2型糖尿病患者并发糖尿病肾病微量白蛋白尿的影响因素研究

Study on the influencing factors of type 2 diabetic complicated with diabetic kidney disease microalbuminuria

目的探讨2型糖尿病患者(T2DM)并发糖尿病肾病(DKD)微量白蛋白尿的影响因素。方法选取2020年8月至2021年4月衡阳市某两所三甲医院收治的308例T2DM患者作为研究对象,根据患者是否出现微量白蛋白尿进行分组,即尿白蛋白排泄率(UAER)为30~300 mg/24 h纳入DKD组,UAER<30 mg/24 h纳入非DKD组。采用二元logistic回归分析T2DM患者发生DKD的影响因素。结果本研究的308例T2DM患者中,DKD微量白蛋白尿患者有136例(44.16%),非DKD微量白蛋白尿患者有172例(55.84%)。单因素分析结果显示,DKD组的年龄、糖尿病病程、收缩压、舒张压、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、高血压史人数占比、腹型肥胖人数占比高于非DKD组,自我效能评分、健康促进生活方式评分低于非DKD组,差异有统计学意义(P<0.05);二元logistic回归分析结果显示,糖尿病病程(β=0.055,OR=1.057,95%CI=1.007~1.109)、收缩压(β=0.039,OR=1.040,95%CI=1.016~1.064)、LDL-C(β=0.333,OR=1.395,95%CI=1.017~1.914)、腹型肥胖(β=0.596,OR=1.815,95%CI=1.039~3.171)、HbA1c(β=0.182,OR=1.199,95%CI=1.071~1.344)是T2DM患者发生DKD微量白蛋白尿的危险因素(P<0.05),健康促进生活方式评分(β=-0.018,OR=0.983,95%CI=0.967~0.998)、自我效能评分(β=-0.029,OR=0.972,95%CI=0.948~0.996)是T2DM患者发生DKD微量白蛋白尿的保护因素(P<0.05)。结论随着糖尿病病程延长、血糖控制不佳,T2DM患者极易并发肾脏疾病,护理人员需注重提高患者的自我效能,倡导健康促进生活方式,从而预防或延缓DKD微量白蛋白尿的发生。

Objective To explore the influencing factors of type 2 diabetes mellitus(T2DM)complicated with diabetic kidney disease(DKD)microalbuminuria.Methods A total of 308 T2DM patients from two tertiary A hospitals in Hengyang City from August 2020 to April 2021 as the research objects.Patients were divided into groups according to the occurrence of microalbuminuria,urinary albumin excretion rate(UAER)of 30-300 mg/24 h was included in the DKD group,UAER<30 mg/24 h was included in the non-DKD group.The influencing factors of DKD in T2DM patients were analyzed by binary logistic regression.Results Among 308 T2DM patients in this study,136(44.16%)were DKD microalbuminuria patients and 172(55.84%)were non-DKD microalbuminuria patients.Univariate analysis showed that age,duration of diabetes,systolic blood pressure,diastolic blood pressure,low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),proportion of history of hypertension and proportion of abdominal obesity in DKD group were higher than those in non-DKD group,self-efficacy score and health promotion lifestyle score in DKD group were lower than those of non-DKD group,and the differences were statistically significant(P<0.05).The results of binary logistic regression analysis showed that the course of diabetes mellitus(β=0.055,OR=1.057,95%CI=1.007-1.109),systolic blood pressure(β=0.039,OR=1.040,95%CI=1.016-1.064),LDL-C(β=0.333,OR=1.395,95%CI=1.017-1.914),abdominal obesity(β=0.596,OR=1.815,95%CI=1.039-3.171),HbA1c(β=0.182,OR=1.199,95%CI=1.071-1.344)were risk factors for DKD microalbuminuria in T2DM patients(P<0.05),health promotion lifestyle score(β=-0.018,OR=0.983, 95%CI=0.967-0.998), self-efficacy score (β=-0.029, OR=0.972, 95%CI=0.948-0.996) was protective factors for DKD microalbuminuria in T2DM patients (P<0.05). Conclusion With the prolonged duration of the course of diabetes mellitus and poor glycaemic control, T2DM patients are prone to kidney disease. Nurses should pay attention to improving the self-efficacy of the patients, advocating a health-promoting lifestyle, which can help prevent or delay the occurrence of microalbuminuria of diabetic kidney disease.