CAJ | 학술논문

目的探讨糖尿病肾病(DN)的相关危险因素.方法 781例2型糖尿病住院患者根据尿白蛋白排泄率分为:单纯糖尿病组(475例)、早期DN组(188例)及临床DN组(118例).收集患者的年龄、性别、病程等基本资料,检测血糖、HbA1c、血脂、尿酸、肾功能等,行24 h尿白蛋白排泄率测定、眼底照相、下肢动脉彩超等检查评估糖尿病慢性并发症.比较3组间的一般情况、生化指标及糖尿病慢性并发症情况,分析其与DN的相关性.结果随DN进展,收缩压、糖尿病病程及尿酸水平呈递增趋势(P均＜0.05);早期DN组和临床DN组体重指数、腰围大于单纯糖尿病组(P均＜0.05);临床DN组舒张压、总胆固醇、低密度脂蛋白-胆固醇及纤维蛋白原高于单纯糖尿病组和早期DN组(P均＜0.05);而血红蛋白、总胆红素及谷丙转氨酶低于单纯糖尿病组和早期DN组(P均＜0.05);临床DN组HbA1c低于单纯糖尿病组(P＜0.05).3组间血粘度、下肢动脉斑块、糖尿病视网膜病变(DR)差异有统计学意义(x2值分别为56.475、27.708、143.600,P均＜0.05).DN病变程度与体重指数、腰围、糖尿病病程、收缩压、舒张压、总胆固醇、低密度脂蛋白-胆固醇、尿酸、纤维蛋白原、下肢动脉斑块、DR呈正相关(r=0.121 ～ 0.420,P均＜0.05),与HbA1c、血红蛋白、总胆红素、谷丙转氨酶、血粘度呈负相关(r =-0.245-0.019,P均＜0.05).DN的发生与尿酸[优势比(OR)=1.006,95％CI:1.003～1.008]、纤维蛋白原(OR=1.450,95％ CI:1.106～1.900)及DR(OR=3.994,95％ CI:2.612～6.108)独立相关(P均＜0.05).结论尿酸、纤维蛋白原及DR是2型糖尿病患者DN的独立危险因素.
목적 탐토당뇨병신병(DN)적상관위험인소.방법 781례2형당뇨병주원환자근거뇨백단백배설솔분위:단순당뇨병조(475례)、조기DN조(188례)급림상DN조(118례).수집환자적년령、성별、병정등기본자료,검측혈당、HbA1c、혈지、뇨산、신공능등,행24 h뇨백단백배설솔측정、안저조상、하지동맥채초등검사평고당뇨병만성병발증.비교3조간적일반정황、생화지표급당뇨병만성병발증정황,분석기여DN적상관성.결과 수DN진전,수축압、당뇨병병정급뇨산수평정체증추세(P균＜0.05);조기DN조화림상DN조체중지수、요위대우단순당뇨병조(P균＜0.05);림상DN조서장압、총담고순、저밀도지단백-담고순급섬유단백원고우단순당뇨병조화조기DN조(P균＜0.05);이혈홍단백、총담홍소급곡병전안매저우단순당뇨병조화조기DN조(P균＜0.05);림상DN조HbA1c저우단순당뇨병조(P＜0.05).3조간혈점도、하지동맥반괴、당뇨병시망막병변(DR)차이유통계학의의(x2치분별위56.475、27.708、143.600,P균＜0.05).DN병변정도여체중지수、요위、당뇨병병정、수축압、서장압、총담고순、저밀도지단백-담고순、뇨산、섬유단백원、하지동맥반괴、DR정정상관(r=0.121 ～ 0.420,P균＜0.05),여HbA1c、혈홍단백、총담홍소、곡병전안매、혈점도정부상관(r =-0.245-0.019,P균＜0.05).DN적발생여뇨산[우세비(OR)=1.006,95％CI:1.003～1.008]、섬유단백원(OR=1.450,95％ CI:1.106～1.900)급DR(OR=3.994,95％ CI:2.612～6.108)독립상관(P균＜0.05).결론 뇨산、섬유단백원급DR시2형당뇨병환자DN적독립위험인소.
Objective To investigate the related risk factors of diabetic nephropathy (DN).Methods Seven hundred and eighty-one patients with T2DM were divided into three groups based on urine albumin excretion rate:simple diabetes mellitus group (n=475),early DN group (n=188) and clinical DN group (n=118).The basic characteristics such as age,gender,diabetes duration were collected.Blood glucose,HbA1c,blood lipids,uric acid and renal function were detected.Diabetic chronic complications were evaluated through 24 h urine albumin excretion rate detection,ocular fundus examination and ultrasonography in lower limb.Indicators were compared among the three groups and the correlations between DN and indicators were analyzed.Results With the progression of DN,systolic blood pressure,diabetic duration and uric acid increased significantly (all P＜0.05).Body mass index(BMI) and waist circumstance in early DN group and clinical DN group were higher than those in simple diabetes mellitus group (all P＜0.05).In clinical DN group,diastolic blood pressure,total cholesterol,low density lipoprotein cholesterol (LDL-C) and fibrinogen were higher,while hemoglobin,total bilirubin,alanine aminotransferase were lower than those in simple diabetes mellitus group and early DN group (all P ＜0.05).HbA1c in clinical DN group was higher than that in simple diabetes mellitus group (P＜0.05).Differences in blood viscosity,lower limb artery plaque and diabetic retinopathy (DR) were statistically significant among the three groups(x2=56.475,27.708,143.600,all P＜0.05).The severity of DN was positively related to BMI,waist circumstance,diabetes duration,systolic blood pressure,diastolic blood pressure,total cholesterol,LDL-C,uric acid,fibrinogen,lower limb artery plaque and DR (r =0.121-0.420,all P＜ 0.05),while negatively related to HbA 1 c,hemoglobin,total bilirubin,alanine aminotransferase and blood viscosity(r =-0.245--0.019,all P＜0.05).Uric acid[odd ratio(OR)=1.006,95％ CI:1.003-1.008],fibrinogen (OR=1.450,95％ CI:1.106-1.900) and DR (OR=3.994,95％ CI:2.612-6.108)were independently related to the occurrence of DN(all P ＜0.05).Conclusion Uric acid,fibrinogen and DR are independent risk factors of DN in patients with T2DM.