糖尿病肾病患者胎孕期岁运特点的临床研究

【作者】 叶正华；

【导师】 柳红芳；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2012， 硕士

【摘要】 [目的]通过对现存病例的数据挖掘,试图整理出在特定的岁运年份里出生的糖尿病患者与其并发症糖尿病肾病之间的联系,为中医疾病的预防和治疗提供理论依据,为优生学提供理论补充,临床上可以进一步指导疾病治疗。[方法]收集2000年1月1日至2012年2月29日北京中医药大学附属东直门医院肾病内分泌科住院病人病例共436份,其中2型糖尿病合并糖尿病肾病共277例,未合并糖尿病肾病的一般2型糖尿病患者159例,收集其相应的一般人口学资料,包括姓名,性别,年龄,出生日期等,以及相应的一些理化指标,包括糖尿病肾病分期、合并其他基础疾病情况、尿微量白蛋白、24h尿蛋白定量、血肌酐、血尿素氮、血浆白蛋白、糖化血红蛋白等,通过回顾性统计分析收集资料指标,总结岁运与2型糖尿病肾病发病倾向之间的联系。[结果]收集的436例患者中,糖尿病肾病组与非糖尿病肾病组均是男性所占比例比女性所占比例偏大,但性别分布经x2检验,X2=0.7827,P=0.3763>0.05,故两组性别分布差异无统计学意义,即两组在性别分布上无显著差异。糖尿病肾病组中,老年人(≥60)病例共159例,比例为57.4%,中青年人病例(<60)共118例,比例为42.6%,非糖尿病肾病组中,老年人(≥60)病例共66例,比例为41.5%,中青年病例(<60)共93例,比例为58.5%,年龄分布经x2检验,X2=10.2145,P=0.0014<0.05,故两组年龄分布差异有统计学意义,即两组在年龄分布上有显著差异,即老年人或者年龄大于等于60岁是并发糖尿病肾病的危险因素之一糖尿病肾病组中,病程在1年及1年以下的患者占多数,共有164,所占比例为59.2%,病程在1年到5年之间的共有94例,占33.9%,病程5年以上的有19例,占6.9%,说明病程1年以内的包括1年的占绝大多数。糖尿病肾病组患者中,岁运为水运不足、土运不足的患者所占比例较其他组都高,分别为13.7%(38例),11.6%(32例),最小的为火运太过和金运不足,均为8.3%,说明糖尿病肾病中水运不足、土运不足患者分布较多,而非糖尿病肾病组中,岁运为水运太过的患者所占比例较其他组都高,为13.8%,最少的为土运不足5.7%。但岁运分布经x2检验,X2=14.4836,P=0.1061>0.05,故两组岁运分布差异无统计学意义,即两组在岁运分布上无显著差异,即目前还不能认为两组在岁运构成比分布上不等。糖尿病肾病组患者中,Ⅲ期患者共有105例,占37.9%,Ⅳ期患者共有110例,占39.7%,V期患者共有61例,占22.4%,说明糖尿病肾病Ⅳ期构成比较其他期大。糖尿病肾病组中合并高血压患者共有243例,占87.7%,非糖尿病肾病组患者中,合并高血压患者共84例,占52.8%,合并高血压情况采用x2检验,X2=65.6034,P=0.0001<0.05,故两组合并高血压情况分布差异有统计学意义,即两组在合并高血压构成比的分布上存在显著差异,即合并高血压是并发糖尿病肾病的危险因素之一糖尿病肾病组患者中,合并冠心病的患者共有161例,占58.1%,非糖尿病肾病组中,合并冠心病患者68例,占42.8%,合并冠心病情况采用x2检验,X2=9.5517,P=0.002<0.05,故两组合并冠心病情况分布差异有统计学意义,即两组在合并冠心病构成比分布上存在显著差异,即合并冠心病是并发糖尿病肾病的危险因素之一糖尿病肾病组患者中,合并脑血管病患者共有79例,占28.5%,非糖尿病肾病组患者中,合并脑血管病患者共有41例,占25.8%,合并脑血管病情况采用x2检验,X2=0.3784,P=0.5384>0.05,故两组合并脑血管病情况分布差异无统计学意义,即目前还不能认为两组在合并脑血管病构成比分布上不等,即合并脑血管病目前还不能认为是并发糖尿病肾病的危险因素之一。糖尿病肾病组患者中,合并血脂异常患者共有188例,占67.9%,非糖尿病肾病组中,合并血脂异常患者共88例,占55.3%,合并血脂异常情况采用x2检验,X2=6.8207,P=0.009<0.05,故两组合并血脂异常情况分布差异有统计学意义,即两组在合并血脂异常构成比分布上存在显著差异,即血脂异常是并发糖尿病肾病的危险因素之一[结论]通过分析数据,在前人的基础上进一步论证了合并高血压、冠心病、血脂异常、老年人(年龄大于等于60岁)是并发糖尿病肾病的危险因素,在各个合并症中,他们的构成比差异是有显著性的。性别构成比无明显差异,岁运当中,水运不足、土运不足糖尿病患者并发肾病的比率高于其他岁运组的,但是土运不足、水运不足的构成比例与其他组别之间的比例差异并不明显,说明五运中岁运的水运不足、土运不足目前还不能认为是糖尿病并发糖尿病肾病的危险因素。更多还原

