2型糖尿病患者心脏自主神经病变与血尿酸等生化指标的相关性研究

发布时间：2018-05-29 02:43

本文选题：2型糖尿病 + 糖尿病心脏自主神经病变　；参考：《皖南医学院》2017年硕士论文

【摘要】：研究背景:2型糖尿病的中国最新流行学调查显示,我国2型糖尿病总人数超过9200万,20岁以上人群的糖尿病的患病率已高达9.7%。糖尿病周围神经病变是糖尿病慢性并发症之一,其中糖尿病心脏自主神经病变(diabetic cardiac autonomic neuropathy,DCAN)是糖尿病周围神经病变之一,关于其发病机制尚无统一定论,可能与代谢异常,氧化应激,微血管病变,神经营养因子缺乏等多因素有关。糖尿病心脏自主神经病变具有起病隐匿、渐进发展、症状出现早、较少自行缓解的临床特征,可引发无痛性心肌缺血、心肌梗死、恶性心律失常甚至心源性猝死等。高尿酸血症则被认为是代谢异常的一种标记,高尿酸血症(Hyperuricemia,HUA)与高血压病、高脂血症、糖尿病肾病、糖尿病周围神经病变密切相关[1]。有试验证实,在2型糖尿病患者中,糖尿病周围神经病变患者其高尿酸血症的患病率高于非糖尿病周围神经病变患者;糖尿病周围神经病变患者血尿酸平均水平高于非糖尿病周围神经病变患者[2]。研究目的:本项研究将采用SUDOSCAN糖尿病并发症探测仪(eZscan仪)筛查糖尿病患者的心脏主神经病变(DCAN),并观察符合条件的2型糖尿病患者血尿酸及相关血生化、临床资料,利用糖尿病患者eZscan仪所测得的心脏自主神经病变风险值(DCAN%),并根据心脏自主神经病变风险值是否≥25%分组:2型糖尿病心脏自主神经风险组与非心脏自主神经风险组,比较两组血尿酸等相关生化指标,从而探讨2型糖尿病患者糖尿病心脏自主神经病变与血尿酸等生化指标的关系,为2型糖尿病患者心脏自主神经病变的预防提供依据。研究方法:选择2016年10月至2017年2月在我院治疗的已确诊平均年龄(60±10)岁的146例2型糖尿病患者。记录患者性别、年龄、体重指数等一般资料。采集患者血清进行血尿酸、总胆固醇、甘油三酯、低密度脂蛋白、糖化血红蛋白、空腹血糖、血肌酐、空腹胰岛素c肽、尿微量白蛋白等多项生化指标;采用sudoscan糖尿病并发症探测仪(ezscan仪)检测所得心脏自主神经病变风险值(dcan%),并根据心脏自主神经病变风险值是否≥25%分为2型糖尿病心脏自主神经病变风险组与2型糖尿病非心脏自主神经病变风险组,另据患者性别以及血糖情况分组,分别进行比较。纳入比较的指标包括收集的患者一般临床资料及实验室生化、尿微量蛋白等,所有数据懫用spss22.0软件进行统计分析。研究结果:1、一般资料:共146例平均年龄(60±10)岁的2型糖尿病患者,男女比例随机,纳入研究,其中男性患者83例,女性患者63例,另2型糖尿病心脏自主神经病变风险组98例,2型糖尿病非心脏自主神经病变风险组48例。2、sudoscan检测技术发现2型糖尿病心脏自主神经病变风险组与2型糖尿病非心脏自主神经风险组在年龄、体重指数(bmi)、血清肌酐方面存在显著统计学差异(p0.001,p=0.017,p0.001)。3、sudoscan检测技术发现在2型糖尿病女性患者组中,心脏自主神经病变与年龄、体重指数、血糖、糖化血红蛋白、血肌酐存在统计学差异(p0.001,p=0.001,p=0.017,p=0.04,p=0.024)。sudoscan检测技术发现在2型糖尿病男性患者组中,心脏自主神经病变与年龄存在统计学差异(P0.01)。4、根据糖尿病风险评估评分值是否≥25%,分为2型糖尿病心脏自主神经病变风险组与2型糖尿病非心脏自主神经病变风险组,SPSS多元logistic回归分析发现年龄[OR=1.213(1.123-1.311),P0.001]、体重指数BMI[OR=1.299(1.073-1.573),P=0.007]与DCAN发病风险密切相关,而血尿酸、性别、血脂、血糖等无明显统计学相关性。5、根据HbA1C目标合理是7%为标准分为血糖达标组及血糖不达标组,发现两组在年龄、空腹血糖、血清肌酐,空腹C肽方面存在显著统计学差异(P=0.038,P=0.000,P=0.001,P=0.02)。研究结论:1、在2型糖尿病患者中,伴随患者年龄、BMI指数,血清肌升高,患者心脏自主神经病变的发病风险增高。2、在2型糖尿病患者中,伴随患者年龄、空腹血糖、血肌酐升高,患者糖化血红蛋白达标率越低。3、经SUDOSCAN检测技术,并未发现血尿酸水平与2型糖尿病患者心脏自主神经病变的显著相关性。
[Abstract]:Background: the latest epidemiological survey of type 2 diabetes in China shows that the total number of type 2 diabetes in China is more than 92 million. The prevalence of diabetes in people over 20 years old is as high as 9.7%. diabetic peripheral neuropathy is one of the chronic complications of diabetes, and the diabetes heart is diabetic cardiac autonomic neuropathy, DCAN) is one of the diabetic peripheral neuropathy. There is no certain theory about its pathogenesis. It may be related to many factors such as metabolic abnormality, oxidative stress, microvascular disease, and neurotrophic factor deficiency. Diabetes heart autonomic neuropathy is characterized by insidious onset, progressive development, early symptoms and less self relieving clinical features. Painless myocardial ischemia, myocardial infarction, malignant arrhythmia and even sudden cardiac death. Hyperuricemia is considered to be a marker of metabolic abnormalities. Hyperuricemia (Hyperuricemia, HUA) is closely related to hypertension, hyperlipidemia, diabetic nephropathy, and diabetic nephropathy, and [1]. has been confirmed in patients with type 2 diabetes. In patients with diabetic peripheral neuropathy, the prevalence of hyperuricemia is higher than that of non diabetic peripheral neuropathy. The average level of blood uric acid in patients with diabetic peripheral neuropathy is higher than that of non diabetic peripheral neuropathy patients with [2]. research. This study will be used to screen sugar by the SUDOSCAN diabetic complication detector (eZscan instrument). Cardiac autonomic neuropathy (DCAN) in patients with urinary disease, and observation of blood uric acid and related blood biochemistry in patients with type 2 diabetes, clinical data, risk values of cardiac autonomic neuropathy (DCAN%) measured by eZscan in diabetic patients, and whether the risk value of cardiac autonomic neuropathy is more than 25%: cardiac autonomic deity of type 2 