上海市社区管理的2型糖尿病患者慢性肾脏病患病情况及其影响因素分析

Prevalence and risk factors for chronic kidney disease among patients with type 2 diabetes mellitus managed in community health centers in Shanghai

目的了解上海市社区管理2型糖尿病患者的慢性肾脏病患病情况，并分析其影响因素。 方法采用随机抽样方法，对上海市社区管理的2型糖尿病患者进行问卷调查、体格检查和生化指标检测，有效样本1 618例。肾小球滤过率采用肾脏病膳食改良公式（MDRD）依据血清肌酐水平估算。运用多因素非条件logistic回归分析，探讨慢性肾脏病的影响因素。 结果社区管理的2型糖尿病慢性肾脏病患病率为43.4%，其中1期16.1%、2期14.8%、3期11.6%和4/5期1.0%。患病知晓率为3.6%。基本特征分布上，女性患病率高于男性（47.3%对37.8%），随年龄增大而患病率升高（χ趋势2＝38.663，P〈0.01）。Logistic回归分析结果显示，影响糖尿病患者发生慢性肾脏病的因素有女性性别、年龄大、文化程度低、家庭人均月收入低、糖尿病病程长、血糖控制不达标、收缩压控制不达标、血三酰甘油控制不达标。 结论上海市社区管理的2型糖尿病患者慢性肾脏病患病率高，知晓率低，在今后的社区管理干预中应定期筛查早发现慢性肾脏病，同时加强血糖、血压和血脂的管理，以延缓慢性肾脏病的发生和发展。

ObjectiveTo estimate the prevalence of chronic kidney disease and to identify influencing factors among patients enrolled in diabetes management by the community health centers in Shanghai. MethodsA questionnaire survey and physical examination were conducted in patients with type 2 diabetes through a random sampling method. Eligible date of 1 618 subjects were enrolled in the study. Estimated glomerular filtration rate was calculated according to equation of the Modification of Diet in Renal Disease Study for serum creatinine. Logistic regression was performed to examine the association between risk factors and chronic kidney disease. ResultsThe prevalence of chronic kidney disease was 43.4%, of which 16.1% were in Stage 1, 14.8% in Stage 2, 11.6% in Stage 3, and 1.0% in Stage 4/5 in the total of 1 618 patients, but only 3.6% of the patients as defined in this study were aware of their condition. A higher prevalence of chronic kidney disease in females than that in males（47.3% vs 37.8%）. The prevalence of chronic kidney disease increased with age （χtend2=38.663, P〈0.01）. Female gender, older age, lower education, lower monthly income per capital, long duration of diabetes, uncontrolled glycosylated hemoglobin, uncontrolled systolic blood pressure, and uncontrolled triglycerides, were influencing factors of chronic kidney disease. ConclusionThe patients under diabetes management in community health centers had higher prevalence of chronic kidney disease with lower awareness. Patients with type 2 diabetes should be encouraged to control blood glucose, blood pressure and blood lipids, to reduce the risk for chronic kidney disease.