2型糖尿病住院原因和慢性并发症患病率及其危险因素分析

发布时间：2018-06-25 17:30

本文选题：2型糖尿病 + 住院原因　；参考：《浙江大学》2015年博士论文

【摘要】：糖尿病是当前威胁全球人类健康的最重要的慢性病之一,根据国际糖尿病联盟(IDF)统计,2011年全球糖尿病患者人数已达3.7亿,2007-2008年期间,我国20岁以上糖尿病的总体患病率为9.7%,其中男性10.6%,女性8.8%,糖尿病前期的患病率为15.5%,并且糖尿病的患病率随着年龄的上升明显增加；到了2010年,我国成年人糖尿病的患病率为11.6%,其中男性12.1%,女性11%,均较3年前有所增加。2型糖尿病大部分发病隐匿,如不能早期诊断,随着病情的进展,容易出现心血管、神经、眼睛等多种威胁生命的并发症。根据中华医学会糖尿病学分会1991年-2000年10年全国住院糖尿病慢性并发症调查结果,显示住院糖尿病患者中高血压患病率达31.9%,脑血管病变12.2%,心血管病变15.9%,糖尿病肾病33.6%,视网膜病变24.3%。糖尿病及其并发症不仅给患病个体带来了肉体和精神上的损害,还给家庭和国家带来了沉重的经济负担。分析糖尿病患者的住院原因,了解糖尿病慢性并发症的患病率,探讨糖尿病并发症的相关危险因素,有针对性的进行分析和干预,对糖尿病及其并发症的防治有十分重要的现实意义。本研究采用回顾性分析的方法,以2014年在浙江大学医学院附属邵逸夫医院内分泌科住院的597例2型糖尿病患者的病例为研究资料,分析2型糖尿病的住院原因、各种慢性并发症的患病率及其在不同亚组人群中的分布情况,以及2型糖尿病慢性并发症的危险因素,提高对糖尿病及其并发症的认识,为糖尿病的综合防治工作提供参考。第一部分2型糖尿病住院原因分析目的：通过病史查阅,分析2型糖尿病患者的住院原因及分布情况,为糖尿病的临床诊疗提供依据。方法：对2014年1月至2014年12月期间在浙江大学医学院附属邵逸夫医院内分泌科住院的597例2型糖尿病患者进行回顾性分析。根据临床资料(主诉及出院诊断,参考临床表现和辅助检查结果)确定住院原因。所有数据用SPSS20.0处理。结果：高血糖和慢性并发症是2型糖尿病患者住院的主要原因,其中高血糖占61.1%,慢性并发症占28.2%。慢性并发症中,周围神经病变占12.7%,视网膜病变占11.6%,糖尿病肾病占8.4%；其他入院原因按从高到低分别为：急性并发症6.7%,合并感染2.7%,糖尿病足1.5%,低血糖0.8%。初诊患者76例,占12.7%,复诊患者521例,占87.3%；两组患者在总体入院原因上存在显著差异。结论：高血糖和慢性并发症(微血管并发症)是2型糖尿病患者内分泌科住院的首要原因。初诊和复诊的2型糖尿病患者入院原因不同。第二部分2型糖尿病慢性并发症患病率及其危险因素分析目的：通过查阅住院2型糖尿病患者的病史资料,分析住院2型糖尿病慢性并发症的患病率及各种慢性并发症的相关危险因素,为临床诊疗提供依据。方法：对2014年1月至2014年12月期间在浙江大学医学院附属邵逸夫医院内分泌科住院的597例2型糖尿病患者进行回顾性分析。分析2型糖尿病相关慢性并发症的患病率及其危险因素。慢性并发症的确定按中华医学会糖尿病学分会慢性并发症调查的实施细则进行。以二分类逻辑回归法分析2型糖尿病慢性并发症的主要危险因素,所有数据用SPSS20.0处理。结果：住院2型糖尿病患者中,高血压和血脂异常的患病率分别为44.89%和37.16%,糖尿病相关慢性并发症(包括大血管病变和微血管病变)的总患病率为80.74%,其中糖尿病肾病和视网膜病变的患病率分别为23.12%和28.31%；糖尿病周围神经病变41.04%；心血管并发症和脑血管并发症的患病率分别为8.88%和13.32%；周围血管病变64.28%；各种慢性并发症相关的危险因素及其相对危险度分别为：脑血管并发症：年龄、病程、收缩压(OR值分别为1.087,1.023,1.011)；心血管并发症：年龄、病程、收缩压、腰围、同型半胱氨酸(OR值分别为1.103,1.098,1.013,1.031,1.039)；周围神经病变：年龄、病程、收缩压、糖化血红蛋白(OR值分别为1.034,1.089,1.013,1.107)；视网膜病变：年龄、病程、收缩压、糖化血红蛋白(OR值分别为1.098,1.023,2.116,1.021)；肾脏病变：年龄、病程、收缩压、糖化血红蛋白、同型半胱氨酸(OR值分别为1.094,1.034,1.039,1.111,1.035)；外周血管病变：年龄、病程、收缩压、甘油三酯(OR值分别为1.059,1.073,1.013,1.724)。结论：年龄和病程是2型糖尿病慢性并发症的不可控因素；收缩压是所有2型糖尿病慢性并发症的可控危险因素；糖化血红蛋白是微血管病变的主要可控危险因素；同型半胱氨酸是糖尿病肾病和大血管并发症的危险因素之一。糖尿病的治疗应包括对这些可控危险因素的综合干预。
[Abstract]:Diabetes is one of the most important chronic diseases that threaten the world's human health. According to the International Diabetes Association (IDF) statistics, the number of diabetics in the world has reached 370 million in 2011. In the 2007-2008 year period, the overall prevalence rate of diabetes in China over 20 years old is 9.7%, including 10.6% men, 8.8% women, and 15.5% prediabetes. And the prevalence of diabetes increased with age. By 2010, the prevalence rate of adult diabetes in China was 11.6%, of which 12.1% of men and 11% of women were more than 3 years ago. Most of the onset of type.2 diabetes was hidden, such as no early diagnosis. With the progress of the disease, there were many kinds of cardiovascular, nerve, and eyes. According to the survey of chronic diabetic complications in hospitalized diabetes in 10 years in 1991, -2000, China Medical Association Diabetes Branch of China, the prevalence of hypertension in hospitalized diabetic patients was 31.9%, cerebrovascular disease 12.2%, cardiovascular disease 15.9%, diabetic nephropathy 33.6%, retinopathy of 24.3%. diabetes and its complications. It only brought physical and mental damage to the sick individuals and brought a heavy financial burden to the family and the country. Analysis of the causes of hospitalization in patients with diabetes, the prevalence of chronic complications of diabetes, the related risk factors of diabetes complications, targeted analysis and intervention, diabetes and its complications. It is of great practical significance to prevent and control.
In this study, 597 cases of type 2 diabetes hospitalized in the Department of Endocrinology, Sir Run Run Shaw Hospital, Zhejiang University, in 2014, were used to analyze the hospital causes of type 2 diabetes, the prevalence of various chronic complications and their distribution in different subgroups, and type 2 diabetes. Risk factors for chronic complications, increase awareness of diabetes and its complications, and provide reference for comprehensive prevention and treatment of diabetes.
Analysis of the causes of type 2 diabetes in the first part of the hospital
Objective:
Objective to analyze the causes and distribution of hospitalization in patients with type 2 diabetes, and provide evidence for clinical diagnosis and treatment of diabetes.
