中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2014年
11期
808-812
,共5页
张明琛%张宏武%茅江峰%曹冰%卡米拉%阿不力克木%朱筠
張明琛%張宏武%茅江峰%曹冰%卡米拉%阿不力剋木%硃筠
장명침%장굉무%모강봉%조빙%잡미랍%아불력극목%주균
糖尿病,2型%早发%血糖管理%大血管并发症%危险因素
糖尿病,2型%早髮%血糖管理%大血管併髮癥%危險因素
당뇨병,2형%조발%혈당관리%대혈관병발증%위험인소
Diabetes mellitus,type 2%Early onset%Glycemia%Macrovascular complication%Risk factor
目的 评价早发糖尿病(EDM)血糖控制现况,并探讨EDM大血管并发症危险因素的特点.方法 选取2012年1月至2013年3月在新疆医科大学一附院内分泌科住院确诊为2型糖尿病(T2DM)的连续性病例共1 734例为研究对象,其中资料完整并同意参与研究的患者为1 255例.将1 255例T2DM患者根据糖尿病诊断年龄分组:诊断年龄≤40岁为EDM组(n=219);诊断年龄＞40岁为对照糖尿病组(n=1 036).另选取同期健康体检者478名为非糖尿病组.测量受试者的身高和体重;测定受试者空腹血糖、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、餐后2h血糖、胰岛素、糖化血红蛋白(HbA1c).评价糖尿病患者的并发症情况.组间比较用t检验,计数资料的组间比较,采用x2检验,采用logistic多元回归分析评价多种危险因素对大动脉粥样硬化的影响.结果 (1)EDM组的收缩压和舒张压均高于对照糖尿病组(t=2.685、2.560,均P＜0.05).两组人群的吸烟率分别为45.2％和36.8％(x2=5.439,P＜0.05).与对照糖尿病组相比,EDM组联合胰岛素治疗比例更高(73.1％比58.7％,x2=15.725,P＜0.001).(2)EDM组:校正年龄和性别比后,与对照糖尿病组相比,EDM组HbA1c水平更高,HbA1c达标率更低(F=3.733,x2=8.508,均P＜0.05).(3)与同龄非糖尿病组比较,EDM组的BMI更大、收缩压及舒张压更高(t=3.623、16.392、7.056,均P＜0.001),LDL-C更高但HDL-C更低(t=4.112、3.174,均P＜0.001).(4)EDM组的女性患者发生动脉粥样硬化的风险高于男性(OR=3.218,95％CI; 1.527～6.781);收缩压和餐后2h血糖是大动脉粥样硬化斑块发生的危险因素(OR=1.04,95％CI:1.016～1.072;OR=1.013,95％CI:1.003～1.029).结论 早发糖尿病患者仅14.2％HbA1c控制达标,超过50％的患者存在糖尿病大血管并发症.早发糖尿病患者,大血管并发症发生与女性、收缩压、餐后2h血糖相关.
目的 評價早髮糖尿病(EDM)血糖控製現況,併探討EDM大血管併髮癥危險因素的特點.方法 選取2012年1月至2013年3月在新疆醫科大學一附院內分泌科住院確診為2型糖尿病(T2DM)的連續性病例共1 734例為研究對象,其中資料完整併同意參與研究的患者為1 255例.將1 255例T2DM患者根據糖尿病診斷年齡分組:診斷年齡≤40歲為EDM組(n=219);診斷年齡＞40歲為對照糖尿病組(n=1 036).另選取同期健康體檢者478名為非糖尿病組.測量受試者的身高和體重;測定受試者空腹血糖、總膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、餐後2h血糖、胰島素、糖化血紅蛋白(HbA1c).評價糖尿病患者的併髮癥情況.組間比較用t檢驗,計數資料的組間比較,採用x2檢驗,採用logistic多元迴歸分析評價多種危險因素對大動脈粥樣硬化的影響.結果 (1)EDM組的收縮壓和舒張壓均高于對照糖尿病組(t=2.685、2.560,均P＜0.05).兩組人群的吸煙率分彆為45.2％和36.8％(x2=5.439,P＜0.05).與對照糖尿病組相比,EDM組聯閤胰島素治療比例更高(73.1％比58.7％,x2=15.725,P＜0.001).(2)EDM組:校正年齡和性彆比後,與對照糖尿病組相比,EDM組HbA1c水平更高,HbA1c達標率更低(F=3.733,x2=8.508,均P＜0.05).(3)與同齡非糖尿病組比較,EDM組的BMI更大、收縮壓及舒張壓更高(t=3.623、16.392、7.056,均P＜0.001),LDL-C更高但HDL-C更低(t=4.112、3.174,均P＜0.001).(4)EDM組的女性患者髮生動脈粥樣硬化的風險高于男性(OR=3.218,95％CI; 1.527～6.781);收縮壓和餐後2h血糖是大動脈粥樣硬化斑塊髮生的危險因素(OR=1.04,95％CI:1.016～1.072;OR=1.013,95％CI:1.003～1.029).結論 早髮糖尿病患者僅14.2％HbA1c控製達標,超過50％的患者存在糖尿病大血管併髮癥.早髮糖尿病患者,大血管併髮癥髮生與女性、收縮壓、餐後2h血糖相關.
