早发2型糖尿病患者的血糖控制现况以及大血管并发症危险因素分析

Glucose control and risk factors of macrovascular complications in early onset type 2 diabetes mellitus

目的 评价早发糖尿病（EDM）血糖控制现况,并探讨EDM大血管并发症危险因素的特点.方法 选取2012年1月至2013年3月在新疆医科大学一附院内分泌科住院确诊为2型糖尿病（T2DM）的连续性病例共1 734例为研究对象,其中资料完整并同意参与研究的患者为1 255例.将1 255例T2DM患者根据糖尿病诊断年龄分组：诊断年龄≤40岁为EDM组（n=219）;诊断年龄＞40岁为对照糖尿病组（n=1 036）.另选取同期健康体检者478名为非糖尿病组.测量受试者的身高和体重;测定受试者空腹血糖、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、餐后2h血糖、胰岛素、糖化血红蛋白（HbA1c）.评价糖尿病患者的并发症情况.组间比较用t检验,计数资料的组间比较,采用x2检验,采用logistic多元回归分析评价多种危险因素对大动脉粥样硬化的影响.结果 （1）EDM组的收缩压和舒张压均高于对照糖尿病组（t=2.685、2.560,均P＜0.05）.两组人群的吸烟率分别为45.2％和36.8％（x2=5.439,P＜0.05）.与对照糖尿病组相比,EDM组联合胰岛素治疗比例更高（73.1％比58.7％,x2=15.725,P＜0.001）.（2）EDM组：校正年龄和性别比后,与对照糖尿病组相比,EDM组HbA1c水平更高,HbA1c达标率更低（F=3.733,x2=8.508,均P＜0.05）.（3）与同龄非糖尿病组比较,EDM组的BMI更大、收缩压及舒张压更高（t=3.623、16.392、7.056,均P＜0.001）,LDL-C更高但HDL-C更低（t=4.112、3.174,均P＜0.001）.（4）EDM组的女性患者发生动脉粥样硬化的风险高于男性（OR=3.218,95％CI; 1.527～6.781）;收缩压和餐后2h血糖是大动脉粥样硬化斑块发生的危险因素（OR=1.04,95％CI：1.016～1.072;OR=1.013,95％CI：1.003～1.029）.结论 早发糖尿病患者仅14.2％HbA1c控制达标,超过50％的患者存在糖尿病大血管并发症.早发糖尿病患者,大血管并发症发生与女性、收缩压、餐后2h血糖相关.

Objective To investigate the glycemic control and macrovascular complications risk factors in early onset type 2 diabetes mellitus（EDM）.Methods This cross-sectional study included three groups：（1） EDM group,adults diagnosed with type 2 diabetes at 18-40 yeas of age （n=219）.（2） Usual onset diabetes mellitus group as control DM group,adults diagnosed with type 2 diabetes older than 40 years （n=1 036）.（3） Age matched non-diabetic group （n=478）.Body mass index（BMI）,blood pressure,fasting glucose,glycated hemoglobin A1c（HbA1c）,fasting insulin,high-density lipoprotein cholesterol（HDL-C）,triglycerides and low-density lipoprotein cholesterol（LDL-C） were measured.For patients with diabetes mellitus,the complications were also examined.The t test and multivariate logistic regression analysis were used for statistical analysis.Results （1） The systolic and diastolic blood pressure was higher in EDM group than those in usual onset DM group （t=2.685,2.560,all P ＜ 0.05）.There were significantly higher smoking rate （x2=5.439,P ＜ 0.05） and higher rate of insulin therapy （x2=15.725,P＜0.05） in EDM group than in control DM group.（2） In EDM group,14.2％ of them had HbA1c＜7％.The prevalence rates of atherosclerotic plaque in arteries,diabetic retinopathy,neuropathy and positive micro-albuminuria were 50.7％,52.5％,53.4％ and 53.0％,respectively.After adjusted age and gender,there were higher HbA 1 c levels （F=3.733,P ＜ 0.05） and lower HbA1c control rate （x2=8.508,P ＜ 0.05）of EDM group than control DM group.（3） Compared with the age matched non-diabetes group,the EDM group had higher levels of BMI （t=3.623,P＜0.05）,blood pressurc （SBP t=16.392,P＜0.001; DBP t=7.056,P＜0.05） and LDL-C （t=4.112,P＜0.05）.（4） In EDM group,women had a higher risk for arterial atherosclerosis than man （OR=3.218,95％CI：1.527-6.781）.The postprandial 2 hour glucose and systolic blood pressure were also the risk factors for arterial atheroselerosis in EDM group （OR=1.04,95％ CI：1.016-1.072; OR=1.013,95％ CI：1.003-1.029 respectively）.Conclusion Only 14.2％ patients with early-onset diabetes meet the HbA1c control target and more than 50％ patients already have macrovascular complications.In EDM patients,female,systolic blood pressure and postprandial 2 hour blood glucose are related with macrovascular complications.