广东省1型糖尿病患者肾病的危险因素分析

Analysis of Risk Factors for Diabetic Nephropathy in Guangdong Type 1 Diabetic Patients

【目的】了解广东省1型糖尿病(T1DM)患者糖尿病肾病(DN)的现况并探讨其危险因素。【方法】通过广东省T1DM临床研究数据库登记2000年1月1日及以后就诊的T1DM患者人口学资料和临床资料,收集随访患者的全血及尿液标本进行糖化血红蛋白(HbA1c)及尿白蛋白/肌酐(UACR)的中心化检测。根据UACR将患者分为正常白蛋白尿组,微量白蛋白尿组及大量白蛋白尿组。用秩和检验和Logistic回归分析DN与各因素的相关性。【结果】2010年8月至2011年3月共纳入814例患者,中位年龄29.4岁(四分位数间距20.2,41.4,下同),糖尿病病程3.2年(0.8,7.2),HbA1c为8.6%(6.9%,11.0%)。其中正常白蛋白尿组636例(78.1%)、微量白蛋白尿组134例(16.5%),大量白蛋白尿组44例(5.4%)。Logistic回归分析显示病程、腰臀比(WHR)、HbAlc是DN的独立危险因素。【结论】该患者群体中患DN的比例较高(21.9%)。T1DM患者DN与病程、WHR、HbAlc相关。迫切需要加强对广东省T1DM患者的综合管理,提高DN的防治水平。

[Objective] To observe current status of diabetic nephropathy （DN） in Guangdong type 1 diabetic patients and to explore its risk factors. [ Methods ] Demographic and clinical data of type 1 diabetic patients diagnosed since Jan 1, 2000 were collected by a provincial-wide registry database. Blood and urine samples were also collected. Glycosylated hemoglobin Alc, （HbA 1 c ） and urine albumin creatinine ratio （UACR） values were measured centrally. Patients were divided into 3 groups according to UACR values： normoalbuminuria, microalbuminuria, and macroalbuminuria. Multivariate logistic regression analysis was performed to assess correlates of DN. [Results] A total of 814 patients were enrolled from August 2010 to March 2011. The age was 29.4 years （interquartile range 20.2, 41.4, and followed same）, duration of T1DM was 3.2 years （0.8,7.2） and HbAlc level was 8.6 % （6.9%, 11.0%）. Normal UACR, microalbuminuria and macroalbuminuria were observed in 636 （78.1%）, 134 （16.5%） and 44 （5.4%） of the patients, respectively. Multivariate logistic regression models showed that the independent risk factors for DN were duration of T1DM, waist-hip ratio （WHR） and HbAlc. [ Conclusion] A relatively higher proportion of patients （21.9%） was observed in this population. DN in T1DM patients was associated with duration, WHR and HbAlc. There is an urgent need for a more comprehensive management for Guangdong T1DM patients.