【作者】 郑金亮；

【导师】 孙丽荣； 聂秀玲； 李明珍；

【作者基本信息】 天津医科大学 ， 内科学， 2010， 硕士

【摘要】 目的：调查天津市住院2型糖尿病(type 2 diabetes mellitus, T2DM)患者1991～2000年与2001～2008年间慢性并发症的患病率及相关危险因素。方法：以2001年中华医学会糖尿病学分会组织的全国住院糖尿病患者慢性并发症(10年)回顾性调查制订的抽样方法为依据,随机抽取天津医科大学代谢病医院和天津市第三医院内分泌科(1991～2008年)住院的T2DM患者2223名,收集相关的临床资料并将其分为1991～2000年(A组)和2001～2008年(B组)两个时间段,调查①1991～2008年间住院T2DM患者慢性并发症的患病率,其中A组病例代表天津市参加了2001年全国住院糖尿病患者慢性并发症10年回顾性调查,B组病例是根据上述调查收集的上两所医院的住院T2DM患者的资料：②比较A组和同期全国抽样调查的住院T2DM患者慢性并发症的患病率；③比较A组和B组慢性并发症的患病率；④分析A组和B组慢性并发症的相关危险因素：⑤所有数据用SPSS13.0软件处理,用Logistic回归模型做多因素筛选。结果：1、一般资料：①所有研究对象：2223例(男／女=1146／1077)、年龄(59.0±11.8)岁、病程(8.4±7.0)年；其中A组893例(男／女=436／457)、年龄(60.3±11.8)岁、病程(8.3±7.0)年,B组1330例(男／女=710／620)、年龄(58.2±11.7)岁、病程(8.4±6.9)年；②全组中,糖尿病家族史阳性者占41.5%(A组33.5%、B组46.9%,P<0.05),有吸烟史者占36.3%(A组29.5%、B组41.0%,P<0.05),合并肥胖(BMI≥28kg／m2)者占19.0%(A组13.0%、B组23.0%,P<0.05),患高血压病者占59.0%(A组54.8%、B组61.9%,P<0.05),血脂异常的患者占71.8%(A组70.1%、B组78.7%,P<0.05)。2、住院T2DM患者慢性并发症的患病率：①全组资料：脑血管并发症19.6%,心血管并发症70.9%,下肢血管并发症14.2%,眼部并发症41.3%,肾脏并发症48.9%,周围神经病变61.7%；②A组与全国同期的比较：脑血管并发症20.5% vs13.2%(P<0.05),心血管并发症59.8% vs.17.1%(P<0.05),下肢血管并发症16.3% vs.5.2%(P<0.05),眼部并发症39.3% vs.35.7%(P<0.05),肾脏并发症54.4% vs.34.7%(P<0.05),周围神经病变63.8% vs 60.7%(P>0.05)；③A组和B组的比较：脑血管并发症20.5% vs.19.0%(P>0.05),心血管并发症59.8%vs.78.4%(P<0.05),下肢血管并发症16.3% vs.12.7%(P<0.05),眼部并发症39.3% vs.42.6%(P>0.05),。肾脏并发症54.4% vs.45.1%(P<0.05),周围神经病变63.8% vs.60.2%(P>0.05)。3、住院T2DM患者各种慢性并发症的相关危险因素分析：①年龄和病程是住院T2DM患者各种慢性并发症共同的危险因素；②高血压几乎是住院T2DM患者所有慢性并发症的危险因素,尤其是收缩压(除周围神经病变和A组下肢血管并发症外),而舒张压是脑血管、肾脏并发症和B组心血管并发症的危险因素。③血脂异常是A组周围神经病变和B组脑血管、下肢血管及肾脏并发症的危险因素；④体质指数是心血管并发症、视网膜病变和B组下肢血管及肾脏并发症的危险因素；⑤糖化血红蛋白A1c仅是B组脑血管并发症和周围神经病变的危险因素；⑥性别中,男性是A组脑血管并发症的危险因素,而女性为A组心血管并发症和B组视网膜病变和周围神经病变的危险因素；⑦阳性糖尿病家族史是视网膜病变和A组周围神经病变的危险因素。4、本组资料中,全部住院T2DM患者至少有1种慢性并发症的患者占94.8%,有3种或3种以上慢性并发症者占60.3%,无慢性并发症患者仅占5.2%。结论：1、天津市住院T2DM患者慢性并发症的患病率：①1991～2000年间高于全国同期水平；②与1991～2000年间相比,2001～2008年间总体上呈降低趋势,但是无症状性心肌缺血和间歇性跛行的患病率较前升高,应予以重视。2、年龄、病程和阳性糖尿病家族史是与天津市住院T2DM患者慢性并发症相关的不可控的危险因素,而高血压、血脂异常、高血糖及不健康的生活方式(肥胖、吸烟等)是其可改变的危险因素。对此,我们应加强对T2DM患者的健康教育,并常规对其进行慢性并发症及相关危险因素的筛查和评估,争取早期发现、早期诊断、早期治疗,以预防或延缓T2DM患者慢性并发症的发生、发展。更多还原

