院内高血糖的现况调查及其特点分析

发布时间：2018-07-24 17:16

【摘要】：目的:1.对山西医科大学第一医院院内高血糖进行现况调查,了解其患病率和分布特点;2.应用“中国糖尿病风险评分标准”对院内血糖高但未确诊糖尿病者与正常血糖者进行风险评价,对“中国糖尿病风险评分量表”进行验证;3.对2型糖尿病(T2DM)单纯并发严重微血管病变者(包括糖尿病视网膜病变和/或肾病)与T2DM单纯合并心脑血管病变者进行临床特征比较。方法:于2014年7月22日—8月3日间,对山西医科大学第一医院(以下简称山医大一院)各临床科室(除外儿科)1465例非急诊住院患者进行院内高血糖现况调查(调查日纳入的患者包括在院和当日出院者,不包括当日入院者)。采集上述调查对象包括性别、年龄、身高、体重、腰围、血压、既往病史(包括特殊药物服用史、糖尿病及其相关微血管并发症、心脑血管病等病史)、有糖尿病史者的糖尿病病程、家族史(包括糖尿病、高血压及心脑血管疾病等)、吸烟史、饮酒史,以及相关检测项目包括尿常规,肝、肾功能,空腹和/或即刻血糖,血脂四项,脂蛋白a,肝脏彩超等资料。糖尿病者加测糖化血红蛋白(Hb Al C)。体质指数(BMI)计算:BMI=体重(Kg)/身高2(m2)(体重的单位为千克,身高的单位为米)。按照院内高血糖判断标准(院内高血糖包括①已知糖尿病;②新诊断糖尿病;③应激性高血糖)进行数据整理,计算一院院内高血糖的患病率和各科室院内高血糖的构成比。应用“中国糖尿病风险评分标准”对院内血糖高但未确诊糖尿病者进行糖尿病风险评价。筛选出年龄、性别构成接近,且资料完整的T2DM伴单纯微血管病变者(包括糖尿病视网膜病变和/或肾病)与T2DM伴单纯心脑血管病变者进行临床特征比较。采用SPSSl3.0软件进行统计学分析,计量资料用均数±标准差(±S)表示,危险因素均数的比较用t检验分析各相关因素的差异性,疾病的危险因素分析采用Logistic多元回归分析法分析,检验水准以P值0.05定义为有统计学意义。结果:1.院内高血糖调查结果1.1山医大一院院内高血糖的患病率为21%。1.2院内高血糖内科高发科室为内分泌科91%、眼科38.5%、老年病科35%、神经内科27%、康复科27%、皮肤科27%、心内科22%。1.3院内高血糖外科高发科室为普外科15%、心胸外科14%、神经外科11%。1.4院内高血糖合并的高发病种顺位排序为:高血压31.5%、冠心病14.9%、脑血管疾病10.4%。2.对“中国糖尿病风险评分标准”验证结果2.1与血糖正常者比较,院内血糖高但未确诊糖尿病者糖尿病风险评分指数、BMI、空腹血糖、收缩压、总胆固醇、均高于正常组(P0.05)。2.2院内血糖高但未确诊糖尿病者其糖尿病风险评分值为31.78±7.86,其中97%高于中国糖尿病风险临界评分值25。3.T2DM单纯并发严重微血管病变者(包括糖尿病视网膜病变和/或肾病)与T2DM单纯合并心脑血管病变者进行临床特征比较3.1与T2DM单纯并发严重微血管病变者比较,T2DM单纯合并心脑血管病变者BMI、收缩压、TC、LDL-C、脂蛋白a均增高,差异有统计学意义(P0.05);与T2DM单纯并发严重微血管病变者比较,T2DM单纯合并心脑血管病变者病程、TG、糖化血红蛋白低,差异有统计学意义(P0.05)。3.2 T2DM单纯并发严重微血管病变者与无T2DM并发症者危险因素进行Logostic回归分析比较,结果显示收缩压、TG、Hb A1c、糖尿病病程是T2DM单纯合并严重微血管病变的独立危险因素。3.3 T2DM单纯合并心脑血管病变与无T2DM并发症者危险因素进行Logostic回归分析比较,结果显示:BMI、Hb A1c、TG、TC是T2DM并发心脑血管疾病的独立相关危险因素。结论:1.山医大一院院内高血糖的患病率为21%。院内高血糖内科高发科室依次为内分泌科、眼科、老年病科、神经内科、康复科、皮肤科、心内科、风湿科;外科高发科室为普外科、心胸外科、神经外科。院内高血糖合并的高发病种为高血压、脑梗死、冠心病。2.采用“中国糖尿病风险评分标准”对院内血糖高但未确诊糖尿病者行风险评分值为31.78±7.86,其中97%高于中国糖尿病风险临界评分值25,也明显高于同期血糖正常的在院患者,提示该评分标准有较好的糖尿病风险预测能力。3.T2DM者其病程、收缩压、糖化血红蛋白和甘油三酯控制状况是微血管病变的主要危险因素;T2DM者其体质指数、糖化血红蛋白、总胆固醇和甘油三酯水平是心脑血管病变的主要危险因素。
[Abstract]:Objective: 1. to investigate the prevalence and distribution characteristics of hyperglycemia in the first hospital of Shanxi Medical University to understand the prevalence and distribution characteristics. 2. the risk assessment of high blood glucose but undiagnosed diabetes and normal blood glucose in the hospital with "China diabetes risk score standard" was used to verify the "Chinese diabetes risk score scale", and 3. to 2. Patients with type diabetes mellitus (T2DM) complicated with severe microvascular lesions (including diabetic retinopathy and / or nephropathy) compared with T2DM alone with cardiovascular and cerebrovascular diseases. Methods: from July 22, 2014 to August, 3 days in the first hospital of Shanxi Medical University (hereinafter referred to as the hospital of the Medical University) 146 (except for Pediatrics). 5 cases of non emergency hospitalized patients were investigated for the prevalence of hyperglycemia (included in the hospital and the day of the hospital, excluding those who were hospitalized on the day). The subjects included sex, age, height, weight, waist circumference, blood pressure, past medical history (including the history of special medication, diabetes and related microvascular complications, heart and brain) The history of diabetes, the history of diabetes, family history (including diabetes, hypertension, cardiovascular and cerebrovascular diseases, etc.), smoking history, drinking history, and related testing items including urine routine, liver, kidney function, fasting and / or immediate blood glucose, blood lipid four, lipoprotein a, liver color Doppler and so on. Diabetic patients with glycated blood red eggs Hb Al C. Body mass index (BMI) calculation: BMI= weight (Kg) / height 2 (M2) (body weight per kilogram, height per meter). According to the hospital hyperglycemia criteria (hospital hyperglycemia including 1 known diabetes; 2 new diagnosis of diabetes; 3. Stress hyperglycemia) data arrangement, calculation of the prevalence of hyperglycemia in the hospital and various subjects The composition ratio of hyperglycemia in the hospital. Using the "Chinese diabetes risk score standard" to evaluate the risk of diabetes in people with high blood glucose but undiagnosed diabetes. Screening out age, sex composition is