP,DBP,LDL-C,TC,HbA1c C-peptide and UA among the 3 groups.Logistic regression analysis showed that diabetic duration and SBP were independent risk factors（OR=1.029 and 1.088,P0.05 for both）.Conclusion A close correlation has been found between duration of diabetes and SBP.Monitoring and evaluating systemic factors will be helpful for prevention and treatment of DN.