社区2型糖尿病患者肾脏并发症早期筛查及危险因素分析

Early screening and related risk factors analysis for type 2 diabetic renal complications in communities

目的筛查社区2型糖尿病(T2DM)患者肾脏并发症,调查糖尿病肾病(DN)患病率及可能的危险因素。方法选取2020-12-25-2021-12-25在苏州高新区狮山街道社区卫生服务中心行DN筛查的453例T2DM患者为研究对象,根据是否患有DN分为非糖尿病肾病组(NDN组)和糖尿病肾病组(DN组),比较2组患者的一般情况和实验室检测指标,采用logistic回归分析筛选DN发生的危险因素。结果453例研究对象,DN组患者216例,占比47.7%。DN组的年龄(t=-5.443,P<0.001)和病程(t=-4.333,P<0.001)大于NDN组,并且其空腹C肽(t=-2.822,P=0.005)、血糖(t=-4.816,P<0.001)、糖化血红蛋白(HbA1c,t=-3.654,P<0.001)、三酰甘油(TG,t=-2.344,P=0.020)、血肌酐(t=-3.010,P=0.003)、血尿素(t=-3.576,P<0.001)和乳酸脱氢酶(LDH,t=-3.019,P=0.003)水平也高于NDN组。DN组中女性比例高于NDN组,χ^(2)=6.703,P=0.010。与NDN组相比,DN组高血压患病率(χ^(2)=23.618,P<0.001)和胰岛素使用率(χ^(2)=6.308,P=0.012)较高,血糖控制满意率较低(χ^(2)=25.386,P<0.001)。DN组的尿糖(χ^(2)=16.561,P<0.001)和尿蛋白(χ^(2)=59.672,P<0.001)阳性率高于NDN组。Logistic回归分析结果显示,女性(OR=0.303,95%CI为0.158~0.581,P<0.001)、高血压患者(OR=0.505,95%CI为0.319~0.798,P=0.003)、尿糖(OR=0.546,95%CI为0.319~0.933,P=0.027)和尿蛋白(OR=0.066,95%CI为0.034~0.130,P<0.001)阳性者、高龄(OR=1.049,95%CI为1.014~1.086,P=0.006)、血肌酐(OR=1.031,95%CI为1.005~1.058,P=0.017)和肾小球滤过率(eGFR,OR=1.043,95%CI为1.008~1.080,P=0.016)水平较高患者有更高的尿白蛋白水平;高龄(OR=1.046,95%CI为1.017~1.075,P=0.001)、女性(OR=2.402,95%CI为1.382~4.173,P=0.002)、高血压病史(OR=1.751,95%CI为1.081~2.837,P=0.023)、尿糖(OR=2.216,95%CI为1.202~4.085,P=0.011)和尿蛋白(OR=11.335,95%CI为4.952~25.943,P<0.001)阳性与DN的发生相关。结论苏州高新区狮山街道社区卫生服务中心T2DM患者DN的患病率较高,女性、高龄、高血压病史、尿糖和尿蛋白阳性是DN发生的可能危险因素。

Objective To investigate the prevalence and possible risk factors of diabetic nephropathy(DN)in type 2diabetes mellitus(T2DM)patients.Methods Totally 453T2DM patients who conducted DN screening were selected between December 25,2020to December 25,2021in the Healthcare Center for Shishan Street Community.The patients were divided into the non-diabetic nephropathy group(NDN group)and the diabetic nephropathy group(DN group).The basic information and laboratory testing indicators of the two groups were compared,and the possible risk factors of DN were analyzed by logistic regression analysis.Results In this study,the prevalence of DN was 47.7%(216/453).The DN group had older age(t=-5.443,P<0.001)and longer disease duration(t=-4.333,P<0.001)than the NDN group,and the levels of fasting C-peptide(t=-2.822,P=0.005),blood glucose(t=-4.816,P<0.001),hemoglobin A1c(HbA1c)(t=-3.654,P<0.001),triglyceride (TG)(t=-2.344,P=0.020),serum creatinine (t=-3.010,P=0.003),blood urea(t=-3.576,P<0.001)and lactic dehydrogenase(LDH)(t=-3.019,P=0.003)were also higher than the NDN group.The proportion of female(χ^(2)=6.703,P=0.010)in the DN group was significantly higher than that in NDN group.Compared with the NDN group,the DN group had higher prevalence of hypertension(χ^(2)=23.618,P<0.001)and insulin utilization rate(χ^(2)=6.308,P=0.012),and lower satisfaction rate of blood glucose control(χ^(2)=25.386,P<0.001).The positive rates of urine glucose(χ^(2)=16.561,P<0.001)and protein(χ^(2)=59.672,P<0.001)in the DN group were significantly higher than the NDN group.Logistic regression analysis results showed that female(OR=0.303,95%CI:0.158-0.581,P<0.001),hypertension patients(OR=0.505,95%CI:0.319-0.798,P=0.003),patients with positive urine glucose(OR=0.546,95%CI:0.319-0.933,P=0.027)and urine protein(OR=0.066,95%CI:0.034-0.130,P<0.001),elderly patients(OR=1.049,95%CI:1.014-1.086,P=0.006),and patients with higher serum creatinine(OR=1.031,95%CI:1.005-1.058,P=0.017)and glomerular filtration rate(eGFR)(OR=1.043,95%CI:1.008-1.080,P=0.016)levels had higher urinary albumin levels.Old age(OR=1.046,95%CI:1.017-1.075,P=0.001),female(OR=2.402,95%CI:1.382-4.173,P=0.002),history of hypertension(OR=1.751,95%CI:1.081-2.837,P=0.023),positive urine glucose(OR=2.216,95%CI:1.202-4.085,P=0.011)and urine protein (OR=11.335,95%CI:4.952-25.943,P<0.001)were associated with DN.Conclusions High rate of prevalence for DN in T2DM patients was shown in the the Healthcare Center For Shishan Street Community.Female subjects,old age,history of hypertension,positive urine glucose and urine protein were possible risk factors for DN.