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目的通过分析2型糖尿病肾病住院患者既往心血管疾病(cardiavascular disease,CVD)发生史、颈动脉粥样硬化及左心室肥厚的情况,探讨2型糖尿病肾病患者CVD的发生情况。方法入选上海交通大学医学院附属仁济医院肾脏科住院治疗的2型糖尿病肾病患者共2 4 5例,根据肾小球滤过率(glomerular filtration rate,GFR)水平分为早中期组[GFR>30 ml/(min·1.73m~2)]、中晚期非透析组[GFR≤30 ml/(min·1.73m~2)]、透析组。收集入选患者CVD的发生情况、颈动脉多普勒超声及心脏彩超检查结果,并与临床相关资料进行比较分析。结果 245例入选患者,其中男性146例,女性99例,平均年龄64岁(55～70岁)。共有150例患者进行了颈动脉多普勒超声检查,其中88例(58.3%)发现颈动脉斑块,在33例早中期患者中,即有21例(63.6%)发现斑块。与正常参考值相比,各组患者的颈动脉内中膜厚度(intima-media thickhess,IMT)、颈总动脉阻力指数均显著增加。153例患者进行了心脏超声检查,其中120例(78.4%)存在左心室肥厚(left ventricular hypertrophy,LVH),在36例早中期患者中,即有21例(58.3%)有LVH。245例2型糖尿病肾病患者中,共147例既往发生CVD(60.0%),远高于普通人群的CVD发生率(36.3%)。各组患者CVD发生率均明显高于普通人群(36.3%),早中期患者的CVD发生率已达47.8%,中晚期患者CVD的发生率(67.9%)比早中期组显著性升高,差异有统计学意义(P=0.01 1)。结论 2型糖尿病肾病患者普遍存在颈动脉粥样斑块和LVH,其CVD发生率较普通人群明显升高,在早中期阶段CVD的发生率即存在增高趋势。
Objective To investigate the incidence of CVD in patients with type 2 diabetic nephropathy by analyzing the history of cardiavascular disease (CVD), carotid atherosclerosis and left ventricular hypertrophy in inpatients with type 2 diabetic nephropathy. Methods Twenty-five patients with type 2 diabetic nephropathy were enrolled in Department of Nephrology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine. According to the glomerular filtration rate (GFR) 30 ml / (min · 1.73m ~ 2)], advanced non-dialysis group [GFR≤30 ml / (min · 1.73m ~ 2)], dialysis group. The incidence of CVD in selected patients, carotid artery Doppler echocardiography and echocardiography were collected and compared with clinical data. Results A total of 245 patients were enrolled, including 146 males and 99 females, with a mean age of 64 years (55-70 years). A total of 150 patients underwent carotid artery Doppler ultrasound examination, of which 88 cases (58.3%) found carotid plaques in 33 cases of early and mid-term patients, that is, 21 cases (63.6%) found plaques. Compared with the normal reference value, the carotid artery intima-media thickness (IMT) and common carotid artery resistance index of each group were significantly increased. Of the 153 patients who underwent echocardiography, left ventricular hypertrophy (LVH) was present in 120 (78.4%) patients and LVH in 21 of 36 (58.3%) early-mid patients. A total of 147 patients with type 2 diabetic nephropathy had a history of CVD (60.0%), which was much higher than that of the general population (36.3%). The incidence of CVD in each group was significantly higher than that in the general population (36.3%). The incidence of CVD was 47.8% in early-mid stage and 67.9% in advanced stage than in early stage, the difference was significant There was statistical significance (P = 0.01 1). Conclusion The prevalence of carotid artery atherosclerotic plaque and LVH in patients with type 2 diabetic nephropathy is significantly higher than that in the general population, and the prevalence of CVD in the patients with type 2 diabetic nephropathy tends to increase.