【作者】 谢玉秀；

【导师】 雷闽湘；

【作者基本信息】 中南大学 ， 临床医学， 2013， 博士

【摘要】 目的：了解中南大学湘雅医院内分泌科2011年及2012年两年期间住院的2型糖尿病(type2diabetes mellitus, T2DM)患者体重指数(body mass index, BMI)、血糖、血脂、血压指标达标情况及慢性并发症患病率情况,分析各相关慢性并发症的危险因素。方法：利用电脑系统查询2011年1月1日至2012年12月31日期间入住中南大学湘雅医院内分泌科的T2DM患者,将患者入院时年龄、性别、病程、BMI、收缩压(systolic blood pressure, SBP)、舒张压(diastolic blood pressure, DBP)、甘油三酯(triglyceride, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、糖化血红蛋白(glycosylated hemoglobin A1c, HbA1c)及糖尿病大血管病变、糖尿病微血管病变(糖尿病肾病、糖尿病视网膜病变)、糖尿病神经病变及糖尿病足的发生情况录入Excel表格中。将所录计量资料及计数资料输入SPSS19.0软件完成统计学分析,计数资料用百分率表示并采用χ2检验进行组间比较。计量资料χ±s用示。使用Logistic逐步回归分析筛选相关危险因素。结果：2011年BMI, HbA1c, SBP, DBP, TG, HDL-C, LDL-C达标率分别为50.39%、27.06%、25.10%、32.55%、65.10%、47.45%、48.23%,7项全部达标率为0.34%；2012年BMI, HbA1C, SBP, DBP, TG, HDL-C,LDL-C达标率分别为42.91%、25.84%、27.53%、34.12%、65.03%、62.84%、47.64%,7项全部达标率为0.98%。2011年糖尿病大血管病变、糖尿病肾病、糖尿病视网膜病变、糖尿病周围神经病变、糖尿病自主神经病变、糖尿病足的患病率分别为43.7%、47.3%、32.9%、74.5%、5.3%、7.5%；2012年上述并发症患病率依次为45.9%、44.3%、38.7%、78.5%、8.8%、9.1%。；糖尿病大血管病变危险因素为年龄、病程、SBP、HbAlc、LDL-C;糖尿病肾病危险因素为病程、SBP、 TG、HbAlc;糖尿病视网膜病变危险因素为病程、SBP、DBP、HbAlc;糖尿病周围神经病变危险因素为年龄、BMI、SBP?HbAlc;糖尿病自主神经病变危险因素为病程、BMI、DBP;糖尿病足相关危险因素为TG、BMI、HbAlc。随着病程的延长,各项生化指标控制率呈现逐渐降低趋势；而各慢性并发症的患病率及并发症出现的种数随着病程的延长及生化指标达标率的下降而增加。结论：2011年及2012年期间入住我院内分泌科的T2DM患者综合达标率低,且综合控制情况及慢性并发症患病率与病程相关。提示我们,对于DM患者,不应只是单纯的控制血糖或追求其他单个指标的控制,而应该注重在降糖、降压、降脂方面的综合治疗,将糖尿病防治指南落实到临床工作中。更多还原

【Abstract】 OBJECTIVE:We attempted to analyze the control status of biochemical indicators via investigating the inpatients with type2diabetes mellitus between2011to2012from the Endocrinology ward of Xiangya hospital. In the mean time, we evaluated the prevalence of different complications and their related risk factors in type2diabetic patients, thus we aimed to give a rational insight into the situation as well as provide an impetus for wider introduction of preventive approaches.Methods:1102T2DM inpatients from the Endocrinology ward of Xiangya Hospital in2011and2012were included in this study. The data was stored via Excel and processed by using SPSS software version19.0. We analyzed the control rate of BMI, hypertension (SBP, DBP), lipid profile(TG, HDL-C, LDL-C) and calculated the prevalence of the chronic complications. Also multiple Logistic stepwise regression analysis was used to dentify risk factors for these related chronic complications, P values<0.05were considered statistically significant.Results:The control rate of BMI, HbAlc, SBP, DBP, TG, HDL-C, LDL-C in2011was:50.39%,27.06%,25.10%,32.55%,65.10%,47.45%, 48.23%.0.34%of the respondents had a total control of these indexes. The rate of control of BMI, HbAlc, SBP, DBP, TQ HDL-C, LDL-C in2012was:42.91%,25.84%,27.53%,34.12%,65.03%,62.84%,47.64%.0.98%of the respondents had a total control of these indexes. The prevalence rate of chronic diabetic complications in2011was:43.7%for macrovascular diseases,47.3%for nephropathy,32.9%for retinopathy,74.5%for peripheral neuropathy,5.3%for autonomic neuropathy,7.5%for diabetic foot. The prevalence rate of chronic diabetic complications in2012was:45.9%for macrovascular diseases,44.3%for nephropathy,38.7%for retinopathy,78.5%for peripheral neuropathy,8.8%for autonomic neuropathy,9.1%for diabetic foot. The risk factors related to macrovascular diseases were age, duration of diabetes, SBP, HbA1c, LDL-C. The risk factors related to nephropathy were duration of diabetes, SBP, TG and HbA1c. The risk factors for retinopathy were duration of diabetes, SBP, DBP, HDL-C and HbA1c. The risk factors for peripheral neuropathy were age, BMI, SBP and HbA1c. The risk factors for autonomic neuropathy were duration of diabetes, BMI and DBP. The risk factors for diabetic foot were TG, BMI and HDL-C.Conclusions:The integrated control of type2diabetes is not ideal during2011and2012. The prevalence of chronic complications is high. There was no obvious improvement in control status during the two years. As the diabetes duration prolonged, the control rate of each biochemical index presented a downtrend. In the meanwhile, the prevalence of the chronic diabetic complications increased with the prolonged duration. The species of chronic complications also increased with the prolonging of duration. All the results suggested that we should strengthen the comprehensive treatment of diabetics via multiple drug combinations to slow down the occurrence and development of chronic complications.更多还原