目的 探讨住院2型糖尿病肾病患者中早发糖尿病与动脉粥样硬化(AS)风险的关系.方法 选取2017年1月至12月期间于本院收治的诊断为2型糖尿病肾病的患者240例(男149例,女91例).依据初诊糖尿病年龄,分为早发组(初诊糖尿病时年龄＜ 40岁,n=46)及晚发组(初诊糖尿病时年龄≥40岁,n=194).分别收集两组患者年龄、性别、初诊糖尿病时年龄、糖尿病病程、是否合并高血压、高血压病程、用药史、吸烟史、饮酒史、身高、体重、收缩压、舒张压、肾功能、血脂、糖化血红蛋白、尿微量白蛋白肌酐比(UACR)等指标及有无合并动脉粥样硬化病史.Logistic回归分析探讨在2型糖尿病肾病患者中早发糖尿病与AS风险的关系.结果 与晚发组相比,早发组年龄更小、合并高血压者更少、高血压病程更短,使用RAAS阻滞剂、其他类型降压药物及降脂药物者更少(P＜0.05),而在发生AS方面,早发组较晚发组更多(76.1％ vs 59.3％,P=0.034),二者在糖尿病病程、吸烟、BMI、SBP、DBP、血脂、HbA1c比较差异无统计学意义(P＞0.05).单因素logistics回归分析显示发早发糖尿病、年龄和糖尿病病程为2型糖尿病肾病患者发生AS的危险因素(P＜0.05).多因素logistics回归分析显示在2型糖尿病肾病患者中,校正性别、年龄、传统代谢因素(包括合并高血压、使用RAAS阻滞剂、使用降脂药物、吸烟、BMI、SBP、DBP、LDL-C、HbA1c)及糖尿病病程后,早发2型糖尿病患者发生AS风险为晚发者2.93倍(95％ CI:1.24,6.93,P=0.014).结论 在2型糖尿病肾病患者中,早发糖尿病增加发生AS风险,且独立于传统代谢因素及糖尿病病程.%Objective To investigate the relationship between early onset diabetes mellitus and atherosclerosis in patients with type 2 diabetic kidney disease.Methods Total 240 hospitalized patients (91 females and 149 males) in our hospital with type 2 diabetic kidney disease from January 2017 to December 2017 were enrolled.According to the age of newly diagnosed diabetes mellitus,the patients were divided into early onset group (the age at first diagnosis of diabetes was ＜ 40 years old,n =46) and late onset group (the age at first diagnosis of diabetes was ≥ 40 years old,n =194).The clinical data,anthropological measurements were collected.The relationships between early onset diabetes mellitus and atherosclerosis were analyzed by t test,u test,and Chi square test for statistical analysis.Logistic regression analysis was performed to obtain odds ratios (OR) for early versus late onset of T2DM.Results Compared with the late onset group,the early onset group was younger,less complicated with hypertension,shorter duration of hypertension,less use of renin-angiotensin-aldosterone system (RAAS) inhibitors and other types of antihypertensive drugs and lipid-lowering drugs (P ＜ 0.05).However,the prevalence of atherosclerosis in early onset group was increased (76.1％ vs 59.3％,P=0.034).There were no significant difference in disease duration,smoking,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),low density lipoprotein (LDL-C) and glycosylated hemoglobin (HbA1 c) between the two groups.Univariate logistics regression analysis showed early onset type 2 diabetes mellitus,age and duration of diabetes were predictors of atherosclerosis (P ＜ 0.05).With the use of multivariate logistic regression,patients with early onset diabetes had higher risks for atherosclerosis when adjusted by gender,age,metabolic factors and disease duration (OR 2.93,95％ CI:1.24,6.93,P =0.014).Conclusions Early onset diabetes mellitus increases the risk of atherosclerosis in patients with type 2 diabetic kidney disease.
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