close, and data complete T2DM with simple microvascular lesions (including diabetic retinopathy and / or nephropathy) and T2DM with simple heart and brain. The clinical characteristics of vascular lesions were compared. Statistical analysis was carried out by SPSSl3.0 software. The measurement data were expressed with mean standard deviation (+ S). The comparison of all risk factors by t test was used to analyze the differences of the related factors. The analysis of the risk factors of the disease was analyzed by Logistic multiple regression analysis. The test level was defined as P value 0.05. Results: 1. the results of the high blood glucose survey in the hospital 1.1, the prevalence of hyperglycemia in the hospital of the hospital was 21%.1.2, the high blood sugar Department in the hospital was 91% in the Department of Endocrinology, 38.5% in the ophthalmology department, 35% in the Department of Geriatrics, 27% in the Department of Neurology, 27% in the Department of rehabilitation, 27% in the Department of Dermatology, and 15% in the high blood sugar surgery department in the hospital. 14% in cardio thoracic surgery, high incidence of hyperglycemia in 11%.1.4 hospital in Department of neurosurgery was ranked as: hypertension 31.5%, coronary heart disease 14.9%, cerebral vascular disease 10.4%.2. to "China diabetes risk score standard" test results 2.1 compared with normal blood glucose, high blood glucose but undiagnosed diabetes risk score index, BMI, fasting Blood sugar, systolic blood pressure, total cholesterol, higher than normal group (P0.05).2.2 high blood glucose but undiagnosed diabetes, the diabetes risk score was 31.78 + 7.86, of which 97% was higher than the Chinese diabetes risk critical score value 25.3.T2DM simple complicated with severe microangiopathy (including diabetic retinopathy and / or nephrosis) and T2DM Comparison of clinical features in patients with cardiovascular and cerebrovascular diseases 3.1 compared with those with T2DM only complicated with severe microvascular lesions, BMI, systolic pressure, TC, LDL-C, and lipoprotein a were all higher in patients with T2DM simply combined with cardio cerebral vascular lesions, and the difference was statistically significant (P0.05). Compared with those with severe and severe microvascular lesions with T2DM, T2DM simply merged with cardiovascular and cerebrovascular diseases. The course of disease, TG, glycated hemoglobin was low, the difference was statistically significant (P0.05).3.2 T2DM complicated with severe microvascular disease and the risk factors of T2DM without T2DM, Logostic regression analysis showed systolic pressure, TG, Hb A1c, and the course of diabetes was an independent risk factor for T2DM single pure microvascular disease.3.3 T2DM sheet. Logostic regression analysis of the risk factors of pure amalgamated cardio cerebrovascular diseases and non T2DM complications showed that BMI, Hb A1c, TG, TC were independent risk factors for T2DM complicated with cardiovascular and cerebrovascular diseases. Conclusion: the prevalence rate of hyperglycemia in the hospital of 1. mountain Medical University was in the Department of Endocrinology, the high blood sugar Department of the hospital in order of 21%.. The high incidence of hyperglycemia in the hospital is high blood pressure, cerebral infarction, and coronary heart disease (.2.) with "Chinese diabetes risk assessment standard" for high blood glucose but undiagnosed diabetes. The score was 31.78 + 7.86, of which 97% were higher than the Chinese diabetes risk critical score (25). It was also significantly higher than the normal blood glucose level in the hospital patients at the same time. It was suggested that the score standard has a better risk predictive ability of.3.T2DM in patients with the disease course, systolic pressure, glycated hemoglobin and glycerol three ester control status as the main risk factor for microvascular disease. T2DM body mass index, glycosylated hemoglobin, total cholesterol and triglyceride levels are the main risk factors for cardiovascular and cerebrovascular diseases.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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