糖尿病肾病发生的相关因素分析

Analysis of risk factors for diabetic nephropathy in patients with type-2 diabetes mellitus

目的 探讨糖尿病肾病（DN）发生的危险因素.方法 90例2型糖尿病患者根据尿蛋白排泄率分为3组：2型糖尿病正常蛋白尿组（DM组）、微量蛋白尿组（DN1组）、临床蛋白尿组（DN2组）.比较3组患者年龄、糖尿病病程、胆固醇、甘油三酯、糖化血红蛋白、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血清P-选择素、血清C反应蛋白、尿单核细胞趋化蛋白1（MCP-1）、尿蛋白排泄率等指标.采用Logistic回归分析DN与各因素的相关性.结果 2型糖尿病病程、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、P-选择素、C反应蛋白、糖化血红蛋白、尿MCP-1等指标在各组间的差异均有统计学意义（P＜0.05）；Logistic回归分析显示,2型糖尿病病程、低密度脂蛋白胆固醇、C反应蛋白、P-选择素和尿MCP-1是DN的独立危险因素（OR值分别为2.238,1.062,6.723,1.166和1.046）.结论 DN的发生及其严重程度与病程、微血管病变及炎性反应独立相关,重视对DN相关因素的监测评价有助于DN的预防和治疗.

Objective To explore the risk factors of diabetic nephropathy. Methods According to the excretion rate of proteinuria, 90 patients were divided into 3 groups： normal diabetic proteinuria group （ DM）, diabetic micro-proteinuria group （ DN1 ）, and clinical diabetic proteinuria group （DN2）. We compared patients＇ages, diabetic course, cholesterol, triglyceride, glycosylated he- moglobin, high density lipoprotein cholesterol （HDL）, low density lipoprotein cholesterol （LDL）, serum p-selectin, serum C-reactive protein, urinary monocyte chemotactic protein, and proteinuria excretion rate. Logistic regression analysis was used to analyze the relation between DN and various factors. Results Differences among these groups were statistically significant in type 2 diabetic course, HDL, LDL, p-selectin, C-reactive protein, glycosylated hemoglobin, and urinary monocyte chemotactic protein （ P 〈 0. 05）. Logistic regression analysis showed that diabetic course, LDL, C-reactive protein, p-selectin, and urinary monocyte chemotactic protein were independent risk factor （ OR values were 2. 238,1. 062,6. 723,1. 166, and 1. 046 ）. Conclusions Occurrence and severity of DN had relationship with course of diabetes, microvascular lesions, and inflammatory reaction. Emphasis on monitoring and evaluation of the DN-related factors would contribute to the prevention and treatment of DN.