老年糖尿病患者微血管并发症的患病率及危险因素

Prevalence of microvascular complications in elderly patients with diabetes mellitus and related risk factors

目的探讨老年糖尿病患者微血管并发症的患病率,并分析发生微血管病变的危险因素。方法回顾性分析北京协和医院2020年1月至2022年12月收治的495例老年糖尿病患者的临床资料,收集患者基线资料和生化指标,统计糖尿病视网膜病变、糖尿病肾病、周围神经病变等微血管并发症的患病率。根据微血管并发症的类型将患者分为4组:糖尿病视网膜病变组(n=107)、糖尿病肾病组(n=81)、周围神经病变组(n=169)及非并发症组(n=138)。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用方差分析或χ^(2)检验进行组间比较。采用多因素logistic回归分析糖尿病微血管病变发生的危险因素。结果495例老年糖尿病患者中共357例发生微血管并发症,总患病率为72.12%,其中糖尿病视网膜病变占21.62%(107/495),糖尿病肾病占16.36%(81/495),周围神经病变占34.14%(169/495)。与非并发症组患者比较,糖尿病视网膜病变组患者糖尿病病程更长,收缩压(SBP)和糖化血红蛋白(HbA1c)水平更高,低密度脂蛋白胆固醇(LDL-C)水平较低;糖尿病肾病组患者糖尿病病程更长,甘油三酯(TG)和24 h尿白蛋白排泄率(UAER)更高;周围神经病变组患者SBP、舒张压(DBP)、HbA1c、总胆固醇(TC)和TG更高,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,糖尿病病程长(OR=3.013,95%CI 1.206~7.526;P=0.019)、高SBP(OR=2.445,95%CI 1.105~5.408;P=0.028)和高HbA1c(OR=3.093,95%CI 1.112~8.606;P=0.031)是并发糖尿病视网膜病变的独立危险因素;糖尿病病程长(OR=2.404,95%CI 1.185~4.877;P=0.016)、高TG(OR=2.654,95%CI 1.241~5.677;P=0.012)和高UAER(OR=3.432,95%CI 1.303~9.036;P=0.013)是并发糖尿病肾病的独立危险因素;高SBP(OR=2.020,95%CI 1.228~3.323;P=0.006)、高DBP(OR=2.560,95%CI 1.109~5.912;P=0.028)、高HbA1c(OR=2.382,95%CI 1.321~4.297;P=0.004)、高TC(OR=2.779,95%CI 1.057~7.303;P=0.039)和高TG(OR=2.266,95%CI 1.237~4.152;P=0.008)是并发周围神经病变的独立危险因素。结论老年糖尿病患者微血管并发症的患病率较高,糖尿病病程长及SBP、DBP、HbA1c、TC、TG、UAER高是微血管并发症的危险因素,临床需重视。

Objective To investigate the prevalence of microvascular complications in elderly patients with diabetes mellitus,and analyze the risk factors of microvascular diseases.Methods A retrospective analysis was conducted on the clinical data of 495 elderly diabetic patients admitted to Peking Union Medical College Hospital from January 2020 to December 2022.Their baseline information and biochemical indicators were collected,and the incidences of microvascular complications such as diabetic retinopathy,diabetic nephropathy and peripheral neuropathy were recorded.According to the type of microvascular complications,the patients were divided into diabetic retinopathy group(n=107),diabetic nephropathy group(n=81),peripheral neuropathy group(n=169)and non-complication group(n=138).SPSS statistics 22.0 was used for data analysis.Based on different data type,one-way ANOVA or Chi-squared test was employed for intergroup comparison.Multivariate logistic regression analysis was applied to determine the related risk factors leading to diabetes microvascular disease.Results Among the 495 elderly patients with diabetes mellitus,357 had microvascular complications,with a total prevalence rate of 72.12%,including 21.62%(107/495)of diabetes retinopathy,16.36%(81/495)of diabetes nephropathy,and 34.14%(169/495)of peripheral neuropathy.Compared with the patients of the non-complication group,those of the diabetic retinopathy group had a longer course of diabetes mellitus,higher systolic blood pressure(SBP)and glycosylated hemoglobin A1c(HbA1c),and lower low-density lipoprotein cholesterol(LDL-C)level;those of the diabetic nephropathy group had longer course of diabetes mellitus and higher TG and 24-hour urine albumin excretion rate(UAER);and those with peripheral neuropathy had higher levels of SBP,diastolic blood pressure(DBP),HbA1c,total cholesterol(TC)and triglyceride(TG)(all P<0.05).Multivariate logistic regression analysis showed that the long duration of diabetes mellitus(OR=3.013,95%CI 1.206-7.526;P=0.019),high SBP(OR=2.445,95%CI 1.105-5.408;P=0.028)and high HbA1c(OR=3.093,95%CI 1.112-8.606;P=0.031)were independent risk factors for diabetic retinopathy.Long duration of diabetes mellitus(OR=2.404,95%CI 1.185-4.877;P=0.016),high TG(OR=2.654,95%CI 1.241-5.677;P=0.012)and high UAER(OR=3.432,95%CI 1.303-9.036;P=0.013)were independent risk factors for diabetic nephropathy.High SBP(OR=2.020,95%CI 1.228-3.323;P=0.006),high DBP(OR=2.560,95%CI 1.109-5.912;P=0.028),high HbA1c(OR=2.382,95%CI 1.321-4.297;P=0.004),high TC(OR=2.779,95%CI 1.057-7.303;P=0.039)and high TG(OR=2.266,95%CI 1.237-4.152;P=0.008)were independent risk factors for peripheral neuropathy.Conclusion Elderly diabetes patients have a higher prevalence of microvascular complications.Long duration of diabetes mellitus,high SBP,DBP,HbA1c,TC,TG and UAER are risk factors for the aforementioned complications,and attention should be paid to these factors.