CAJ | 학술논문

目的分析2型糖尿病周围神经病变(DPN)的危险因素,以期为临床治疗和预防指导提供依据.方法根据神经电生理检查等综合诊断将我院287例2型糖尿病患者分为DPN组和非DPN组.通过回顾病例、问卷调查等方式了解患者一般情况和病史资料,并测定体质量指数、血压、空腹血糖(FPG)、2h餐后血糖(2 hPG)、胰岛素、C肽、糖化血红蛋白(HbA1c)、血脂、胆固醇等临床指标.计算2型糖尿病人群中DPN的患病率,并对各因素进行t检验和x2检验和Logistic多因素回归分析.结果 287例2型糖尿病患者中,DPN患病率为39.4％ (113/287).DPN组年龄、病程、吸烟率明显高于非DPN组,而运动、学历和收入水平明显低于非DPN组(x2值分别为4.378、8.430、4.525、4.500、4.203、6.890,P＜0.05或P＜0.01).DPN组收缩压(137.52±16.10) mmHg、FPG(11.42±3.08) mmol/L、2hPG(18.70±4.61) mmol/L、HbA1c(10.21±2.50)％高于非DPN组收缩压(132.67±15.80) mmHg、FPG(9.96±3.76) mmol/L、2hPG(15.38±5.26) mmol/L、HbAlc (9.54±2.83)％,空腹胰岛素(13.52±4.92)mmol/L、2h胰岛素(36.20±17.52) mmol/L、空腹C肽(1.44±0.62) mmol/L、2 hC肽(3.89±3.01)mmol/L低于非DPN组空腹胰岛素(16.76±5.24) mmol/L、2h胰岛素(47.95±15.04) mmol/L、空腹C肽(1.83±0.57) mmol/L、2 hC肽(5.24±3.45) mmol/L(t值分别为2.512、3.592、5.635、2.105、5.312、5.863、5.372、3.502,P＜0.05或P＜0.001).多因素Logistic回归分析显示,糖尿病病程、HbA1c、2 hPG水平与DPN发生呈正相关,为DPN发生的独立危险因素[OR(95％CI)1.040(1.018 ～1.062),1.331(1.032～1.717),1.366(1.044～ 1.787),P均＜0.05],空腹胰岛素、空腹及餐后2 hC肽水平为DPN发生的独立保护因素[OR(95％ CI)0.803(0.725 ～0.889),0.923(0.731 ～0.954),0.863(0.801 ～0.930),P均＜0.05].结论 2型糖尿病患者中DPN的发生较为常见.糖尿病病程、HbA1c、2hPG为DPN发生的危险因素,空腹胰岛素、空腹及餐后2 hC肽越低越危险. 目的分析2型糖尿病週圍神經病變(DPN)的危險因素,以期為臨床治療和預防指導提供依據.方法根據神經電生理檢查等綜閤診斷將我院287例2型糖尿病患者分為DPN組和非DPN組.通過迴顧病例、問捲調查等方式瞭解患者一般情況和病史資料,併測定體質量指數、血壓、空腹血糖(FPG)、2h餐後血糖(2 hPG)、胰島素、C肽、糖化血紅蛋白(HbA1c)、血脂、膽固醇等臨床指標.計算2型糖尿病人群中DPN的患病率,併對各因素進行t檢驗和x2檢驗和Logistic多因素迴歸分析.結果 287例2型糖尿病患者中,DPN患病率為39.4％ (113/287).DPN組年齡、病程、吸煙率明顯高于非DPN組,而運動、學歷和收入水平明顯低于非DPN組(x2值分彆為4.378、8.430、4.525、4.500、4.203、6.890,P＜0.05或P＜0.01).DPN組收縮壓(137.52±16.10) mmHg、FPG(11.42±3.08) mmol/L、2hPG(18.70±4.61) mmol/L、HbA1c(10.21±2.50)％高于非DPN組收縮壓(132.67±15.80) mmHg、FPG(9.96±3.76) mmol/L、2hPG(15.38±5.26) mmol/L、HbAlc (9.54±2.83)％,空腹胰島素(13.52±4.92)mmol/L、2h胰島素(36.20±17.52) mmol/L、空腹C肽(1.44±0.62) mmol/L、2 hC肽(3.89±3.01)mmol/L低于非DPN組空腹胰島素(16.76±5.24) mmol/L、2h胰島素(47.95±15.04) mmol/L、空腹C肽(1.83±0.57) mmol/L、2 hC肽(5.24±3.45) mmol/L(t值分彆為2.512、3.592、5.635、2.105、5.312、5.863、5.372、3.502,P＜0.05或P＜0.001).多因素Logistic迴歸分析顯示,糖尿病病程、HbA1c、2 hPG水平與DPN髮生呈正相關,為DPN髮生的獨立危險因素[OR(95％CI)1.040(1.018 ～1.062),1.331(1.032～1.717),1.366(1.044～ 1.787),P均＜0.05],空腹胰島素、空腹及餐後2 hC肽水平為DPN髮生的獨立保護因素[OR(95％ CI)0.803(0.725 ～0.889),0.923(0.731 ～0.954),0.863(0.801 ～0.930),P均＜0.05].結論 2型糖尿病患者中DPN的髮生較為常見.糖尿病病程、HbA1c、2hPG為DPN髮生的危險因素,空腹胰島素、空腹及餐後2 hC肽越低越危險.
