高血压与非胰岛素依赖型糖尿病合并肾病的关系——配对病例-对照研究

Relation of Hypertension to Diabetic Nephropathy in Patients with Non- insulin- dependent Diabetes Mellitus ——A Pair- matched Case- control Study

评估高血压在非胰岛素依赖型糖尿病 (NIDDM)合并糖尿病肾病 (DN)中的作用。方法回顾性分析按年龄、性别、种族、居住地匹配的两组 NIDDM患者，其中 1组为非蛋白尿组 (尿蛋白 < 300 mg/24 h， n=106)，另 1组为蛋白尿组 (尿蛋白≥ 500 mg/24 h, n=106)。资料处理使用条件 logistic回归分析。结果单因素分析结果显示：其高血压史，高血压病程，既往最高收缩压 (SBP)、最高舒张压 (DBP)均分别与 DN有统计学关联；其比值比 (OR)及其 95％的可信区间 (CI)分别为 2.00(1.17～ 3.43)、 1.25(1.08～ 1.46)、 1.38(1.15～ 1.66)、 1.33(1.09～ 1.62)；但高血压家族史未显示与 NIDDM并发 DN有统计学联系。用可能的混杂因素调整后上述关联依然存在。结论对于 NIDDM患者来说，有高血压史，高血压病程较长，既往最高 SBP、最高 DBP较高均可独立增加 NIDDM患者合并 DN的危险性。

Objective The study aimed to assess the role of hypertension in the cause of nephropathy in patients with NIDDM. Methods A retrospective analysis was done on two groups of non- insulin- dependent diabetes mellitus (NIDDM) patients, one group without proteinuria (< 300 mg/24 h, n=106) and the other group with proteinuria (≥ 500 mg/24 h, n=106). The groups were matched by age(≤± 3)years, sex, race, and resident place. Some information of these subjects including demographic, history of disease, family history of diseases, life and behavior style variables were obtained by questionnaire, some variables were measured including systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting blood glucose, and quantity of protein in 24 h urine. Finally the conditional logistic regression analysis was done. Results Some factors were independently associated with the occurrence risk of diabetic nephropathy (DN) associated history of hypertension, longer duration of hypertension, higher levels of the past highest SBP and DBP. Their corresponding odd ratios(OR) with 95％ confidence intervals(CI) were 2.00(1.17～ 3.43), 1.25(1.08～ 1.46), 1.38(1.15～ 1.66), and 1.33(1.09～ 1.62) respectively. But family history of hypertension was not significantly associated with the development of DN.When the above－ mentioned relations were adjusted by some relevent confounding factors, the associations were still present. Conclusions History and longer duration of hypertension, history of the highest SBP and DBP are independent risk factors for DN.