【Abstract】 Objective:To survey the prevalence of its chronic complications and associated risk factors between 1991 and 2000 and between 2001 and 2008 in hospitalized patients with type 2 diabetes in Tianjin.Methods:To retrospectively analyze the clinical and laboratory data of 2223 type 2 diabetic inpatients in the Affiliated Metabolic Diseases Hospital of Tianjin Medical University and the Endocrinology Department of the Third Hospital in Tianjin during Jan 1 1991 to Dec 31 2008. Data were collected according to the unified strategy in the programme of the 10-year retrospective analysis of diabetic chronic complications in Chinese diabetic inpatients launched by Chinese Diabetes Society, Chinese Medical Association in 2001. We investigated and analyzed the prevalence of cerebro-vascular diseases, cardiovascular diseases, lower extremity vascular diseases, eye diseases, nephropathy, neuropathy and their risk factors, and the change of risk factors between group A(1991-2000) and group B(2001-2008). Multivariate logistic regression model was used to identify independent risk factors for related chronic complications. All data was stored and processed by using SPSS software vesrionl3.0. P values<0.05 were considered statistically significant.Results:1. To study 1146 men and 1077 women with type 2 diabetes, mean age (59.0±11.8) years, mean duration (8.4±7.0) years (436 men and 457 women of group A, mean age 60.3±11.8 years, mean duration 8.3±7.0 years; 710 men and 620 women of group B, mean age 58.2±11.7 years, mean duration 8.4±6.9 years); 41.5% of subjects had a family history of diabetes, in which 33.5% of A and 46.9% of B(P< 0.05); 36.3% had a history of smoking (29.5% of A and 41.0% of B)(P<0.05); obesity(BMI≥28kg/m2)19.0%(13.0% of A and 23.0% of B)(P<0.05); hypertension 59.0%(54.8% of A and 54.8% of B)(P<0.05); dyslipidemia 71.8% (70.1% of A group and 70.1% of B group, P<0.05).2. The prevalence of chronic complications of inpatients with type 2 diabetes:① all inpatients:cerebrovascular complications 19.6%, cardiovascular complications 70.9%, lower extremity vascular complications 14.2%, diabetic retinopathy 41.3%, diabetic nephropathy 48.9%, diabetic neuropathy 61.7%;②compare group A with the group of the contemporary national survey:cerebrovascular complications in 20.5% vs.13.2%(P<0.05), cardiovascular complications in 59.8% vs.17.1%(P<0.05), lower extremity vascular complications in 16.3% vs.5.2%(P<0.05), diabetic retinopathy of 39.3% vs.35.7%(P<0.05), diabetic nephropathy 54.4% vs.34.7%(P<0.05), diabetic neuropathy 63.8% vs.60.7%(P>0.05);③compare group A with the group B:cerebro-vascular complications 20.5% vs.19.0%(P>0.05), cardiovascular complications 59.8% vs.78.4%(P<0.05), lower extremity vascular complications 16.3% vs.12.7% (P<0.05), diabetic retinopathy 39.3% vs.42.6%(P>0.05), diabetic nephropathy 54.4% vs.45.1%(P<0.05), diabetic neuropathy 63.8% vs.60.2%(P>0.05).3. The related risk factors of chronic complications in hospitalized patients with type 2 diabetes:①Age and duration were the common risk factors of the chronic complications of inpatients with type 2 diabetes.②Except peripheral neuropathy and lower extremity vascular complications of group A, hypertension is the risk factor of other chronic complications in hospitalized patients with type 2 diabetes; in particular, systolic blood pressure is their common risk factor, and diastolic blood pressure is risk factor of cerebrovascular complications, diabetic nephropathy and cardiovascular complications of group B.③Dyslipidemia is the risk factor of peripheral neuropathy of group A and cerebrovascular complications, lower extremity vascular complicati-ons and diabetic nephropathy of group B.④Body mass index is the risk factor of cardiovascular complication, retinopathy and lower extremity vascular complications, diabetic nephropathy of group B.⑤Glycated hemoglobin Ale is the risk factor of cerebrovascular complication and peripheral neuropathy of group B.⑥Man is the risk factor of cerebrovascular complications of group A, while woman is the risk factor of cardiovascular complications of group A and retinopathy and peripheral neuropathy of group B.⑦Diabetic family history is the risk factor of retinopathy and peripheral neuropathy of group A.4. All patients, about 95% inpatients with type 2 diabetes at least had one kind of chronic complication; more than 60% of patients had more than 3 chronic complications; only 5.2% of patients had no complication.Conclusion:1. The prevalence of chronic complications of inpatients with type 2 diabetes in Tianjin:①The prevalence in 90s years was more than the national level;②compared the years 1991 to 2000 with the years 2001 to 2008, it showed a general decreasing trend, but the prevalence of the silent myocardial ischemia and intermittent claudication increased, which should be paid attention to.2. Age, the duration and the positive family history of type 2 diabetes were the uncontrolled risk factors of chronic complications of inpatients with type 2 diabetes in Tianjin. Hypertension, dyslipidemia, hyperglycemia and unhealthy lifestyle (obesity, smoking, etc.) were the controlled risk factors. In this regard, we should pay attention to the health education on inpatients with type 2 diabetes, and screen and assess their risk factors associated with chronic complications conventionally for early detection, early diagnosis and early treatment, and prevent or delay the occurrence and development of the chronic complications of patients with type 2 diabetes.更多还原