中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2014年
27期
58-61
,共4页
2型糖尿病%肥胖%并发症%治疗方案
2型糖尿病%肥胖%併髮癥%治療方案
2형당뇨병%비반%병발증%치료방안
Type 2 diabetic mellitus%Obesity%Complications%Treatment proposal
目的：探讨不同体重指数(BMI)对初发2型糖尿病并发症的发生率及治疗方案的影响。方法选取重庆市南川区人民医院2010年1月~2013年6月诊治初发2型糖尿病患者310例，按BMI标准分为三组，A组(BMI<25 kg/m2)118例、B组(BMI：25~28 kg/m2)117例、C组(BMI>28 kg/m2)75例，随访时间1~3年。随访结束时比较分析三组患者肾功能、糖尿病视网膜病变、糖尿病足(手)、糖尿病周围神经病变、低血糖晕厥、高渗性昏迷、酮症酸中毒并发症。结果随访结束时，C组血肌酐[(142.6±44.3)μmol/L]、尿白蛋白[(142.0±36.7)mg/24 h]、尿钠[(579.4±163.8)mmol/24 h]水平均高于A组[(122.2±36.3)μmol/L、(113.2±23.2)mg/24 h、(422.3±125.9)mmol/24 h]及B组[(127.9±40.8)μmol/L、(120.3±32.6)mg/24 h、(467.8±155.4)mmol/24 h]水平，差异有高度统计学意义(P<0.01)，而尿肌酐A组[(9.3±1.9)mmol/24 h]、B组[(9.1±2.1)mmol/24 h]、C组[(9.4±1.7)mmol/24 h]三组比较，差异无统计学意义(P>0.05)。 A、B和C组间糖尿病肾病的发病率差异无统计学意义(P>0.05)。 A、B、C三组糖尿病视网膜病变分期差异有统计学意义(P<0.05)，BMI值越大，糖尿病视网膜病变越严重。 A、B、C三组糖尿病足、低血糖晕厥、酮症酸中毒及高渗性昏迷发病率差异有统计学意义(P<0.05)，而糖尿病周围神经病变发病率差异无统计学意义(P>0.05)。三组间治疗方案有明显差异，且差异有统计学意义(P<0.05)。 BMI和胰岛素剂量呈正相关(r=0.56，P<0.05)。结论 BMI越大，糖尿病患者并发症发生率越大，预后越差，对过度肥胖的糖尿病患者，及早联合应用胰岛素治疗，可能会减少糖尿病并发症的发生率。
目的：探討不同體重指數(BMI)對初髮2型糖尿病併髮癥的髮生率及治療方案的影響。方法選取重慶市南川區人民醫院2010年1月~2013年6月診治初髮2型糖尿病患者310例，按BMI標準分為三組，A組(BMI<25 kg/m2)118例、B組(BMI：25~28 kg/m2)117例、C組(BMI>28 kg/m2)75例，隨訪時間1~3年。隨訪結束時比較分析三組患者腎功能、糖尿病視網膜病變、糖尿病足(手)、糖尿病週圍神經病變、低血糖暈厥、高滲性昏迷、酮癥痠中毒併髮癥。結果隨訪結束時，C組血肌酐[(142.6±44.3)μmol/L]、尿白蛋白[(142.0±36.7)mg/24 h]、尿鈉[(579.4±163.8)mmol/24 h]水平均高于A組[(122.2±36.3)μmol/L、(113.2±23.2)mg/24 h、(422.3±125.9)mmol/24 h]及B組[(127.9±40.8)μmol/L、(120.3±32.6)mg/24 h、(467.8±155.4)mmol/24 h]水平，差異有高度統計學意義(P<0.01)，而尿肌酐A組[(9.3±1.9)mmol/24 h]、B組[(9.1±2.1)mmol/24 h]、C組[(9.4±1.7)mmol/24 h]三組比較，差異無統計學意義(P>0.05)。 A、B和C組間糖尿病腎病的髮病率差異無統計學意義(P>0.05)。 A、B、C三組糖尿病視網膜病變分期差異有統計學意義(P<0.05)，BMI值越大，糖尿病視網膜病變越嚴重。 A、B、C三組糖尿病足、低血糖暈厥、酮癥痠中毒及高滲性昏迷髮病率差異有統計學意義(P<0.05)，而糖尿病週圍神經病變髮病率差異無統計學意義(P>0.05)。三組間治療方案有明顯差異，且差異有統計學意義(P<0.05)。 BMI和胰島素劑量呈正相關(r=0.56，P<0.05)。結論 BMI越大，糖尿病患者併髮癥髮生率越大，預後越差，對過度肥胖的糖尿病患者，及早聯閤應用胰島素治療，可能會減少糖尿病併髮癥的髮生率。
목적：탐토불동체중지수(BMI)대초발2형당뇨병병발증적발생솔급치료방안적영향。방법선취중경시남천구인민의원2010년1월~2013년6월진치초발2형당뇨병환자310례，안BMI표준분위삼조，A조(BMI<25 kg/m2)118례、B조(BMI：25~28 kg/m2)117례、C조(BMI>28 kg/m2)75례，수방시간1~3년。수방결속시비교분석삼조환자신공능、당뇨병시망막병변、당뇨병족(수)、당뇨병주위신경병변、저혈당훈궐、고삼성혼미、동증산중독병발증。결과수방결속시，C조혈기항[(142.6±44.3)μmol/L]、뇨백단백[(142.0±36.7)mg/24 h]、뇨납[(579.4±163.8)mmol/24 h]수평균고우A조[(122.2±36.3)μmol/L、(113.2±23.2)mg/24 h、(422.3±125.9)mmol/24 h]급B조[(127.9±40.8)μmol/L、(120.3±32.6)mg/24 h、(467.8±155.4)mmol/24 h]수평，차이유고도통계학의의(P<0.01)，이뇨기항A조[(9.3±1.9)mmol/24 h]、B조[(9.1±2.1)mmol/24 h]、C조[(9.4±1.7)mmol/24 h]삼조비교，차이무통계학의의(P>0.05)。 A、B화C조간당뇨병신병적발병솔차이무통계학의의(P>0.05)。 A、B、C삼조당뇨병시망막병변분기차이유통계학의의(P<0.05)，BMI치월대，당뇨병시망막병변월엄중。 A、B、C삼조당뇨병족、저혈당훈궐、동증산중독급고삼성혼미발병솔차이유통계학의의(P<0.05)，이당뇨병주위신경병변발병솔차이무통계학의의(P>0.05)。삼조간치료방안유명현차이，차차이유통계학의의(P<0.05)。 BMI화이도소제량정정상관(r=0.56，P<0.05)。결론 BMI월대，당뇨병환자병발증발생솔월대，예후월차，대과도비반적당뇨병환자，급조연합응용이도소치료，가능회감소당뇨병병발증적발생솔。
