糖尿病肾病患者心血管疾病患病率及其影响因素分析

Incidence of Cardiac Vascular Disease and Its Risk Factors of Patients with Diabetic Kidney Disease

目的探讨糖尿病肾病患者心血管疾病患病情况及其相关影响因素。方法选取2014年1月—2015年10月在同济大学附属杨浦医院住院尚未行肾脏替代治疗的糖尿病肾病患者256例,统计患者心血管疾病的合并情况,根据是否合并心血管疾病将患者分为合并心血管疾病组(159例)和未合并心血管疾病组(97例)。收集患者的一般资料及实验室检查结果等,包括性别、年龄、体质量、身高、高血压病史、吸烟史、血红蛋白、清蛋白、空腹血糖、糖化血红蛋白、血肌酐、血尿酸、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、脂蛋白(a)、钙、磷、甲状旁腺激素、C反应蛋白、脑钠肽、24 h尿蛋白定量、同型半胱氨酸、血β2-微球蛋白水平。糖尿病肾病患者合并心血管疾病影响因素采用多因素Logistic回归分析。结果 256例糖尿病肾病患者中,合并心血管疾病159例(62.11%),其中冠状动脉疾病(CAD)、左心室肥厚(LVH)、充血性心力衰竭(CHF)、脑血管疾病(CVA)、大血管动脉粥样硬化(LA)的患病率分别为21.09%(54/256)、8.20%(21/256)、8.59%(22/256)、23.44%(60/256)、49.22%(126/256)。慢性肾脏病(CKD)1~5期患者的心血管疾病患病率分别为48.94%(46/94)、59.18%(29/49)、69.70%(46/66)、74.07%(20/27)、80.00%(16/20),不同CKD分期患者心血管疾病患病率比较,差异有统计学意义(χ~2=12.920,P=0.012)。合并心血管疾病组与未合并心血管疾病组患者性别、年龄、体质指数(BMI)、高血压患病率、吸烟率、糖化血红蛋白、血肌酐、血尿酸、总胆固醇、低密度脂蛋白胆固醇、脂蛋白(a)、甲状旁腺激素、同型半胱氨酸、血β2-微球蛋白水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、血尿酸、脂蛋白(a)、同型半胱氨酸及血β2-微球蛋白水平是糖尿病肾病患者合并心血管疾病的独立影响因素(P<0.05)。结论糖尿病肾病患者心血管疾病患病率高,患者的年龄、血尿酸、脂蛋白(a)、同型半胱氨酸及血β2-微球蛋白水平对糖尿病肾病患者心血管疾病发病有重要影响。

Objective To investigate the prevalence of cardiac vascular disease and its influencing factors of patients with diabetic kidney disease. Methods A total of 256 patients with diabetic kidney disease who had not received renal replacement therapy in Yangpu Hospital, Tongji University from January 2014 to October 2015 were selected. Detection of patients with cardiovascular disease was collected. The patients were divided into group combined with cardiac vascular disease（ n = 159） and group combined without cardiovascular disease（ n = 97） according to whether they were combined with cardiac vascular disease or not. The general information and laboratory test results including gender,age,body mass,height,history of hypertension, smoking history, hemoglobin, albumin, fasting blood glucose, glycosylated hemoglobin（HbA1c）,serum creatinine,serum uric acid, total cholesterol, triglyceride, low density lipoprotein cholesterin, high density lipoprotein cholesterol,lipoprotein（ a）,calcium,phosphorus,parathyroid hormone,C-reactive protein,brain natriuretic peptide,24-hour urinary protein quantitation,homocysteine,and serum β2-microglobulin levels of patients were collected. Multivariate Logistic regression analysis was used to analyze the influencing factors of diabetic kidney disease patients combined with cardiac vascular disease. Results Among the 256 patients with diabetic kidney disease,159（ 62. 11%） were detected with cardiac vascular disease,and the detection rates of coronary artery disease（ CAD）,left ventricular hypertrophy（ LVH）,congestive heart failure（ CHF）,cerebral vascular accident（ CVA）,and large atherosclerosis（ LA） were 21. 09%（ 54/256）,8. 20%（ 21/256）,8. 59%（ 22/256）,23. 44%（ 60/256）,and 49. 22%（ 126/256） respectively. The detection rates of cardiac vascular disease in patients with chronic kidney disease（ CKD） from the first stage to the fifth were 48. 94%（ 46/94）,59. 18%（ 29/49）,69. 70%（ 46/66）,74. 07%（ 20/27）, and 80. 00%（ 16/20） respectively. There was significant differences in the detection rate of cardiac vascular disease among patients in different stages of CKD（ χ~2= 12. 920, P= 0. 012）. There were significant differences in the gender,age,body mass index（ BMI）,history of hypertension,rate of smoking,Hb A1 c,serum creatinine,serum uric acid,total cholesterol,low density lipoprotein cholesterin,lipoprotein（ a）,parathyroid hormone,homocysteine,and serum β2-microglobulin levels of patients between the two groups（ P〈0. 05）.Multivariate Logistic regression analysis showed that age,serum uric acid,lipoprotein（ a）,homocysteine,and serum β2-microglobulin levels were independent influence factors of diabetic kidney disease patients combined with cardiac vascular disease（ P〈0. 05）. Conclusion The prevalence of cardiac vascular disease is high among the patients with diabetic kidney disease.The age of patients,and the levels of serum uric acid,lipoprotein（ a）,homocysteine and serum β2-microglobulin have a significant impact on the incidence of cardiac vascular disease in patients with diabetic kidney disease.