维吾尔族2型糖尿病患者1 507例并发症相关因素分析

Complications and related risk factors in Uygur patients with type 2 diabetes mellitus

目的了解新疆维吾尔自治区维吾尔族2型糖尿病患者临床特点及并发症的相关因素。方法回顾性分析2010年1月至2015年10月于新疆医科大学第一附属医院住院治疗的1507例成年维吾尔族2型糖尿病患者(诊断6个月)的临床资料,比较、分析不同年龄阶段患者的临床特点、代谢性疾病危险因素、降糖药物应用情况及血糖、糖化血红蛋白、血脂等生化指标水平及并发症发生情况;采用多因素logistic回归法分析糖尿病并发症的相关因素。结果1507例患者年龄均≥20岁,男性924例(61.3%),病程≥5年者564例(37.4%),糖化血红蛋白>10%者189例(12.5%),合并高血压者475例(31.5%);平均BMI为(27.4±5.2)kg/m^2,肥胖者(≥28.0kg/m^2)648例(43.0%),吸烟者434例(28.8%),体育锻炼<150min/周者980例(65.0%),未应用降糖药物治疗者564例(37.4%)。糖尿病合并并发症者1064例(70.6%),合并1、2和≥3个并发症的比例分别为28.7%(432/1507)、19.2%(290/1507)和22.7%(342/1507);合并大血管并发症包括冠状动脉性心脏病、脑卒中/短暂性脑缺血发作和大动脉粥样硬化的比例分别为32.4%(489/1507)、10.4%(156/1507)和35.8%(539/1507);合并微血管并发症包括糖尿病视网膜病变、糖尿病肾病和糖尿病神经病变比例分别为23.4%(353/1507)、6.5%(98/1507)和35.8%(540/1507)。≥60岁患者合并大动脉粥样硬化、糖尿病视网膜病变比例最高分别为38.2%(163/427)、27.2%(116/427),其中50~59岁患者合并糖尿病神经病变比例最高,为40.3%(207/514)。多因素logistic回归分析显示糖化血红蛋白>10%、肥胖、收缩压≥140mmHg(1mmHg=0.133kPa)、舒张压≥90mmHg、吸烟及体育锻炼<150min/周等是糖尿病并发症发生的相关因素,OR(95%CI)值分别为2.74(1.40~5.34)、1.54(1.07~2.21)、1.42(1.01~1.99)、0.37(0.21~0.67)、1.53(1.09~2.15)和1.42(1.07~1.89),均P<0.05。结论新疆维吾尔族2型糖尿病患者并发症率较高,血糖控制差、肥胖、高血压、吸烟与体育锻炼<150min/周是糖尿病患者发生并发症的相关因素,需加强控制血糖、血压、戒烟及加强锻炼。

Objective To investigate the prevalence of complication and related risk factors in Uygur patients with type 2 diabetes mellitus(T2DM).Methods Total 1 507 Uygur patients aged above 20 with T2DM were recruited in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to October 2015.Clinical characteristics,biochemical parameters and related complications were analyzed in different age groups of patients.Multivariate logistic regression was performed to determine associated factors for diabetic complications.Results Among 1 507 cases,there were 61.3%male patients(n=924),37.4%(n=564)with diabetes duration≥5 years,12.5%(n=189)with HbA1c>10%,31.5%(n=475)with hypertension,28.8%(n=434)with smoking history and 37.4%(n=564)patients without antidiabetic drug treatment.The average body mass index(BMI)of patients was(27.4±5.2)kg/m^2 with a obesity rate of 43.0%(648/1 507),and 65.0%(980/1 507)had physical exercise<150 min/week.The prevalence of diabetic complication was 70.6%(1 064/1 507),in which 28.7%,19.2%and 22.7%cases had 1,2 and 3 or more complications,respectively.The proportion of patients with coronary heart disease,stroke/transient ischemic attack and large artery atherosclerosis was 32.4%,10.4%and 35.8%,respectively.The proportion of patients with diabetic retinopathy,nephropathy and neuropathy were 23.4%,6.5%and 35.8%,respectively.Patients aged≥60 years had highest prevalence of large artery atherosclerosis(38.2%,163/427)and diabetic retinopathy(27.2%,116/427);patients in age group 50-59 years had highest prevalence of diabetic neuropathy(40.3%,207/514).Multivariate logistic regression analysis showed that HbA1c>10%(OR=2.74,95%CI:1.40-5.34),obesity(OR=1.54,95%CI:1.07-2.21),systolic pressure≥140 mmHg(1 mmHg=0.133 kPa)(OR=1.42,95%CI:1.01-1.99),diastolic pressure≥90 mmHg(OR=0.37,95%CI:0.21-0.67),smoking(OR=1.53,95%CI:1.09-2.15)and physical activity<150 min/week(OR=1.42,95%CI:1.07-1.89)were the risk factors of diabetic complications.Conclusion Uygur patients with type 2 diabetes in Xinjiang show a relatively high prevalence of complications.Poor glycemic control,obesity,hypertension,smoking and physical inactivity may contribute to development of complications,while well-controlled blood glucose and hypertension and quitting smoking and increasing physical activity may reduce diabetic complications.