목적 분석2형당뇨병주위신경병변(DPN)적위험인소,이기위림상치료화예방지도제공의거.방법 근거신경전생리검사등종합진단장아원287례2형당뇨병환자분위DPN조화비DPN조.통과회고병례、문권조사등방식료해환자일반정황화병사자료,병측정체질량지수、혈압、공복혈당(FPG)、2h찬후혈당(2 hPG)、이도소、C태、당화혈홍단백(HbA1c)、혈지、담고순등림상지표.계산2형당뇨병인군중DPN적환병솔,병대각인소진행t검험화x2검험화Logistic다인소회귀분석.결과 287례2형당뇨병환자중,DPN환병솔위39.4％ (113/287).DPN조년령、병정、흡연솔명현고우비DPN조,이운동、학력화수입수평명현저우비DPN조(x2치분별위4.378、8.430、4.525、4.500、4.203、6.890,P＜0.05혹P＜0.01).DPN조수축압(137.52±16.10) mmHg、FPG(11.42±3.08) mmol/L、2hPG(18.70±4.61) mmol/L、HbA1c(10.21±2.50)％고우비DPN조수축압(132.67±15.80) mmHg、FPG(9.96±3.76) mmol/L、2hPG(15.38±5.26) mmol/L、HbAlc (9.54±2.83)％,공복이도소(13.52±4.92)mmol/L、2h이도소(36.20±17.52) mmol/L、공복C태(1.44±0.62) mmol/L、2 hC태(3.89±3.01)mmol/L저우비DPN조공복이도소(16.76±5.24) mmol/L、2h이도소(47.95±15.04) mmol/L、공복C태(1.83±0.57) mmol/L、2 hC태(5.24±3.45) mmol/L(t치분별위2.512、3.592、5.635、2.105、5.312、5.863、5.372、3.502,P＜0.05혹P＜0.001).다인소Logistic회귀분석현시,당뇨병병정、HbA1c、2 hPG수평여DPN발생정정상관,위DPN발생적독립위험인소[OR(95％CI)1.040(1.018 ～1.062),1.331(1.032～1.717),1.366(1.044～ 1.787),P균＜0.05],공복이도소、공복급찬후2 hC태수평위DPN발생적독립보호인소[OR(95％ CI)0.803(0.725 ～0.889),0.923(0.731 ～0.954),0.863(0.801 ～0.930),P균＜0.05].결론 2형당뇨병환자중DPN적발생교위상견.당뇨병병정、HbA1c、2hPG위DPN발생적위험인소,공복이도소、공복급찬후2 hC태월저월위험.
Objective To analyze the risk factors of type 2 diabetic peripheral neuropathy (DPN),in order to provide incidence for clinical treatment and prevention.Methods Two hundred and eighty-seven patients with type 2 diabetes were divided into DPN group(113 cases) and non-DPN group(174 cases)according to electrophysiological examination and diagnosis.The clinical information were collected including body mass index (BMI),blood pressure,fasting plasma glucose (FPG),2 h postprandial plasma glucose (2 h PG),fasting plasma insulin (FINS),C peptide,glycosylated hemoglobin (HbAl c),blood fat and cholesterin.The DPN prevalence in patients with type 2 diabetes was calculated,and t or x2 analysis and multivariate logistic regression analysis were applied.Results Among the 287 patients with type 2,the DPN prevalence was 39.4％ (113/287).The level of age,duration of diabetes and smoking in DPN group were significantly higher than those of non-DPN group,while exercise,income situation and educational background were significantly lower than those of non-DPN group (x2 =4.378,8.430,4.525,4.500,4.203,6.890,P ＜ 0.05 or ＜ 0.01).Systolic blood pressure((137.52 ± 16.10) mmHg),FPG ((11.42 ± 3.08) mmol/L),2 hPG ((18.70 ± 4.61) mmol/L),HbA1c ((10.21 ± 2.50)％) in DPN group were higher than those of non DPN group ((systolic pressure (132.67± 15.80) mmHg,FPG(9.96 ±3.76) mmol/L,2 hPG(15.38 ±5.26) mmol/L,HbA1c(9.54 ±2.83)％).In DPN group,Fasting insulin,2 h insulin,fasting C peptide were (13.52 ± 4.92) mmol/L,(36.20 ± 17.52) mmol/L,(1.44 ± 0.62) mmol/L,(3.89 ± 3.01) mmol/L,lower than those of non DPN group ((16.76 ± 5.24) mmol/L,(47.95 ± t5.04) mmol/L,(1.83 ± 0.57) mmol/L,(5.24 ± 3.45) mmol/L),and the differences were significant (t =2.512,3.592,5.635,2.105,5.312,5.863,5.372,3.502,P ＜0.05 or P ＜ 0.001).Multiple logistic regression analysis revealed that the level of duration of diabetes,HbA1c,2 hPG were positively correlated with DPN prevalence,and those were the independent risk factors of DPN (OR(95％CI) 1.040(1.018-1.062),1.331(1.032-1.717),1.366(1.044-1.787),P＜0.05).The level of FINS,Fasting C peptide,2 h C peptide were negatively correlated with DPN prevalence,and those were independent protective factors of DPN (OR (95 ％ CI) 0.803 (0.725-0.889),0.923 (0.731-0.954),0.863 (0.801-0.930),P ＜ 0.05).Conclusion The occurrence of DPN is common in patients with type 2 diabetes.The indices of duration of diabetes,HbA1c,2 hPG were risk factors of DPN,and there is more dangerous with the lower level of FINS,Fasting C peptide,2 h C peptide.