【Abstract】 Objective:Through data of existing cases, trying to sort out in diabetic patients born in the year of specific-year-old transportation link between the complications of diabetic nephropathy in the future, to provide a theoretical basis for disease prevention and treatment of TCM, eugenics provided a theoretical complement to the clinical treatment of disease can be further guidance.Methods:Collected a total of436of the January1,2000to February2012,28, Affiliated Dongzhimen Hospital of Beijing University of Chinese Medicine nephropathy Endocrinology, inpatient cases. Among them,277cases of type2diabetes with diabetic nephropathy,159cases of type2diabetic patients without diabetic nephropathy, to collect general demographic data, including name, gender, age, date of birth, as well as some physical and chemical indicators, including diabetic nephropathy stage, combined with other underlying diseases of the urinary albumin24h urinary protein excretion, serum creatinine, blood urea nitrogen, serum albumin, glycated hemoglobin, retrospective statistical analysis of the collection of data indicators through statistical analysis, summarize the link between the tendency to years old shipped with type2diabetes, and to explore type2diabetic nephropathy-year-old transport between the groups in the distribution of various physical and chemical.Results:Collected436cases of patients with diabetic nephropathy and non-diabetic nephropathy are male proportion than women, the proportion is too large, but the gender distribution by x2test,X2=0.7827, P=.3763>0.05, so the two gender distribution of the difference was not statistically significant, no significant difference between the two groups in gender distribut ion.Diabetic nephropathy in the elderly (≥60) cases of a total of159cases, the ratio was57.4%, cases of young people (<60) for a total of118cases,42.6%in non-diabetic nephropathy, the elderly (≥60) cases of a total, of66cases, the ratio was41.5%, a total of93cases of young patients (<60),58.5%, the age distribution of the X2test, X2=10.2145, P=0.0014<0.05, so the two groups the age distribution of the difference was statistically significance, namely, the two groups in age distribution, there are significant differences in the elderly or older than60years of age is one of the risk factors of diabetic nephropathy.Diabetic nephropathy in the course of patients in1year and less than1year the majority of164, the proportion was59.2%, the duration of one year to five years,94cases (33.9%), duration of more than5years19cases, accounting for6.9%, including1-year duration of less than1year accounted for the vast majority.In patients with diabetic nephropathy, Yun of insufficient water, Yun of insufficient soil, the two proportion of patients are higher than other groups, respectively,13.1%(38cases),11.6%(32cases), the smallest overmuch fire Yun and insufficient gold Yun, are8.3%, indicating the lack of water Yun in diabetic nephropathy, the lack of soil Yun patients were more rather than the others. In the non-diabetic nephropathy group. The proportion of patients at the overmuch water Yun compared to other groups is high,13.8%, a minimum of Yun of insufficient soil,less than5.7%. The distribution of Yun of the year is test by the x2test, X2=14.4836, P=0.1061>0.05, therefore, no significant distribution difference of two sets of Yun of the year, the two groups in the distribution of Yun of the year was no significant difference, and currently it can not be considered that the distribution of Yun of the year is unequal in the diabetic nephropathy group and non-diabetic nephropathy group.Diabetic nephropathy patients. Ⅲ in patients with a total of105cases, accounting for37.9%, Ⅳ in patients with a total of110cases, accounting for39.7%, the V patients with a total of61cases, accounting for22.4%indicating that the diabetic nephropathy IV constitute compared with the other of.The group of diabetic nephropathy in hypertensive patients with a total of243cases, accounting for87.7%, non-diabetic nephropathy patients, patients with hypertension and84cases, accounting for52.8%, hypertension circumstances X2test, X2=65.6034, P=0.0001<0.05, so the two groups of hypertension The distribution of the difference was statistically significant, groups with hypertension constitute a significant difference in the distribution ratio, ie, hypertension is a risk factor for diabetic nephropathy.Patients with diabetic nephropathy, coronary heart disease patients with161. cases, accounting for58.1%, non-diabetic nephropathy, coronary heart disease91cases (57.2%), coronary heart disease the situation using the X2test, X2 =9.5517, P=0.002<0.05, so the two groups with coronary heart disease and distribution of the difference was statistically significant, two groups of coronary heart disease than there were significant differences on the distribution, ie, coronary heart disease is a risk factor for diabetic nephropathy.Pat ients wi th cerebrovascular disease in pat ients wi th diabet ic nephropathy, unconsolidated total of198cases, accounting for71.5%, non-diabetic nephropathy patients, patients with cerebrovascular disease unconsolidated total of118cases, accounting for74.2%, combined cerebrovascular disease situation using the X2test, x2=0.3784, P=0.5384>0.05, so the two groups with cerebral vascular disease situation distribution was no significant difference, that the current can not be considered to constitute unequal than the distribution, the two groups in the combined cerebrovascular disease, namely coronary heart disease is still can not be considered to be one of the risk factors of diabetic nephropathy.Patients with diabet ic nephropathy, unconsol idated dyslipidemia in patients with a total of165cases, accounting for56.7%in non-diabetic nephropathy in pat ients with dyslipidemia,88cases (55.3%), dyslipidemia using the x2test, X2=6.8207, P=0.009<0.05, so the two groups with dyslipidemia distribution difference was statistically significant, groups with dysl ipidemia constitute significantly different than the distribution of dyslipidemia is one of the risk factors for diabetic nephropathy. Conclusion:By analyzing the data mining in the former on the basis of further argument with hypertension, coronary heart disease, dyslipidemia risk factors for diabetic nephropathy in various complications, the difference is significant.-Year-old transported among water transport, soil transported less than diabetic patients with nephropathy patients is higher than the other-year-old transport groups, but the lack of soil transported, the ratio between the difference in the waterway less than the proportion of the composition with other groups and no significant difference water transport of the five movements-year-old transportation and soil transport can not be considered risk factors for diabetes complicated by diabetic nephropathy.更多还原