糖尿病肾病的危险因素及其与中医证型的相关性研究

发布时间：2018-03-30 04:23

本文选题：糖尿病肾病　切入点：中医证型　出处：《大连医科大学》2016年硕士论文

【摘要】：目的:对大连医科大学附属第二医院住院的2型糖尿病患者及糖尿病肾病(diabetic nephropathy,DN)患者的病历资料进行回顾性分析,研究2型糖尿病患者并发DN的危险因素,并探讨糖尿病肾病中医证型与相关指标之间的内在联系,从而为糖尿病肾病的预防干预提供思路,为糖尿病肾病临床辨证提供参考。方法:随机选择2014年3月到2015年10月在大连医科大学附属第二医院内分泌科、肾内科、中医科确诊为2型糖尿病的患者共183例,其中伴有糖尿病肾病的有96例,分为DN组;不伴有糖尿病肾病的有87例,分为NDN(non diabetic nephropathy)组。将糖尿病肾病患者分为阴虚燥热型、气阴两虚型、脾肾气虚型、阴阳两虚型4个中医证型。对所有患者的性别、年龄、病程、体质指数、血脂(胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白)、血压(收缩压、舒张压、脉压差)、血糖(空腹血糖、餐后2h血糖)、糖化血红蛋白、空腹胰岛素、胰岛素敏感指数、胱抑素C、尿蛋白/肌酐比值进行统计。分析2型糖尿病并发DN的危险因素,探讨糖尿病肾病各证型与上述各个指标间的相关性。观察结果用SPSS13.0进行统计学分析,所有计量资料用均数±标准差(sx?)表示,符合正态分布的采用成组t检验,不符合正态分布的采用秩和检验,多组间比较采用方差分析;计数资料以百分率(%)表示,采用χ2卡方检验;用Logistic回归分析分析相关危险因素。结果:1.DN组与NDN组在吸烟史、年龄、病程方面差异具有统计学意义(P0.05),DN组较NDN组吸烟患者更多,年龄更大,病程更长。两组间在性别、饮酒史、糖尿病家族史、体质指数方面差异无统计学意义(P0.05)。2.DN组与NDN组的收缩压、脉压差差异具有统计学意义(P0.05),DN组患者收缩压和脉压差水平高于NDN组;而两组间舒张压、血脂水平差异无统计学意义(P0.05)。3.DN组空腹血糖、空腹胰岛素、胱抑素C水平高于NDN组,DN组胰岛素敏感指数低于NDN组,差异具有统计学意义(P0.05),两组间餐后2h血糖、糖化血红蛋白差异无统计学意义(P0.05)。4.为明确DN发生的相关危险因素,将上述与DN发生具有显著性差异的相关因素进行Logistic回归分析,结果显示:病程(OR=1.083,P=0.006)、胱抑素C(OR=2.427,P=0.037)、空腹血糖(OR=1.131,P=0.011)、空腹胰岛素(OR=1.021,P=0.044)是糖尿病肾病的危险因素。5.DN各证型组间病程、胱抑素C、尿蛋白/肌酐并不完全相等(P0.05),两两比较结果得出,在病程方面,脾肾气虚组和阴阳两虚组均与阴虚燥热组有统计学差异(P0.05),脾肾气虚组和阴阳两虚组患者病程均长于阴虚燥热组患者;阴阳两虚组在胱抑素C和尿蛋白/肌酐方面均较其他三个证型组高,差异有统计学意义(P0.05)。DN各证型组间性别、年龄、BMI、血压、血脂、吸烟史、饮酒史、糖尿病家族史、空腹血糖、餐后2h血糖、糖化血红蛋白、胰岛素敏感指数、胱抑素C、尿蛋白/肌酐比的差异均无统计学意义(P0.05)。结论:1.年龄、病程、吸烟史、收缩压、脉压差、胱抑素C、空腹血糖、空腹胰岛素、胰岛素敏感指数与糖尿病肾病的发病有关,其中病程、空腹血糖、胱抑素C、空腹胰岛素是糖尿病肾病的危险因素。病程越长、空腹血糖越高、空腹胰岛素越高、胱抑素C越高,越容易并发糖尿病肾病。2.病程、胱抑素C、尿蛋白/肌酐与糖尿病肾病的中医分型存在联系:脾肾气虚组和阴阳两虚组患者病程均长于阴虚燥热组患者;阴阳两虚组胱抑素C、尿蛋白/肌酐比值均较其余三个证型组高,提示了阴阳两虚型是糖尿病肾病的终末证型。
[Abstract]:Objective: to patients with type 2 diabetes and diabetic nephropathy in Second Affiliated Hospital of Dalian Medical University (diabetic nephropathy, DN) were analyzed retrospectively. The risk factors of DN in patients with type 2 diabetes mellitus, and to explore the relationship between TCM Syndromes of diabetic nephropathy and related indicators, so as to provide ideas for the prevention and intervention of diabetes mellitus kidney disease, to provide reference for the clinical diagnosis of diabetic nephropathy. Methods: randomly selected from March 2014 to October 2015 in the Second Affiliated Hospital of Dalian Medical University, Department of Endocrinology, Department of traditional Chinese medicine, Department of Nephrology, diagnosed with type 2 diabetes patients with a total of 183 cases with diabetic nephropathy in 96 cases, divided into the DN group; not associated with diabetic nephropathy in 87 cases, divided NDN (non diabetic nephropathy) group. The patients with diabetic nephropathy were divided into yin deficiency, Qi Yin deficiency, spleen qi deficiency, yin and yang two The 4 type of deficiency syndromes. All patients gender, age, duration, body mass index, blood lipids (cholesterol, triglycerides, high density lipoprotein, low density lipoprotein), blood pressure (systolic blood pressure, diastolic blood pressure, pulse pressure), blood glucose (fasting blood glucose, postprandial blood glucose, glycosylated hemoglobin, 2H) fasting insulin, insulin sensitivity index, Cystatin C, urinary protein / creatinine ratio statistics. Analysis of type 2 diabetes risk factors associated with DN, to investigate the correlation between diabetic nephropathy syndrome type with the indexes. Results were statistically analyzed using SPSS13.0 standard deviation for all measurement data (SX?) said that accord with normal distribution using t test, does not meet the normal distribution