宁波社区2型糖尿病患者发生糖尿病肾病危险因素调查

doi:10.3785/j.issn.1008-9292.2018.04.09

浙江大学学报（医学版）

2018, Vol. 47

Issue (2): 163-168 DOI: 10.3785/j.issn.1008-9292.2018.04.09

原著

宁波社区2型糖尿病患者发生糖尿病肾病危险因素调查

李小勇1(

),沈鹏1,林鸿波1,虞哲彬2,陈坤2,*(

),王建炳2,*(

)

1. 宁波市鄞州区疾病预防控制中心健康教育与慢性病防治科, 浙江宁波 315040
2. 浙江大学医学院公共卫生系, 浙江杭州 310058

A community-based survey on risk factors of type 2 diabetic kidney disease in Ningbo, China

LI Xiaoyong1(

),SHEN Peng1,LIN Hongbo1,YU Zhebin2,CHEN Kun2,*(

),WANG Jianbing2,*(

)

1. Department of Health Education and Chronic Disease Control, Ningbo Yinzhou District Center for Disease Control and Prevention, Ningbo 315040, Zhejiang Province, China
2. School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China

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摘要：

目的: 调查宁波市鄞州区2型糖尿病患者糖尿病肾病的发生率，并分析2型糖尿病患者发生糖尿病肾病的危险因素。方法: 收集浙江省宁波市鄞州区所有在册管理且开展过糖尿病肾病筛查的2型糖尿病患者的人口学、临床检测信息、糖尿病合并症和行为危险因素等信息，利用logistic回归分析筛选糖尿病肾病发生的危险因素。结果: 本研究共纳入糖尿病患者10 604例，其中发生糖尿病肾病3744例（35.31%）。单因素分析结果显示，糖尿病肾病发生的风险可能与患者的性别、年龄、文化程度、糖尿病病程、血糖控制情况、是否合并高血压、是否合并脑卒中、是否吸烟和腰围等因素相关（P < 0.05或P < 0.01）。多因素logistic回归分析结果显示，男性、高龄、糖尿病病程长、合并高血压、吸烟等因素可能是糖尿病肾病发生的危险因素（P < 0.05或P < 0.01）。结论: 宁波市鄞州区2型糖尿病患者糖尿病肾病的发生率较高。男性、高龄、吸烟、糖尿病病程长、合并高血压可能会增加糖尿病患者发生糖尿病肾病的风险。

关键词： 糖尿病, 2型/并发症; 糖尿病肾病/病因学; 危险因素; logistic模型; 比值比; 血压; 吸烟

Abstract:

Objective: To investigate the prevalence and risk factors of diabetic nephropathy in Ningbo Yinzhou district. Methods: Nephropathy screening was conducted among patients with type 2 diabetes mellitus (T2DM) registered in Ningbo Yinzhou district. Demographic information, clinical examination information, diabetes complications and behavioral risk factors of enrolled patients were collected. Logistic regression model was used to identify possible risk factors for the occurrence of diabetic nephropathy. Results: Among 10 604 T2DM patients included in this study, there were 3744 cases of diabetic nephropathy(35.31%). Univariate analysis showed that gender, age, education level, diabetes duration, glycemic control, hypertension, stroke, smoking and waist circumference were associated with diabetic nephropathy (P < 0.05 or P < 0.01). Multivariate logistic regression analysis showed that male, elders, long diabetes duration, hypertension and smoking were independent risk factors of diabetic nephropathy (P < 0.05 or P < 0.01). Conclusions: Diabetic nephropathy is of high prevalence in T2DM patients. Male patients, elders, and those with long diabetes duration, hypertension and smoking habits are more likely to have diabetic nephropathy.

Key words: Diabetes mellitus, type 2/complications Diabetic nephropathies/etiology Risk factors Logistic models Odds ratio Blood pressure Smoking

收稿日期: 2017-10-27 出版日期: 2018-07-24

R587.2

基金资助: 浙江省医药卫生科技计划(201512434)

通讯作者: 陈坤,王建炳 E-mail: 40642702@qq.com;ck@zju.edu.cn;wangjianbing@zju.edu.cn

作者简介: 李小勇(1981-), 男, 学士, 主治医师, 主要从事慢性非传染性疾病防控工作; E-mail: 40642702@qq.com; https://orcid.org/0000-0001-7693-1133

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引用本文:

李小勇,沈鹏,林鸿波,虞哲彬,陈坤,王建炳. 宁波社区2型糖尿病患者发生糖尿病肾病危险因素调查[J]. 浙江大学学报（医学版）, 2018, 47(2): 163-168.

