1758例2型糖尿病住院患者糖尿病肾病的相关因素分析

Analyses on the relative factors regarding diabetic nephropathy among 1758 cases of type 2 diabetic patients

目的探讨2型糖尿病患者糖尿病肾病（DN）相关因素。方法采用回顾性分析方法选取2003--2010年卫生部北京医院住院治疗的1758例2型糖尿病患者，按尿微量白蛋白排泄率（UAER）结果分为三组，UAER〈20μg／min为无糖尿病肾病组（NA），20-200μg／min为DN微量白蛋白组（MA），≥200μg／min为DN大量白蛋白尿组（LA）。对患者的临床数据进行比较，用多因素logistic回归探寻DN的相关因素。结果（1）1758例2型糖尿病患者中NA组1246例，MA组408例，LA组104例，DN构成比为29．1％。（2）NA、MA、LA组患者年龄分别为（59．87±12．77、62．52±12．74、64．44±12．74）岁，体重指数（BMI）分别为（24．90±3．42、25．53±4．00、25．53±3．91）kg／m2，糖尿病病程分别为（8．39±7．12、10．77±8．02、12．84±7．97）年，收缩压（SBP）分别为（133．42±18．19、142．72±20．21、151．12±21．91）mmHg，舒张压分别为（78．75±10．66、80．79±12．21、83．33±13．61）mrftHg，空腹血糖（FBS）分别为（8．25±3．43、9．02±3．72、9．22±4．62）mmol／L，糖化血红蛋白（HbAlc）分别为（8．88±2．10、9．34±2．36、9．10±2．36）％，尿酸（UA）分别为（288．04±90．41、307．23±96．96、374．28±105．47）mmol／L，甘油三酯分别为（1．72±1．51、2．06±1．88、1．94±1．42）mmol／L，高密度脂蛋白胆固醇分别为（1．08±0．30、1．02±0．29、1．07±0．28）mmol／L、空腹胰岛素水平分别为（9．24±9．02、11．24±9．74、11．06±9．29）μU／ml，空腹C肽分别为（462．31±289．94、510．02±350．08、595．93±445．86）pmol／L，上述指标3组间差异有统计学意义（P〈0．05或P〈0．01）。（3）logistic回归分析显示，DN与糖尿病病程、BMI、SBP、HbAlc、FBS、UA有关（OR值分别为1．041、1．055、1．028、1．116、1．100、1．004，P〈0．05或P〈0．01）。结论2型糖尿病患者应综合控制体重、血压、血糖和UA水平，有助于防治DN。

Objective To analyze the prevalence rate of diabetic nephropathy （DN） and the related factors on DN among type 2 diabetic patients. Methods A total number of 1758 type 2 diabetic patients who were hospitalized in the Beijing Hospital from 2003 to 2010 were analyzed retrospectively. Three groups were divided according to the rate of urinary albumin excretion （UAER）. Patients whose UAER〈20μg/min belonged to normal albuminuria （NA） group. The ones whose UAER from 20 to 200μg/min belonged to microalbuminuria （MA） group, and the others whose UAER≤200 μg/min belonged to large albuminuia （LA） group. The clinical characteristics were then compared. The related factors of DN were analyzed. Results （1） There were 1246 patients in NA group, 408 patients in MA group, and 104 patients in LA group. The constituent ratio of nephropathy was 29.1%. （2） The ages of NA group, MA group and LA group were （59.87 ± 12.77,62.52± 12.74, 64.44 ± 12.74） years old, respectively, with body mass index （BMI） as （24.90 ± 3.42,25.53 ± 4.00, 25.53 ± 3.91） kg/m2 respectively; duration of diabetes as （8.39 ± 7.12, 10.77 ± 8.02, 12.84 ± 7.97） years; systolic blood pressure （SBP） as （133.42 ± 18.19,142.72±20.21,151.12 ± 21.91 ） mm Hg;diastolic blood pressure as （78.75± 10.66,80.79 ± 12.21,83.33 ±13.61 ） mm Hg; fasting blood suger （FBS） as （8.25± 3.43,9.02 ± 3.72,9.22 ±4.62）mmol/L; glycated hemoglobin（HbA1 c） as （8.88 ± 2.10, 9.34 ±2.36, 9.10 ± 2.36）% ; uric acid （UA） as （288.04 ± 90.41,307.23 ± 96.96,374.28 ± 105.47） mmol/L; triglyceride as （1.72 1.51, 2.06 ± 1.88, 1.94 ± 1.42） mmol/L, high density lipoprotein cholesterol as （ 1.08 ±0.30, 1.02 ± 0.29, 1.07 ± 0.28） mmol/L; fasting insulin as （9.24 ± 9.02, 11.24± 9.74, 11.06±9.29） μU/ml; fasting C peptide as （462.31 ± 289.94,510.02 ± 350.08, 595.93± 445.86） pmol/L. There were significant differences between NA, MA and LA groups in all above items （P〈0.01 or P〈0.05）. （3）Logistic regression analysis showed that DN were related with duration ofdiabetes,BMI, SBP,HbAlc,FBS,UA（OR values were 1.041,1.055, 1.028, 1.116, 1.100, 1.004 respectively, P〈0.05 or P〈0.01 ）. Conclusion It would be helpful to prevent and retard progression of DN that comprehensively controlling high blood glucose, hypertension, hyperuricemia and body weight of tyle 2 diabetic patients.