北京什刹海社区糖尿病肾脏病的早期筛查研究

Screening of early diabetic kidney disease in ShiChaHai community in Beijing

目的了解早期糖尿病肾脏病(diabetic kidney disease,DKD)在社区的流行病学和管理情况。方法随机选取2015年1月至2015年12月期间在北京什刹海卫生中心和社区服务站就诊并已确诊的2型糖尿病患者120例为研究对象,男59例,女61例,平均年龄(65.3±15.3)岁,并选取同期体检的健康体检者80例作为对照组,男48例,女32例,平均年龄(64.7±13.1)岁。对患者一般资料、体检化验结果(血压、血脂、血糖、尿微量白蛋白/尿肌酐)、药物及非药物治疗情况进行分析并探索相关风险因素。结果糖尿病患者中早期DKD发病率为34.1%,早期DKD患者血糖、血压、血脂治疗未达标者分别占68.2%、78%、65.8%,健康体检者血糖、血压、血脂治疗未达标者分别占2.5%、25%、26.3%。2组比较,差异均具有统计学意义(P<0.05)。卡方检验提示年龄、病程为早期DKD的风险因素(P<0.05)。在32例血压不达标早期DKD患者中使用血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体AT1拮抗剂的比例较低;59.4%的患者未足量联合使用降压药物,大部分患者降糖、降脂药物使用不足。在41例早期DKD患者中,44%缺乏规律运动,83%未控制蛋白质摄入量,70.8%未限制钠盐的摄入量。结论社区就诊糖尿病患者中早期DKD发病率高,且患者血压、血糖、血脂控制达标率低,药物及非药物治疗的管理不规范。早期DKD与年龄、糖尿病病程有关,开展社区DKD早期筛查及规范治疗是非常必要的。

Objective To study the epidemiology and management of early diabetic kidney disease in the community.Methods 120 patients diagnosed as having type 2 diabetes from January 2015 to December 2015 in ShiChaHai community in Beijing for treatment were selected as the research subjects,including 59 males and 61 females with median age of（65.31±15.27）years old.The general information,physical examination results（blood pressure,blood lipids,blood glucose,urinary albumin/creatinine）,and drug and non-drug treatment in all patients were analyzed,and the risk factors associated with diabetic kidney disease were explored.Eighty physical examination volunteers with non-diabetic kidney disease in the same period were selected as the control group,including 48 males and 32 females with mean age of（64.66±13.08）years old.Results The incidence of early DKD in diabetes mellitus patients was 34.1%.The treatment nonconformance rate of blood glucose,blood pressure and lipid in early DKD group was 68.2%,78% and 65.8% respectively,and that in nonDKD group was 2.5%,25% and 26.3% respectively,with the difference being significant between two groups（P〈0.05）.Chi-square test suggested that age and disease duration were the risk factors of early DKD（P〈0.05）.In 32 cases of early DKD with blood pressure substandard,the use of angiotensin converting enzyme inhibitors（ACEI）/angiotensin II receptor ATI antagonist（ARB）was decreased.Less than half of patients were not given sufficient anti-hypertensive drugs.Sugar and lipidlowering drugs were given insufficiently in most patients.In41 early DKD patients,44% had no regular exercise,the intake of protein was not controlled in 83%,and sodium intake was not limited in70.8%.Conclusions The incidence of early DKD is still high in patients with diabetes in the community,and the standard rate of blood pressure,blood glucose,and blood lipid is still so low.The management of drug and non-drug treatment is not standardized.Early DKD is related to the age and course of diabetes.It is very necessary to carry out early screening and standard treatment of DKD in community.