LI Xiaoyong,SHEN Peng,LIN Hongbo,YU Zhebin,CHEN Kun,WANG Jianbing. A community-based survey on risk factors of type 2 diabetic kidney disease in Ningbo, China. J Zhejiang Univ (Med Sci), 2018, 47(2): 163-168.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2018.04.09 或 http://www.zjujournals.com/med/CN/Y2018/V47/I2/163

影响因素		糖尿病肾病[n(%)]		P值	OR值(95% CI)
影响因素		是	否	P值	OR值(95% CI)
“—”无相关数据；OR:比值比.^*以患者检测尿微量白蛋白和肌酐时的空腹血糖值判断；^#调整了年龄、性别、糖尿病病程；^△腰围正常指男性腰围在90 cm以下或女性腰围在85 cm以下.
性别	男	1445(38.6)	2890(42.1)	—	1.000
	女	2299(61.4)	3970(57.9)	＜0.01	0.863(0.796~0.937)
年龄段	≤40岁	24(0.6)	52(0.8)	—	1.000
	＞40~50岁	136(3.6)	285(4.2)	＞0.10	1.034(0.612~1.748)
	＞50~60岁	526(14.0)	1261(18.4)	＞0.10	0.904(0.551~1.482)
	＞60~70岁	1425(38.1)	3154(46.0)	＞0.10	0.979(0.601~1.594)
	＞70岁	1633(43.6)	2108(30.7)	＜0.05	1.678(1.030~2.734)
文化程度	小学以下	884(23.6)	1316(19.2)	—	1.000
	小学	1913(51.1)	3644(53.1)	＜0.01	0.782(0.706~0.865)
	初中	792(21.2)	1577(23.0)	＜0.01	0.748(0.663~0.843)
	高中及以上	155(4.1)	323(4.7)	＜0.01	0.714(0.579~0.881)
糖尿病病程	≤5年	1182(31.6)	2689(39.2)	—	1.000
	＞5~10年	1721(46.0)	3062(44.7)	＜0.01	1.279(1.168~1.400)
	＞10年	840(22.4)	1105(16.1)	＜0.01	1.729(1.545~1.936)
血糖控制情况^*	较好(＜7.0 mmol/L)	2591(69.9)	4881(71.8)	—	1.000
	较差(≥7.0 mmol/L)	1114(30.1)	1916(28.2)	＜0.10	1.077(0.986~1.178)
合并高血压^#	无	1575(42.1)	3727(54.3)	—	1.000
	有	2169(57.9)	3133(45.7)	＜0.01	1.442(1.325~1.573)
合并脑卒中^#	无	3721(99.4)	6838(99.7)	—	1.000
	有	23(0.6)	22(0.3)	＜0.10	1.612(0.891~2.913)
吸烟^#	否	3106(33.7)	6113(66.3)	—	1.000
	是	638(46.1)	747(53.9)	＜0.01	1.752(1.501~1.965)
饮酒^#	否	513(36.1)	6860(63.9)	—	1.000
	是	3231(35.2)	5953(64.8)	＞0.10	1.030(0.920~1.160)
体质指数^#(kg/m²)	低体质量(＜18.5)	29(41.4)	41(58.6)	＞0.10	1.310(0.800~2.120)
	正常(18.5~＜24.0)	1682(34.8)	3145(65.2)	—	1.000
	超重(24.0~＜28.0)	1702(35.9)	3037(64.1)	＞0.10	1.050(0.960~1.140)
	肥胖(≥28.0)	331(43.3)	633(65.7)	＞0.10	0.980(0.840~1.130)
腰围^#△	正常	2517(34.6)	4765(65.4)	—	1.000
	超标	1227(35.8)	1963(64.2)	＜0.01	1.142(1.045~1.257)
每周运动时间^#(min)	0	737(35.4)	1343(64.6)	—	1.000
	＞0~＜30	1969(35.4)	3597(64.6)	＞0.10	1.001(0.895~1.102)
	30~＜60	592(34.8)	1110(65.2)	＞0.10	1.005(0.860~1.167)
	≥60	385(35.3)	705(64.7)	＞0.10	0.995(0.854~1.160)

表 1 2型糖尿病患者发生糖尿病肾病危险因素的单因素分析

表 2 2型糖尿病患者发生糖尿病肾病危险因素的多因素分析

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