文化程度与北京社区2型糖尿病患者心血管病危险因素达标率及微血管并发症患病率的相关性研究

Relationship between education levels and the control of CVD risk factors and the morbidities of microvascular complications in patients with T2DM in Beijing communities

目的了解文化程度与北京社区T2DM患者心血管病危险因素达标率和微血管并发症患病率的关系。方法纳入北京27个社区2213例T2DM患者，分为初中及以下组1312例和高中及以上组901例。比较两组HbA1c、LDL-C、BP达标率和糖尿病微血管并发症患病率。结果与初中及以下组比较，高中及以上组HbA1c（51．9％vs46．5％）、BP达标率（39．1％vs28．3％）更高（P〈0．05或P〈0．01），HbA1c＋LDL-C＋BP综合达标率也高于初中及以下组（9．8％vs6．0％，P〈0．01），DPN（10．2％＂US18．8％）、DR（21.6％vs27．7％）和DN（26．6％vs32．5％）患病率均较初中及以下组低（P〈0．01）。校正年龄、性别、吸烟、教育、医保、LDL-C等因素后，SBP不达标者DPN、DR、DN患病率高于SBP达标者rOR（95％CI）：1．017（1.007～1．027）、1．011（1．002～1．019）、1．019（1．01～1．027）]；HbA1c不达标者DR、DN患病率高于HbA1c达标者[OR（95％CI）：1．141（1．0741．213）、1．195（1．127～1．268）]。结论北京社区T2DM患者中，高中及以上组心血管病危险因素控制效果更好，糖尿病微血管并发症患病率更低。

Objective To explore the relationship between education attainment and the control of cardiovascular disease （CVD） risk factors and the morbidities of microvascular complications in patients with type 2 diabetes mellitus （T2DM） in Beijing communities. Methods 2213 T2DM patients from 27 Beijing communities were enrolled and divided into 2 groups according to education levels. 1312 patients with education lower than junior high school were defined as the low education level group, and 901 were referred to the high education level group. The control rates of HbA1 c, LDL-C,BP and the morbidities of microvascular complications were investigated. Results Compared with the low education level group, the high level group had higher control rates of HbA1 c, BP and HbA1 c＋ LDL-C＋BP （51.9 % vs 46.5 %, P〈0.05;39.1% vs 28.3%, P 〈 0.01; 9.8% vs 6.0%, P 〈0. 01）, lower prevalence rates of diabetic peripheral neuropathy （DPN）, diabetic retinopathy （DR） and diabetic nephropathy （DN） （10.2% vs 18.8%,21.6% vs 27.7%,26.6% vs 32.5%; P〈0.01）. After adjustment for age, gender, smoking,education level, insurance, diabetic duration, BMI and LDL-C, compared with those with controlled SBP, the odds ratios （OR, 95%CI） for the prevalence of DPN, DR and DN were 1. 017 （1. 007 ～ 1. 027）, 1. 011 （1. 002～1. 019） and 1. 019（1.01～1. 027） in T2DM patients with uncontrolled SBP, respectively; and for HbAlc,the OR for DR and DN were 1. 141 （1. 074～1. 213） and 1. 195（1. 127～1. 268） in patients with uncontrolled HbA1 c, respectively. Conclusion Higher education attainment is associated with a better control of diabetes and lower prevalence rates of mierovascular complications.