II型糖尿病血糖控制情况与合并肾病的关系

Relations of glycemic control to diabetic nephropathy in patients with non-insulin-dependent diabetes mellitus(NIDDM)—A pair-matched case-control study

目的 探讨II型糖尿病 (NIDDM )病人的血糖控制情况对糖尿病肾病 (DN)发生的影响。方法 对合并有DN及未合并有DN的NIDDM患者进行配对病例对照研究 ,共 10 6对。采用硫柳酸法测定 2 4h尿中总蛋白含量 ,根据患DM以来 (对于已患DN的患者 ,至其发生DN前 ) ,平均空腹血糖值 (FBG)是否 >140mg/dl来评估血糖控制情况。对资料进行条件logistic回归分析。 结果 单因素结果显示 :血糖控制情况与DN有统计学联系 ,比值比 (OR)及其 95 %的可信区间 (CI)分别为 0 .43( 0 .2 5～ 0 .75 ) ,用可能起混杂作用的因素调整后 ,这种关系仍然存在。结论 良好的血糖控制可减少NIDDM患者合并DN的危险 ,其作用独立于其它危险因素 (包括DM病程 )。

Objective To describe the relations between glycemic control and development of diabetic nephropathy(DN) in patients with noninsulindependent diabetes mellitus (NIDDM). Methods A retrospective analysis was carried out on two groups of NIDDM patients, one group without proteinuria (<300 mg/day, n=106) and the other group with proteinuria (> or =500 mg/day, n=106). The two groups were matched by age ≤ ±3yrs, sex, race and resident place. Information of these subjects including demographic, history of diseases, family history of diseases, lifestyle and behavior style was obtained by selfadministered questionnaire. Variables including systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting blood glucose(FBG), quantity of protein in 24h urine were measured. Successful glycemic control denoted that the mean value of FBG's surveillance was less than 140mg/dl after the occurrence of DM (the duration to the development of DN for the patients with DN.). Conditional logistic regression analysis was carried out. Results Results from univariate analysis showed that development of proteinuria was associated with glycemic control, the FBG level at diagnosis of NIDDM and the highest FBG level in the past. The corresponding odd ratios (OR) with 95% confidence intervals(CI) were 0.43 ( 0.25 0.75 ); 1.34 ( 1.05 1.72 ) and 1.35 ( 1.07 1.70 ) respectively. When data were adjusted by possible confounding factors, the relation of glycemic control to DN still existed,but the other two relations disappeared. Conclusion Successful glycemic control decreased the occurrence risk of DN, independent of other risk factors including diabetic duration.