597 patients with type 2 diabetes hospitalized in Department of Endocrinology, Sir Run Run Shaw Hospital, Zhejiang University from January 2014 to December 2014, were analyzed retrospectively. The hospitalization reasons were determined according to clinical data (main complaint and discharge diagnosis, reference clinical manifestation and auxiliary examination results). All data were treated with SPSS20.0.
Result:
Hyperglycemia and chronic complications were the main causes of hospitalization in type 2 diabetes, of which 61.1% were high blood sugar, chronic complications accounted for 28.2%. chronic complications, peripheral neuropathy accounted for 12.7%, retinopathy accounted for 11.6%, diabetic nephropathy accounted for 8.4%, and other hospitalization reasons were from high to low, 6.7% in acute complications, 2.7% in combined infection, and sugar. Urine disease 1.5%, hypoglycemia 0.8%. 76 cases of initial diagnosis, accounting for 12.7%, 521 cases of revisit patients, accounting for 87.3%; two groups of patients in the overall admission reasons there are significant differences.
Conclusion:
Hyperglycemia and chronic complications (microvascular complications) are the primary causes of hospitalization in the Department of Endocrinology for type 2 diabetes. The reasons for admission to type 2 diabetes in patients with primary and secondary diagnosis are different.
The second part is the prevalence and risk factors of chronic complications in type 2 diabetes mellitus.
Objective:
By consulting the medical history data of patients with type 2 diabetes in hospital, the incidence of chronic complications in type 2 diabetes and the related risk factors of various chronic complications were analyzed in order to provide the basis for clinical diagnosis and treatment.
Method:
A retrospective analysis was made of 597 patients with type 2 diabetes hospitalized in the Department of Endocrinology, Sir Run Run Shaw Hospital, Zhejiang University from January 2014 to December 2014. The prevalence and risk factors of chronic complications related to type 2 diabetes were analyzed. The chronic complications were determined according to the chronic complications of the Chinese Medical Association. The main risk factors of chronic complications of type 2 diabetes were analyzed by two logistic regression method. All data were processed by SPSS20.0.
Result:
Among patients with type 2 diabetes, the prevalence of hypertension and dyslipidemia was 44.89% and 37.16%, respectively, and the total prevalence rate of diabetes related chronic complications (including macroangiopathy and microvascular disease) was 80.74%, including 23.12% and 28.31% of diabetic nephropathy and retinopathy, and 41.04% diabetic peripheral neuropathy, 41.04% The prevalence of cardiovascular and cerebrovascular complications was 8.88% and 13.32%; peripheral vascular lesions were 64.28%; the risk factors associated with various chronic complications and relative risk were cerebrovascular complications: age, course of disease, systolic pressure (OR value, 1.087,1.023,1.011, respectively); cardiovascular complications: age, course of disease, Systolic pressure, waist circumference, homocysteine (OR value is 1.103,1.098,1.013,1.031,1.039); peripheral neuropathy: age, course of disease, systolic pressure, glycosylated hemoglobin (OR, respectively 1.034,1.089,1.013,1.107); retinopathy: age, course of disease, systolic pressure, glycosylated hemoglobin (OR value 1.098,1.023,2.116,1.021, respectively); kidney disease Change: age, course of disease, systolic blood pressure, glycosylated hemoglobin, homocysteine (OR value is 1.094,1.034,1.039,1.111,1.035, respectively); peripheral vascular lesions: age, course of disease, systolic pressure, triglyceride (OR value of 1.059,1.073,1.013,1.724, respectively).
Conclusion:
Age and course of disease are uncontrollable factors for chronic complications of type 2 diabetes; systolic pressure is a controllable risk factor for all chronic complications of type 2 diabetes; glycosylated hemoglobin is a major controllable risk factor for microvascular diseases; homocysteine is one of the risk factors for diabetic nephropathy and major vascular complications. Treatment should include comprehensive intervention on these controllable risk factors.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R587.2

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