减重手术对肥胖合并2型糖尿病患者的糖尿病肾病和视网膜病变的影响和预后研究

发布时间：2022-04-28 20:21

　　目的糖尿病发病率逐年增加,糖尿病肾病作为糖尿病最常见的微血管并发症之一,因发病率高、治疗效果不佳给患者和社会带来沉重的负担。近年来研究发现减重手术除可以明显降低肥胖患者体重外,还能够有效改善术后患者血糖水平及糖尿病肾病及糖尿病其他相关并发症。本文研究糖尿病肾病的相关危险因素,并对减重手术对肥胖合并2型糖尿病患者糖尿病肾病及糖尿病视网膜病变的影响和预后予以研究。方法入组219例糖尿病患者,根据有无糖尿病肾病将其分为单纯糖尿病组和糖尿病肾病组,比较两组患者各临床资料之间的差异以分析糖尿病患者发生糖尿病肾病的危险因素。同时对于127例行减重手术的肥胖合并2型糖尿病患者进行前瞻性研究,随访时间为一年,比较术后一年患者体重、血糖水平、糖尿病肾病、及糖尿病微血管并发症的差异和术后转归的预测因子,以评估减重手术对此类患者的治疗效果。结果糖尿病肾病组患者与单纯糖尿病组患者相比,糖尿病病程、BMI、收缩压、舒张压、糖化血红蛋白、肾小球滤过率、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、糖尿病视网膜病变存在明显差异,对糖尿病肾病的多因素二元logistic回归分析显示,长糖尿病病程、肥胖、高血压、高... 

【文章页数】：129 页

【学位级别】：博士

【文章目录】：
摘要
abstract
中英文缩写词
中文部分
    第一部分 糖尿病肾病相关危险因素的分析
        1.1 引言
        1.2 对象及方法
            1.2.1 研究对象
            1.2.2 排除标准
            1.2.3 体格及生化指标采集
            1.2.4 眼底检查
            1.2.5 糖尿病肾病定义
        1.3 数据分析
            1.3.1 软件应用
            1.3.2 统计方法
        1.4 结果
            1.4.1 基本情况
            1.4.2 DN组肾功能与DM组无显著差异
            1.4.3 DN组血压和血脂显著高于DM组
            1.4.4 DN组糖尿病视网膜病变发病率显著高于DM组
            1.4.5 DN相关危险因素的多因素二元logistic回归分析
        1.5 讨论
        1.6 结论
    第二部分 减重手术对肥胖合并2型糖尿病患者的糖尿病肾病和视网膜病变的影响和预后研究
        2.1 引言
        2.2 对象及方法
            2.2.1 研究对象
            2.2.2 排除标准
            2.2.3 终止随访标准和终点事件
            2.2.4 病史及术前指标采集
            2.2.5 眼底检查
        2.3 统计学方法
            2.3.1 软件应用
            2.3.2 统计方法
        2.4 结果
            2.4.1 全体糖尿病患者基本情况
            2.4.2 全体糖尿病患者生化指标
                2.4.2.1 患者血糖水平明显下降
                2.4.2.2 患者尿蛋白及肾脏超滤过明显改善
                2.4.2.3 患者血脂紊乱明显改善
                2.4.2.4 患者糖尿病视网膜病变无明显改变
            2.4.3 术前合并有糖尿病肾病患者的亚组分析
                2.4.3.1 术前合并糖尿病肾病患者的基本情况
                2.4.3.2 术前合并糖尿病肾病患者生化指标转归
                    2.4.3.2.1 血糖水平显著下降
                    2.4.3.2.2 糖尿病肾病明显缓解
                    2.4.3.2.3 血脂紊乱明显改善
                    2.4.3.2.4 糖尿病视网膜病变未见明显改善
            2.4.4 糖尿病肾病缓解的预测因子比较
        2.5 讨论
        2.6 结论
    总结与展望
        一、研究工作与总结
        二、本研究的创新性及临床价值
        三、本研究的局限和不足
英文部分
    Part Ⅰ The research of risk factors of diabetic nephropathy
        1.1 Introduction
        1.2 Objects and methods
            1.2.1 Study subjects
            1.2.2 Exclusion standard
            1.2.3 Physical and biochemical data collection
            1.2.4 Diabetic retinopathy examination
            1.2.5 Definition of diabetic nephropathy
        1.3 Data analysis
            1.3.1 Software Application
            1.3.2 Statistical methods
        1.4 Results
            1.4.1 Basic characteristics
            1.4.2 No significant differences between DM group and DN group in kidney function
            1.4.3 Blood pressure and blood lipids are higher in DN group than DM group
            1.4.4 Incidence of diabetic retinopathy are higher in DN group
            1.4.5 Multivariate binary logistic regression analysis of risk factors for DN
        1.5 Discussion
        1.6 Conclusion
    Part Ⅱ The research of the effect and prognosis of weight loss surgery on diabetic nephropathy and retinopathy of obese patients with T2DM
        2.1 Introduction
        2.2 Objects and methods
            2.2.1 Study subjects
            2.2.2. Exclusion standard
            2.2.3 Follow-up and end-point events
            2.2.4 Physical and biochemical data collection before surgery
            2.2.5 Diabetic retinopathy examination
        2.3 Data analysis
            2.3.1 Software Application
            2.3.2 Statistical methods
        2.4 Results
            2.4.1 Basic characteristics of all diabetic patients
            2.4.2 Biochemical characteristics of all diabetic patients
                2.4.2.1 Blood sugar and Hb A1c showed significant decrease
                2.4.2.2 Proteinuria and hyperfiltration improved significantly in all patients
                2.4.2.3 Blood lipid decreased significantly
                2.4.2.4 Diabetic retinopathy showed no significant changes
            2.4.3 Subgroup analysis of patients with diabetic nephropathy at baseline
                2.4.3.1 Basic characteristics of patients with diabetic nephropathy at baseline
                2.4.3.2 Biochemical characteristics of patients with DN at baseline
                    2.4.3.2.1 Blood sugar and Hb A1c showed significant decrease
                    2.4.3.2.2 Albuminuria and hyperfiltration improved significantly
                    2.4.3.2.3 Blood lipid decreased significantly
                    2.4.3.2.4 Diabetic retinopathy showed no significant changes
            2.4.4 Comparison of preoperative factors of DN remission
        2.5 Discussion
        2.6 Conclusions
    Summarize and Expectation
        1.Summary of the research
        2. Innovation of the research
        3.Limitation of the research
参考文献
致谢
学术论文和科研成果目录
八年制学位论文要求


【参考文献】：
期刊论文
[1]肥胖型2型糖尿病减重手术筛选与术前评估[J]. 张晓娟,程中,田浩明.  药品评价. 2013(09)



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