500例糖尿病肾病患者出院后1a现状分析

Analysis of 500 cases of diabetic nephropathy 1 year after discharge

目的通过对糖尿病肾病(DN)患者的追踪随访,探讨DN患者出院后状况及存在问题,评估疾病发展的主要危险因素,为改善DN患者的预后及转归提供理论基础。方法选取2014年1月至2015年9月期间在河南科技大学第一附属医院住院治疗的612例DN患者的临床资料,筛选符合条件者530例,随访1 a,失随访者共30例,有效统计样本500例。根据1 a内患者规范饮食情况、血糖水平、血压水平、血脂调整水平和规律用药情况等分别进行分组,对比因上述因素变化造成的疾病进展事件(包括DN从Ⅲ期发展到Ⅳ期;DN从Ⅳ期发展到Ⅴ期;SCr升高1倍;接受透析治疗;DN导致死亡等)的发生率、24 h尿蛋白定量、超敏C反应蛋白(hs-CRP)表达水平、同型半胱氨酸(HCY)表达水平、胱抑素C(CysC)表达水平的差异。结果经过1 a的随访,500例患者中发生54例DN进展事件,发生率为10.8%(54/500);空腹血糖水平>7.0 mmol/L者(160例)DN进展事件的发生率为21.3%(34/160),24 h尿蛋白定量为(1.3±0.2)g/24 h、hs-CRP为(8.7±6.1)mg/L、HCY为(9.6±2.7)μmol/L、CysC为(3.1±1.4)mg/L,各观察指标均明显高于空腹血糖水平≤7.0 mmol/L者;未行低蛋白饮食者、血压控制不良者、血脂水平调整不佳者DN进展事件的发生率均高于平均水平(P<0.05),24 h蛋白定量、hs-CRP、HCY、CysC表达水平亦有明显升高(P<0.05)。结论 DN患者出院后存在饮食不规范,用药依从性差,血压、血糖、血脂控制不佳等情况,饮食结构,合理用药,血糖、血压及血脂水平是导致DN患者病情发展的主要危险因素,降低血压、控制血糖可减缓DN的发展速度。

Objective To evaluate the risk factors of diabetic nephropathy （DN） and provide a theoretical basis for impro- ving the prognosis and prognosis of DN by exploring the status and problems of DN patients after discharge. Methods The clini- cal data of 612 patients with DN who were admitted to the First Affiliated Hospital of Henan University of Science and Technology from January of 2014 to September of 2015 were followed up for one year, and 530 eligible patients were screened out. During a follow - up period of 1 year, a total of 30 cases were lost, and 500 cases were as statistically valid samples. The patients were di- vided into different groups according to the standard diet, blood glucose, blood pressure, blood lipid and regular medication situ- ation within one year. The incidence of disease progression events （ including DN from stage Ⅲ to stage Ⅳ, DN from stage IV to stage V, SCr increased by one time, receiving dialysis treatment, death caused by DN and so on）, urinary protein quantity in 24 hours, the expression levels of HCY, hs - CRP, CysC were compared. Results After 1 year of follow - up, the incidence of DN progression events was 10. 8% （54 cases） in 500 patients, and the rate of DN progress events was 21.3% （34/160） in 160 patients with fasting blood glucose 〉 7.0 mmol/L, hs - CRP （ 8.7 ± 6. 1 ） mg/L, HCY （9. 6 ± 2. 7） μmol/L, CysC （ 3. 1 ± 1.4） mg/24 h, the levels of observed indicators were significantly higher than patients with the fasting blood glucose 〈~ 7.0 mmol/L. The incidence of DN progression events of those who did not follow a low protein diet, or have poor blood pressure control, or poor blood lipid regulation was higher than the average level（P 〈 0. 05）. The expression of hs - CRP, HCY and CysC were significantly increased（P 〈 0. 05 ）. Conclusion Patients with DN have irregular diet, poor compliance, blood pressure, blood glucose, blood lipid control and so on. Diet structure, rational use of drugs, blood glucose, blood pressure and blood lipid levels are the main risk factors for the development of DN. Lowering blood pressure and controlling blood sugar can slow down the development of DN.