糖尿病周围神经病与糖尿病肾病的相关性分析

Clinical association analysis between diabetic peripheral neuropathy and diabetic nephropathy

目的探讨2型糖尿病患者糖尿病周围神经病(diabetic peripheral neuropathy,DPN)与糖尿病肾病(diabetic nephropathy,DN)的共同患病危险因素及二者的相关性。方法对365例2型糖尿病患者的临床资料进行回顾性分析。依据肌电图结果将患者分为无糖尿病周围神经病组(NDPN组)及糖尿病周围神经病组(DPN组),比较两组患者DN相关生化指标以及DN患病率的差异。根据尿白蛋白排泄率(urinary albumin excretion rates,UAER)及估算肾小球滤过率(estimated glomerular filtration rate,eGFR),参考Mogensen DN分期,将365例2型糖尿病患者分为无白蛋白尿组(包括单纯糖尿病、DNⅠ期和Ⅱ期患者)195例、微量白蛋白尿组(UAER 30~300mg/24h)84例、临床白蛋白尿组(UAER>300mg/24h)57例及终末肾衰组[eGFR<15ml/(min·1.73m^2)]29例,比较各组DPN患病率的差异。以逐步二元logistic回归法分析DN和DPN的共同患病风险因素。结果 DPN组DN患病率明显高于NDPN组,差异有显著性(P<0.05)。依照UAER分组时,随着UAER升高,DPN患病率也逐渐上升,4组间差异有显著性(P<0.01)。DPN与DN的共同风险因素包括年龄、病程、收缩压、低密度脂蛋白胆固醇水平。结论 DPN与DN间有相关性,二者存在共同的患病风险因素。

Objective To investigate the risk factors of diabetic peripheral nephropathy（DPN） and diabetic nephropathy（DN） in type 2 diabetes mellitus patients and the relationship between DN and DPN. Method Retrospective analysis was performed on the clinical data of 365 patients with type 2 diabetes. These patients were divided into no diabetic peripheral neuropathy（NDPN） group and DPN group according to the results of electromyography. The differences in renal biochemical markers and the prevalence of DN were compared between the two groups. According to the urinary albumin excretion rate（UAER） and the estimated glomerular filtration rate（eGFR）, refer to the Mogensen diabetic nephropathy stage, all patients were divided into four groups： albumin-free group（including simple diabetes, DN Ⅰ and Ⅱ patients）, microalbuminuria group（UAER 30-300 mg/24 h）, clinical albuminuria group（UAER300 mg/24 h） and terminal renal failure group [eGFR15 ml/（min·1.73 m^2）], the differences in the prevalence of DPN among the four groups were compared. Multiple regression analysis was used to analyze the risk factors of DN and DPN. Result The prevalence of DN in DPN group was significantly higher than that in NDPN group（P〈0.05）. The prevalence of DPN increased gradually with the increase of UAER, there were significant differences among the four groups（P〈0.01）. Common risk factors for DPN and DN included age, duration, systolic blood pressure and Low-density lipoprotein cholesterol levels. Conclusion There is a correlation between DPN and DN, and there are some common risk factors between them.