2型糖尿病患者微血管并发症的影响因素分析

Factors affecting microvascular complications among patients with type 2 diabetes mellitus

目的 了解2型糖尿病(T2DM)患者微血管并发症(DMAP)的影响因素,为DMAP防治提供依据。方法 选取2021年1月—2022年1月山东省潍坊市某三甲医院内分泌科住院治疗的T2DM患者为研究对象,采用问卷收集患者基本信息、生活方式和疾病史等资料;实验室检测空腹胰岛素、空腹血糖和糖化血红蛋白等指标;采用多因素logistic回归模型和决策树模型分析T2DM患者并发DMAP的影响因素。结果 纳入T2DM患者1 003例,其中男性515例,占51.35%;女性488例,占48.65%。DMAP患者403例,患病率为40.18%。多因素logistic回归结果显示,年龄≥60岁(OR=2.510,95%CI:1.441~4.374)、T2DM病程≥10年(OR=3.205,95%CI:2.242~4.581)、空腹胰岛素<3.21μIU/mL(OR=1.749,95%CI:1.239~2.469)、使用药物或胰岛素控制血糖(OR=1.880,95%CI:1.143~3.092)、糖化血红蛋白≥7%(OR=1.751,95%CI:1.172~2.615)是T2DM患者发生DMAP的影响因素。决策树分析结果显示,T2DM病程是DMAP的主要影响因素,病程≥10年且空腹胰岛素<3.21或≥16.32μIU/mL患者的DMAP患病率为70.22%,病程5~<10年且年龄≥60岁患者的DMAP患病率为44.23%,病程<5年且空腹胰岛素<3.21μIU/mL患者的DMAP患病率为43.10%。结论 60岁及以上、T2DM病程长、空腹胰岛素低和糖化血红蛋白高增加T2DM患者DMAP风险。

Objective To identify the factors affecting microvascular complications among patients with type 2 diabetes(T2DM),so as to provide insights into the management of microvascular complications of T2DM.Methods T2DM pa-tients hospitalized in the Department of Endocrinology of a tertiary hospital in Weifang City,Shandong Province from January 2021 to January 2022 were enrolled,and subjects'basic information,lifestyle and medical history were collect-ed using questionnaire surveys.Fasting insulin,fasting blood glucose and glycated hemoglobin were measured,and fac-tors affecting microvascular complications were identified among T2DM patients using a multivariable logistic regression model and a decision tree model.Results Totally 1003 T2DM inpatients were enrolled,including 515 men(51.35%)and 488 women(48.65%),and the prevalence of microvascular complications was 40.18%.Multivariable logistic regres-sion analysis showed that age of 60 years and older(OR=2.510,95%CI:1.441-4.374),T2DM duration of 10 years and longer(OR=3.205,95%CI:2.242-4.581),fasting insulin of lower than 3.21μIU/mL(OR=1.749,95%CI:1.239-2.469),using of agents or insulin to control blood glucose(OR=1.880,95%CI:1.143-3.092),glycated hemoglobin level of 7%and higher(OR=1.751,95%CI:1.172-2.615)as factors affecting microvascular complications among T2DM patients.Deci-sion tree analysis identified course of T2DM as a major factor affecting the risk of microvascular complications among T2DM patients,and the prevalence of microvascular complications was 70.22%among T2DM patients with disease course of 10 years and longer and fasting insulin of lower than 3.21μIU/mL or 16.32μIU/mL and higher,44.23%among T2DM patients with disease course of 5 to 10 years and at ages of 60 years and older,and 43.10%among T2DM patients with disease course of less than 5 years and fasting insulin of lower than 3.21μIU/mL.Conclusion Advanced age,long course of T2DM,low fasting insulin and high glycated hemoglobin may increase the risk of micro-vascular complications among T2DM patients.