2型糖尿病住院患者糖尿病肾脏疾病的发生率及危险因素分析

摘要

目的:分析2型糖尿病住院患者的糖尿病肾脏疾病(DKD)的发生率及危险因素,为临床糖尿病肾脏疾病的防治工作提供理论依据.方法:对2008年1月～2010年8月在上海交通大学附属第六人民医院内分泌代谢科住院的2型糖尿病患者测定血糖、肾功能、血脂谱、24 h尿白蛋白等.应用简化肾脏病膳食改良试验(MDRD)公式计算肾小球滤过率(GFRMDRD).所有患者均由眼科医生进行眼底摄片.按2007年美国肾脏病基金会(NKF)的糖尿病和慢性肾脏疾病的临床诊断治疗指南,将研究人群分为正常组(NCKD)、非糖尿病性肾脏疾病(NDRD)组及DKD组.结果:(1)共入选患者2 225例,男1 184例,女1 041例;平均年龄为(60.5±11.7)岁.本研究人群中,DKD的发生率为15.4%,NDRD的发生率为18.5%.(2)DKD组患者的年龄、糖尿病病程、收缩压、血肌酐、总胆固醇(TC)、低密度胆固醇水平(LDL-C)、24 h尿白蛋白量均显著高于NDRD组(P<0.05).(3)Logistic 回归分析显示:糖尿病病程(OR=1.077,95%CI为1.059～1.096,P<0.01)、收缩压(OR=1.039,95%CI为1.032～1.047,P<0.01)、糖化血红蛋白(OR=1.092,95%CI为1.032～1.156,P<0.01)、TC(OR=1.171,95%CI为1.050～1.306,P<0.01)、HDL-C(OR=0.558,95%CI为0.369～0.844,P<0.01)是DKD发生的独立危险因素.结论:为有效地延缓2型糖尿病肾脏病变的发生及发展,临床工作中要严格控制血压、血糖、血脂.%Objective: Objective To analyze the prevalence and risk factors of diabetic kidney disease( DKD ) in hospitalized type 2 diabetic patients and to provide more theoretical evidences for prevention and treatment of diabetic kidney disease. Methods: A total of 2 225 type 2 diabetic patients hospitalized in the department of endocrinology and metabolism in our hospital from January 2008 to August 2010 were enrolled. The blood glucose, kidney function, lipid profile, 24 hour urinary albumin were measured in all the subjects. Glomerular filtration rate ( GFR ) was estimated by modified MDRD equation. Fundus photography was performed in all the patients by ophthalmologist. According to the clinical diagnosis and treatment guideline for diabetic kidney disease of national kidney foundation ( NKF ), 2007, the study population was divided into three groups: non - chronic kidney disease group ( NCKD ), non -diabetic renal disease group ( NDRD ) and diabetic kidney disease group ( DKD ). Results:( 1 )A11 the 2 225 subjects included 1 184 men and 1 041 women with mean age 60. 5 ±11.7 years. The prevalence of DKD and NDRD is 15. 4% and 18. 5% in this study population, respectively.( 2 )The age, diabetes duration, systolic blood pressure, serum creatinine, total cholesterol ( TC ), low density lipoprotein cholesterol ( LDL - C ) ,24 hour urinary albmin of DKD group was significantly higher than NDRD group ( P < 0.05 ). ( 3 ) Logistic regression analysis demonstrated that diabetes duration ( OR = 1.077, 95% CI 1.059 ～1.09,P<0.01 ), systolic blood pressure (OR = 1.039, 95% CI 1.032～1.047, P<0.01 ), hemoglobin Ale ( OR = 1.092, 95% CI 1.032 ～ 1. 156, P<0.01 ),TC( OR = 1.171,95% CI 1.050-1. 306, P<0.01), HDL - C ( OR =0. 558, 95% CI 0. 369 ～0. 844, P <0. 01 ) were independent risk factors for DKD. Conclusion:It is necessary to control blood pressure, blood glucose, lipid level intensively in clinical work to delay the onset and progress of type 2 diabetic kidney disease.