using the rank sum test, analysis of variance was used to compare between groups; count data by percentage (%), with 2 chi square test; analysis of the related risk factors with Logistic regression analysis. Results: 1.DN group and NDN group in the history of smoking, age, course of disease was statistically significant difference (P0.05), DN group compared with NDN group, smoking patients had more older, longer duration. Between the two groups in gender, drinking history, family history of diabetes, there was no significant difference on body mass index (P0.05) of.2.DN group with the NDN group of systolic blood pressure, pulse pressure difference was statistically significant (P0.05), DN group of patients with systolic pressure and pulse pressure levels higher than the NDN group; and two groups of diastolic pressure, no significant difference of serum lipid levels (P0.05) in group.3.DN, fasting blood glucose, fasting insulin, serum cystatin C levels higher than the NDN group, DN group the insulin sensitivity index was lower than the NDN group, the difference was statistically significant between the two groups (P0.05), 2h postprandial blood glucose, no statistically significant difference in glycated hemoglobin (P0.05) specific.4. related risk factors of DN, DN and the related factors with significant difference Logistic regression analysis results showed that duration (OR=1.083, P=0.006), Cystatin C (OR=2.427, P=0.037), fasting blood glucose (OR=1.131, P=0.011), fasting insulin (OR=1.021, P=0.044).5.DN is a risk factor for diabetic nephropathy syndromes group course of cystatin C, urinary protein / creatinine (P0.05 is not completely equal 22), the results showed that in the course of disease, both spleen and kidney qi deficiency group and Yin and yang deficiency group had significant difference with the two yinxuzaore group (P0.05), spleen and kidney qi deficiency group and Yin and Yang of the two virtual group patients were longer than those of yin asthenia and heat group patients; two of yin and yang deficiency group in cystatin C and urine protein / creatinine compared with other three groups, the difference was statistically significant (P0.05.DN) the syndrome group between gender, age, BMI, blood pressure, blood fat, smoking history, drinking history, family history of diabetes, fasting blood glucose, 2h postprandial blood glucose, glycosylated hemoglobin, insulin sensitive index, inhibition of cystine C, urine protein / creatinine ratio differences were not statistically significant (P0.05). Conclusion: 1. age, disease duration, smoking history, systolic blood pressure, pulse pressure, Cystatin C, fasting blood glucose, fasting insulin, insulin sensitivity index, the incidence of diabetic nephropathy with the course of disease, fasting blood glucose, fasting serum cystatin C insulin is a risk factor for diabetic nephropathy. The longer the duration, the higher the fasting blood glucose, fasting insulin is higher, Cystatin C is higher, more prone to diabetic nephropathy in the course of.2., Cystatin C, urinary protein / creatinine and diabetic nephropathy in TCM are linked: spleen kidney qi deficiency group and Yin and yang deficiency patients were two course longer than yinxuzaore group patients; two of yin and yang deficiency group of cystatin C, urinary protein / creatinine ratio was better than the other three groups, suggesting that the two type is the end of yin and yang deficiency syndrome of diabetic nephropathy.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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