diabetes mellitus The relationship between the two groups of blood uric acid and other biochemical indexes was compared between the risk group and the non cardiac autonomic nerve risk group. The relationship between the diabetic cardiac autonomic neuropathy and the biochemical indexes of blood uric acid was discussed in the patients with type 2 diabetes mellitus, and the basis for prevention of cardiac autonomic neuropathy in type 2 diabetic patients was studied. The methods of study were selected from October 2016 to 2017. In February, 146 patients with type 2 diabetes, aged (60 + 10), were treated in our hospital. General data of sex, age and body mass index were recorded. Serum uric acid, total cholesterol, triglycerides, low density lipoprotein, glycated hemoglobin, fasting blood glucose, serum creatinine, fasting insulin C peptide, microalbuminuria, etc. were collected from the patients' serum. Multiple biochemical indexes; the risk value of cardiac autonomic neuropathy (dcan%) measured by the sudoscan diabetes complication detector (ezscan instrument), and the risk group of type 2 diabetic cardiopathy based on the risk value of cardiac autonomic neuropathy and risk group of type 2 diabetic non cardiac autonomic neuropathy, according to the risk group of type 2 diabetes, according to the patient sex Spss22.0 software was used for statistical analysis. 1, general data: a total of 146 patients with average age of age (60 + 10) years of age 2 diabetes, the proportion of men and women was random, The study included 83 male patients, 63 female patients, 98 patients with type 2 diabetic cardio neuropathy risk group, 48 non cardiac autonomic neuropathy risk group of type 2 diabetes mellitus (.2), sudoscan detection technique, and the risk group of type 2 diabetic cardiac autonomic neuropathy and the non cardiac autonomic nerve risk group of type 2 diabetes in age, body There were significant differences in weight index (BMI) and serum creatinine (p0.001, p=0.017, p0.001).3. Sudoscan detection techniques found that there were statistical differences between cardiac autonomic neuropathy and age, body mass index, blood sugar, glycated hemoglobin, and serum creatinine (p0.001, p=0.001, p=0.017, p=0.04, p=0.024) in the group of women with type 2 diabetes. The detection techniques found that in the male patients with type 2 diabetes, the cardiac autonomic neuropathy and age were statistically different (P0.01).4, according to whether the score of diabetes risk assessment was more than 25%, divided into the risk group of type 2 diabetic cardio neuropathy and the risk group of non cardiac autonomic neuropathy in type 2 diabetes mellitus, SPSS multivariate logistic regression score The age [OR=1.213 (1.123-1.311), P0.001], body mass index BMI[OR=1.299 (1.073-1.573), P=0.007] were closely related to the risk of DCAN, but the blood uric acid, sex, blood lipid, blood sugar and so on were not statistically significant.5. According to the HbA1C target, 7% were divided into standard blood glucose standard group and blood glucose level group, and the two groups were found in the age and empty stomach. There were significant differences in blood glucose, serum creatinine, and fasting C peptide (P=0.038, P=0.000, P=0.001, P=0.02). 1. In type 2 diabetic patients, the risk of cardiac autonomic neuropathy increased with age, BMI index, serum muscle increase, and.2 in patients with cardiac autonomic neuropathy, with patients age, fasting blood glucose, and blood in type 2 diabetic patients. The higher the creatinine, the lower the glycated hemoglobin standard rate was.3, and the SUDOSCAN detection technique did not find a significant correlation between the level of blood uric acid and the cardiac autonomic neuropathy in type 2 diabetic patients.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2

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