2型糖尿病患者缺血性脑血管疾病的流行状况和相关因素研究

发布时间：2018-07-22 20:50

【摘要】：目的:分析2型糖尿病患者缺血性脑血管疾病的流行状况和分布特点,并探索2型糖尿病患者中陈旧性脑梗塞和慢性脑供血不足的相关因素,为糖尿病患者缺血性脑血管疾病的防治提供科学研究依据。方法:回顾性查阅2008年1月1日至2013年3月1日天津医科大学代谢病医院住院的2型糖尿病患者(2525例)的病历资料,摘录相关信息,选取其中有明确脑血管疾病史和本次住院进行过CT或MRI检查的2型糖尿病患者共2169例作为本次的研究对象,分析2型糖尿病患者陈旧性脑梗死及慢性脑供血不足的患病情况和分布特点;分别选取其中陈旧性脑梗死的2型糖尿病患者178例、慢性脑供血不足的2型糖尿病患者388例作为病例组,无脑血管病的2型糖尿病患者1372例作为对照组,采用非条件Logistic回归模型分析陈旧性脑梗死及慢性脑供血不足的相关因素,计算比值比(OR)及其95%可信区间(95%CI)。结果:1、在2169例2型糖尿病住院患者中,797例有脑血管疾病,患病率为36.7%,包括陈旧性脑梗塞178例,患病率为8.2%,慢性脑供血不足388例,患病率为17.9%;1372例2型糖尿病患者无脑血管疾病。陈旧性脑梗塞和慢性脑供血不足患者的患病率均随着2型糖尿病患者年龄和病程的增加而增加。2、陈旧性脑梗塞组平均年龄、SBP、血尿酸水平及周围神经病变、高血压、冠心病、糖尿病足、高纤维蛋白原血症的患病率高于无脑血管疾病组。慢性脑供血不足组的平均年龄及骨质疏松患病率高于无脑血管疾病组。差异具有统计学意义。陈旧性脑梗塞组及脑供血不足组的Hb A1c水平均低于无脑血管疾病组,差异具有统计学意义。3、单因素Logistic回归分析结果显示:高龄、男性、糖尿病病程长、合并周围神经病变、高血压、冠心病、糖尿病足、高纤维蛋白血症、骨质疏松、高血压家族史、BMI(29)24kg/m2与2型糖尿病中陈旧性脑梗塞高风险有统计学关联。高龄、糖尿病病程长、周围神经病变、高血压、冠心病、高纤维蛋白血症及骨质疏松与2型糖尿病中慢性脑供血不足的高风险有统计学关联。对上述单因素Logistic分析有统计学关联的变量,采用前进法进行多因素Logistic回归分析,结果显示高龄、男性、糖尿病病程长、BMI(29)24kg/m2及有高血压疾病史与2型糖尿病中陈旧性脑梗塞的高风险有关。年龄大、合并骨质疏松与2型糖尿病中慢性脑供血不足的高风险有关。结论:2型糖尿病患者中缺血性脑血管疾病的患病率较高。陈旧性脑梗塞和慢性脑供血不足的患病率均随2型糖尿病患者年龄和病程的增加而增加。2型糖尿病患者的年龄、性别以及相关疾病可能与陈旧性脑梗塞和慢性脑供血不足有关。
[Abstract]:Objective: to analyze the prevalence and distribution of ischemic cerebrovascular diseases in patients with type 2 diabetes, and to explore the related factors of old cerebral infarction and chronic cerebral insufficiency in patients with type 2 diabetes. To provide scientific basis for the prevention and treatment of ischemic cerebrovascular disease in diabetic patients. Methods: from January 1, 2008 to March 1, 2013, the medical records of 2525 patients with type 2 diabetes mellitus in the metabolic disease hospital of Tianjin Medical University were reviewed and the relevant information was extracted. A total of 2169 patients with type 2 diabetes mellitus who had a definite history of cerebrovascular disease and had been examined by CT or MRI in this hospital were selected as the subjects of this study. To analyze the prevalence and distribution of old cerebral infarction and chronic cerebral insufficiency in patients with type 2 diabetes mellitus, 178 cases of type 2 diabetes mellitus with old cerebral infarction were selected. There were 388 cases of type 2 diabetes with chronic cerebral insufficiency and 1372 cases of type 2 diabetes without cerebrovascular disease as control group. The factors related to old cerebral infarction and chronic cerebral insufficiency were analyzed by non-conditional logistic regression model. Calculate the ratio (OR) and its 95% confidence interval (95 CI). Results among 2169 hospitalized patients with type 2 diabetes, 797 had cerebrovascular disease, the prevalence rate was 36.7, including 178 cases of old cerebral infarction, the prevalence rate was 8.2 and 388 cases of chronic cerebral blood supply insufficiency. The prevalence rate was 17.9% and 1372 cases of type 2 diabetes without cerebrovascular disease. The prevalence of old cerebral infarction and chronic cerebral insufficiency increased with the increase of age and course of disease in type 2 diabetes mellitus. The mean age of patients with old cerebral infarction was SBP, serum uric acid level, peripheral neuropathy, hypertension, coronary heart disease. The prevalence of diabetic foot and hyperfibrinogenemia was higher than that of non-cerebrovascular disease group. The average age and the prevalence of osteoporosis in chronic cerebral insufficiency group were higher than those without cerebrovascular disease group. The difference is statistically significant. The levels of HB A1c in the old cerebral infarction group and the cerebral blood supply insufficiency group were lower than those in the non-cerebrovascular disease group, the difference was statistically significant. The results of univariate logistic regression analysis showed that the age, male, long course of diabetes, and peripheral neuropathy were the same as those in the old cerebral infarction group and the cerebral blood supply insufficiency group. Hypertension, coronary heart disease, diabetic foot, hyperfibrinemia, osteoporosis, family history of hypertension, BMI _ (29) 24kg/m2 were significantly associated with the high risk of old cerebral infarction in type 2 diabetes. Advanced age, long course of diabetes, peripheral neuropathy, hypertension, coronary heart disease, hyperfibrinemia and osteoporosis were associated with high risk of chronic cerebral insufficiency in type 2 diabetes. Multivariate logistic regression analysis was carried out for the variables with statistical correlation in the single factor logistic analysis. The results showed that the elderly, male, and male, were analyzed by multivariate logistic regression analysis. 24kg/m2 and history of hypertension were associated with high risk of old cerebral infarction in type 2 diabetes. Older patients with osteoporosis are associated with a high risk of chronic cerebral insufficiency in type 2 diabetes. Conclusion the prevalence of ischemic cerebrovascular disease is higher in type 2 diabetes mellitus. The prevalence of old cerebral infarction and chronic cerebral insufficiency increased with the increase of age and course of disease in type 2 diabetes mellitus. The age, sex and related diseases of type 2 diabetes mellitus patients may be related to old cerebral infarction and chronic cerebral insufficiency.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743;R587.2

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