목적 평개조발당뇨병(EDM)혈당공제현황,병탐토EDM대혈관병발증위험인소적특점.방법 선취2012년1월지2013년3월재신강의과대학일부원내분비과주원학진위2형당뇨병(T2DM)적련속성병례공1 734례위연구대상,기중자료완정병동의삼여연구적환자위1 255례.장1 255례T2DM환자근거당뇨병진단년령분조:진단년령≤40세위EDM조(n=219);진단년령＞40세위대조당뇨병조(n=1 036).령선취동기건강체검자478명위비당뇨병조.측량수시자적신고화체중;측정수시자공복혈당、총담고순(TC)、감유삼지(TG)、고밀도지단백담고순(HDL-C)、저밀도지단백담고순(LDL-C)、찬후2h혈당、이도소、당화혈홍단백(HbA1c).평개당뇨병환자적병발증정황.조간비교용t검험,계수자료적조간비교,채용x2검험,채용logistic다원회귀분석평개다충위험인소대대동맥죽양경화적영향.결과 (1)EDM조적수축압화서장압균고우대조당뇨병조(t=2.685、2.560,균P＜0.05).량조인군적흡연솔분별위45.2％화36.8％(x2=5.439,P＜0.05).여대조당뇨병조상비,EDM조연합이도소치료비례경고(73.1％비58.7％,x2=15.725,P＜0.001).(2)EDM조:교정년령화성별비후,여대조당뇨병조상비,EDM조HbA1c수평경고,HbA1c체표솔경저(F=3.733,x2=8.508,균P＜0.05).(3)여동령비당뇨병조비교,EDM조적BMI경대、수축압급서장압경고(t=3.623、16.392、7.056,균P＜0.001),LDL-C경고단HDL-C경저(t=4.112、3.174,균P＜0.001).(4)EDM조적녀성환자발생동맥죽양경화적풍험고우남성(OR=3.218,95％CI; 1.527～6.781);수축압화찬후2h혈당시대동맥죽양경화반괴발생적위험인소(OR=1.04,95％CI:1.016～1.072;OR=1.013,95％CI:1.003～1.029).결론 조발당뇨병환자부14.2％HbA1c공제체표,초과50％적환자존재당뇨병대혈관병발증.조발당뇨병환자,대혈관병발증발생여녀성、수축압、찬후2h혈당상관.
Objective To investigate the glycemic control and macrovascular complications risk factors in early onset type 2 diabetes mellitus(EDM).Methods This cross-sectional study included three groups:(1) EDM group,adults diagnosed with type 2 diabetes at 18-40 yeas of age (n=219).(2) Usual onset diabetes mellitus group as control DM group,adults diagnosed with type 2 diabetes older than 40 years (n=1 036).(3) Age matched non-diabetic group (n=478).Body mass index(BMI),blood pressure,fasting glucose,glycated hemoglobin A1c(HbA1c),fasting insulin,high-density lipoprotein cholesterol(HDL-C),triglycerides and low-density lipoprotein cholesterol(LDL-C) were measured.For patients with diabetes mellitus,the complications were also examined.The t test and multivariate logistic regression analysis were used for statistical analysis.Results (1) The systolic and diastolic blood pressure was higher in EDM group than those in usual onset DM group (t=2.685,2.560,all P ＜ 0.05).There were significantly higher smoking rate (x2=5.439,P ＜ 0.05) and higher rate of insulin therapy (x2=15.725,P＜0.05) in EDM group than in control DM group.(2) In EDM group,14.2％ of them had HbA1c＜7％.The prevalence rates of atherosclerotic plaque in arteries,diabetic retinopathy,neuropathy and positive micro-albuminuria were 50.7％,52.5％,53.4％ and 53.0％,respectively.After adjusted age and gender,there were higher HbA 1 c levels (F=3.733,P ＜ 0.05) and lower HbA1c control rate (x2=8.508,P ＜ 0.05)of EDM group than control DM group.(3) Compared with the age matched non-diabetes group,the EDM group had higher levels of BMI (t=3.623,P＜0.05),blood pressurc (SBP t=16.392,P＜0.001; DBP t=7.056,P＜0.05) and LDL-C (t=4.112,P＜0.05).(4) In EDM group,women had a higher risk for arterial atherosclerosis than man (OR=3.218,95％CI:1.527-6.781).The postprandial 2 hour glucose and systolic blood pressure were also the risk factors for arterial atheroselerosis in EDM group (OR=1.04,95％ CI:1.016-1.072; OR=1.013,95％ CI:1.003-1.029 respectively).Conclusion Only 14.2％ patients with early-onset diabetes meet the HbA1c control target and more than 50％ patients already have macrovascular complications.In EDM patients,female,systolic blood pressure and postprandial 2 hour blood glucose are related with macrovascular complications.
