摘要
目的 探讨糖尿病肾病（DN）的相关危险因素.方法 781例2型糖尿病住院患者根据尿白蛋白排泄率分为：单纯糖尿病组（475例）、早期DN组（188例）及临床DN组（118例）.收集患者的年龄、性别、病程等基本资料,检测血糖、HbA1c、血脂、尿酸、肾功能等,行24 h尿白蛋白排泄率测定、眼底照相、下肢动脉彩超等检查评估糖尿病慢性并发症.比较3组间的一般情况、生化指标及糖尿病慢性并发症情况,分析其与DN的相关性.结果 随DN进展,收缩压、糖尿病病程及尿酸水平呈递增趋势（P均＜0.05）;早期DN组和临床DN组体重指数、腰围大于单纯糖尿病组（P均＜0.05）;临床DN组舒张压、总胆固醇、低密度脂蛋白-胆固醇及纤维蛋白原高于单纯糖尿病组和早期DN组（P均＜0.05）;而血红蛋白、总胆红素及谷丙转氨酶低于单纯糖尿病组和早期DN组（P均＜0.05）;临床DN组HbA1c低于单纯糖尿病组（P＜0.05）.3组间血粘度、下肢动脉斑块、糖尿病视网膜病变（DR）差异有统计学意义（x2值分别为56.475、27.708、143.600,P均＜0.05）.DN病变程度与体重指数、腰围、糖尿病病程、收缩压、舒张压、总胆固醇、低密度脂蛋白-胆固醇、尿酸、纤维蛋白原、下肢动脉斑块、DR呈正相关（r=0.121 ～ 0.420,P均＜0.05）,与HbA1c、血红蛋白、总胆红素、谷丙转氨酶、血粘度呈负相关（r =-0.245-0.019,P均＜0.05）.DN的发生与尿酸[优势比（OR）=1.006,95％CI：1.003～1.008]、纤维蛋白原（OR=1.450,95％ CI：1.106～1.900）及DR（OR=3.994,95％ CI：2.612～6.108）独立相关（P均＜0.05）.结论 尿酸、纤维蛋白原及DR是2型糖尿病患者DN的独立危险因素.
Objective To investigate the related risk factors of diabetic nephropathy （DN）.Methods Seven hundred and eighty-one patients with T2DM were divided into three groups based on urine albumin excretion rate：simple diabetes mellitus group （n=475）,early DN group （n=188） and clinical DN group （n=118）.The basic characteristics such as age,gender,diabetes duration were collected.Blood glucose,HbA1c,blood lipids,uric acid and renal function were detected.Diabetic chronic complications were evaluated through 24 h urine albumin excretion rate detection,ocular fundus examination and ultrasonography in lower limb.Indicators were compared among the three groups and the correlations between DN and indicators were analyzed.Results With the progression of DN,systolic blood pressure,diabetic duration and uric acid increased significantly （all P〈0.05）.Body mass index（BMI） and waist circumstance in early DN group and clinical DN group were higher than those in simple diabetes mellitus group （all P〈0.05）.In clinical DN group,diastolic blood pressure,total cholesterol,low density lipoprotein cholesterol （LDL-C） and fibrinogen were higher,while hemoglobin,total bilirubin,alanine aminotransferase were lower than those in simple diabetes mellitus group and early DN group （all P 〈0.05）.HbA1c in clinical DN group was higher than that in simple diabetes mellitus group （P〈0.05）.Differences in blood viscosity,lower limb artery plaque and diabetic retinopathy （DR） were statistically significant among the three groups（x2=56.475,27.708,143.600,all P〈0.05）.The severity of DN was positively related to BMI,waist circumstance,diabetes duration,systolic blood pressure,diastolic blood pressure,total cholesterol,LDL-C,uric acid,fibrinogen,lower limb artery plaque and DR （r =0.121-0.420,all P〈 0.05）,while negatively related to HbA 1 c,hemoglobin,total bilirubin,alanine aminotransferase and blood viscosity（r =-0.245--0.019,all P〈0.05）.Uric acid[odd ratio（OR）=1.006,95% CI：1.003-1.008],fibrinogen （OR=1.450,95% CI：1.106-1.900） and DR （OR=3.994,95% CI：2.612-6.108）were independently related to the occurrence of DN（all P 〈0.05）.Conclusion Uric acid,fibrinogen and DR are independent risk factors of DN in patients with T2DM.
出处
《国际内分泌代谢杂志》
2015年第3期153-157,共5页
International Journal of Endocrinology and Metabolism
基金
天津市科技支撑计划重点项目，天津市卫生局科技基金
关键词
2型糖尿病
糖尿病肾病
尿白蛋白排泄率
危险因素
Type 2 diabetes mellitus
Diabetic nephropathy
Urinary albumin excretion rate
Risk factors