Objective To explore the influence of different body mass index (BMI) on the complications of type 2 dia-betic mellitus (T2DM) incidence and treatment plan. Methods From January 2010 to June 2013, in the People's Hospi-tal of Nanchuan District in Chongqing City, 310 patiens with T2DM were selected and divided into three groups accord-ing to BMI, group A (BMI<25 kg/m2) 118 cases, group B (BMI:25-28 kg/m2) 117 cases, group C (BMI>28 kg/m2) 75 cases, and followed up for 1-3 years. The renal function, retinal pathological changes, diabetic foot, peripheral nerve sensory dysfunction, syncope, high permeability of hypoglycaemia coma, ketoacidosis of three groups were compared and analyzed. Results The level of serum creatinine [(142.6±44.3) μmol/L], urine albumin [(142.0±36.7) mg/24 h] and urine sodium [(579.4±163.8) mmol/24 h] of group C were higher than those of A group [ (122.2±36.3) μmol/L, (113.2±23.2) mg/24 h, (422.3±125.9) mmol/24 h] and group B [(127.9±40.8)μmol/L, (120.3±32.6)mg/24 h, (467.8±155.4)mmol/24 h ], the differences were statistically significant (P<0.05). The level of urine creatinine in group A [(9.3±1.9) mmol/24 h], group B [(9.1±2.1) mmol/24 h] and group C [(9.4±1.7) mmol/24 h] were compared, the difference was not statisti-cally significant (P > 0.05). The incidence of diabetic nephropathy had no statistically significant difference among group A, B and C (P> 0.05). The difference of diabetic retinopathy stage was statistically significant among the three groups (P<0.05);the greater the BMI, the worse the diabetic retinopathy. The differences of incidence of diabetic foot,hypoglycemia syncope, ketoacidosis and hyperosmolar coma were statistically significant among the three groups (P<0.05), and the difference of incidence of diabetic periph-eral neuropathy was not significant among the three groups (P>0.05). The difference of treatment plans were statistical among the three groups (P<0.05). BMI was positively correlated with the dose of insulin (r=0.56, P<0.05). Conclusion The higher the BMI, the greater incidence of complications in diabetic patients will be. Combination with insulin as early as possible for the diabetes patients with over-obesity may be reducing the incidence of diabetes complications.
