早发糖尿病的血糖控制及影响大血管并发症的危险因素分析

Analysis of glycemic control and risk factors affecting macrovascular complications in early onset diabetes mellitus

目的探讨早发糖尿病(EDM)患者血糖控制情况及大血管并发症危险因素特点。方法回顾性分析2015年1月至2016年8月于该院就诊的2型糖尿病连续性患者520例。将患者按诊断糖尿病的年龄分组:EDM病组(200例)、晚发组(320例);分析两组的一般情况及血糖、血脂、血压情况;分析两组并发症发病率,Logistic回归分析影响EDM组大血管并发症独立危险因素。结果与晚发组比较,EDM组吸烟、糖尿病家族史及联合胰岛素治疗的比例均增高;年龄、病程、诊断年龄降低;收缩压(SBP)、舒张压、糖化血红蛋白(HbA1c)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)水平均增高。EDM组心血管病、脑血管病、颈动脉粥样硬化和尼龙丝感觉测定异常的患病率、尿蛋白阳性率均低于晚发组。单因素分析显示EDM组的年龄、体质量指数(BMI)、SBP、HbA1c、空腹血糖(FPG)、餐后2h血糖(2hPG)、三酰甘油(TG)、TC、HDL-C、吸烟与大血管并发症的发生相关。多因素分析显示,年龄、BMI、TG、HbA1C、2hPG、SBP、吸烟是EDM组大血管并发症的独立危险因素。结论早发糖尿病患者易于并发大血管并发症,应加强对早发糖尿病患者高危因素的控制。

Objective To investigate the glycemic control situation and risk factors characteristics of macrovascular complications in the patients with early onset type 2 diabetes mellitus(EDM).Methods A total of 520 consecutive patients with type 2 diabetes mellitus(T2DM)in this hospital from January 2015 to August 2016 were retrospectively analyzed.The patients were divided into two groups:EDM group(n=200)and late onset group(n=320)according to the age at which diabetes was diagnosed.The general condition,blood glucose,blood fat and blood pressure were analyzed in the two groups;the occurrence rate of complications in the two groups was analyzed.The Logistic regression analysis was used to analyze the independent risk factors affecting macrovascular complications in the EDM group.Results Compared with the late onset group,the proportions of smoking,diabetes positive family history and proportion of combining with insulin treatment in the EDM group were increased;the age,disease course and diagnosis age were decreased;diastolic pressure,systolic pressure,HbAlc and total cholesterol,HDL-C in the EDM group were increased.The morbidity rates of cardiovascular diseases,brain vascular diseases,neck artery atherosclerosis,electromyographic abnormality and positive rate of urine protein in EDM group were lower than those in the late onset group.The univariate analysis showed that age,BMI,SBP,HbA1c,FPG,2hPG,TG,TC,HDL-C and smoking in the EDM group were correlated with macrovascular complication occurrence.The multivariate analysis showed age,BMI,TG,HbA1C,2hPG,SBP and smoking in the EDM group were the independent risk factors of macrovascular complications.Conclusion The patients with EDM are easier to be complicated with macrovascular complications.The control of high risk factors in the patients with EDM should be strengthened.