糖尿病肾病患者心脑血管疾病的相关危险因素分析

    Analysis on related risk factors for cardiocerebral vascular diseases in patients with diabetic kidney disease

    • 摘要: 目的 探讨糖尿病肾病(DKD)患者心脑血管疾病流行病学及相关危险因素。方法 纳入2016年1月至2017年12 月在青岛市城阳区人民医院所有的住院DKD患者800例。根据是否合并心脑血管疾病将患者分为合并心脑血管疾病组(558例)和未合并心血管疾病组(242例)。收集患者性别、年龄、体质量、身高、收缩压(SBP)、舒张压(DBP)、吸烟史、饮酒史等一般资料,检测空腹血糖(FBG)、糖化血红蛋白(HbA1C)、肝肾功能、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、脂蛋白a(Apoa)、甲状旁腺素(PTH)、C 反应蛋白(CRP)、血红蛋白(Hb)、白细胞(WBC)、脑钠肽(BNP)、尿微量白蛋白/尿肌酐(UACR)、血β2-微球蛋白(β2-MG)水平等指标。危险因素采用多因素 Logistic 回归分析。结果 800例DKD患者合并心脑血管疾病558例(69.75%),其中冠状动脉疾病(CAD)、左心室肥厚(LVH)、充血性心力衰竭(CHF)、脑血管疾病(CVA)、大血管动脉粥样硬化(LA)的患病率分别为12.50%(100/800)、4.13%(33/800)、4.37%(35/800)、13.75%(110/800)、35.00%(280/256);DKD患者慢性肾脏病(CKD)1-5期患者的心脑血管疾病患病率分别为2.50%(20/800)、3.75%(30/800)、12.50%(100/800)、17.50%(140/800)、33.50%(268/800),DKD不同慢性肾脏病(CKD)分期患者心脑血管疾病患病率比较,差异有统计学意义(χ2=14.138,P=0.001)。合并心血管疾病组与未合并心血管疾病组患者年龄、体质量指数(BMI)、SBP、饮酒率、吸烟率、HbA1C、Scr、SUA、TC、LDL-C、UACR、Apoa、PTH、β2-MG水平比较,差异均有统计学意义(P<0.05);多因素 Logistic回归分析显示,年龄、SUA、Apoa、LDL-C、UACR及β2-MG水平是DKD患者合并心脑血管疾病的独立影响因素(P<0.05)。结论 DKD患者易于检出心脑血管疾病,患者的年龄、SUA、Apoa、LDL-C、UACR及β2-MG水平影响DKD患者心脑血管疾病发病。

       

      Abstract: Objective To investigate the epidemiology and related risk factors for cardiocerebral vascular diseases in patients with diabetic kidney diseases(DKD).Methods A total of 800 patients with DKD hospitalized in Chengyang District People's Hospital of Qingdao from January 2016 to December 2017 were enrolled in this study.Based on complications of cardiocerebral vascular diseases, the patients were divided into the cardiocerebral vascular disease group(n=558) and group without cardiocerebral vascular diseases(n=242).The general information,including gender,age,body mass,height,systolic blood pressure(SBP), diastolic blood pressure (DBP),drinking history and smoking history, and laboratory test indicators, including fasting blood glucose (FBG), glycosylated hemoglobin (HbA1C), liver and kidney functions, total cholesterol (TCH), triglyceride (TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol (HDL-C), Lipoprotein A (Apoa),parathyroid hormone (PTH), C-reactive protein (CRP), hemoglobin (Hb), white blood cells (WBC), brain natriuretic peptide (BNP), urinary microalbumin/urinary creatinine ratio (UACR) and serum β2-microglobulin(β2-MG)were detected. Multivariate Logistic regression analysis was used to analyze the risk factors in diabetic kidney disease patients with cardiocerebral vascular diseases.Results Among the 800 patients with diabetic kidney disease,558 ones had cardiocerebral vascular complications (69.75%), with the incidences of coronary artery disease (CAD),left ventricular hypertrophy (LVH),congestive heart failure (CHF),cerebral vascular accident (CVA)and large atherosclerosis (LA)of 12.50%(100/800), 4.13% (33/800), 4.37% (35/800), 13.75% (110/800)and,35.00% (280/256),respectively.The incidences of the above five cardiocerebral vascular complications of DKD patients with chronic kidney disease (CKD) stage I to V were 2.50% (20/800), 3.75% (30/800), 12.50% (100/800), 17.5% (140/800) and 33.5% (268/800), respectively.The differences of the incidences of the above five cardiocerebral vascular complications between DKD patients with difference CKD stages had statistical significance(χ2=14.138,P=0.001).There were differences of statistical significance (P<0. 05) of age, body mass index (BMI), SBP, drinking rate, smoking rate, HbA1C, Scr, SUA, TC, LDL-C, UACR, Apoa, PTH and β2-MG between the two groups. Multivariate Logistic regression analysis showed that age,SUA,Apoa, LDL-C,UACR and serum β2-MG levels were independent influence factors for cardiocerebral vascular complications in diabetic kidney disease patients (P<0.05).Conclusions Cardiocerebral vascular complications are prone to detect in DKD patients, Age, SUA, Apoa, LDL-C, UACR and β2-MG levels influence incidences of cardiocerebral vascular complications in DKD patients.

       

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