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目的探讨糖尿病肾病与非肾病患者冠心病患病率及其危险因素的相关性。方法回顾性分析295例2型糖尿病患者的临床资料,根据Mogensen糖尿病肾病诊断标准分为糖尿病肾病组(DN组)和非肾病组(N-DN组),比较两组患者性别、年龄、病程、吸烟史、体质指数(BMI)、糖化血红蛋白(HbA1C)、血压、血脂谱、血清尿酸(UA)、血浆纤维蛋白原(FIB)、血清肌酐(Cr)、肌酐清除率(CCr)、24h尿微量白蛋白(uMA)水平及冠心病患病率;采用Logistic回归分析糖尿病肾病对冠心病患病的影响。结果DN组患者Cr(97.17vs71.34)、uMA(279.56vs14.56)高于N-DN组,CCr低于N-DN组(94.82vs121.94),差别有统计学意义(P<0.01)。DN组冠心病患病率(57.33%vs38.62%)、糖尿病病程、血压、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、UA及FIB水平高于N-DN组(P<0.05);单因素Logistic回归分析显示,糖尿病肾病与糖尿病病程、血压、TC、LDL-C、UA及FIB显著正相关;多因素Logistic回归分析显示,CCr(OR=0.987,95%CI:0.987～0.996)、年龄(OR=1.040,95%CI:1.015～1.065)、收缩压(OR=1.017,95%CI:1.005～1.029)是冠心病的独立危险因素。结论糖尿病肾病患者冠心病患病率较高;CCr下降是2型糖尿病患者合并冠心病的独立危险因素。
Objective To investigate the correlation between the prevalence of coronary heart disease and its risk factors in patients with diabetic nephropathy and non-nephropathy. Methods The clinical data of 295 patients with type 2 diabetes mellitus were retrospectively analyzed. According to the diagnostic criteria of Mogensen diabetic nephropathy, the patients were divided into diabetic nephropathy group (DN group) and non-nephropathy group (N-DN group). The gender, age, course of disease, Smoking history, body mass index (HbA1C), blood pressure, blood lipid profile, serum uric acid (UA), fibrinogen (FIB), serum creatinine (Cr), creatinine clearance (CCr) Albumin (uMA) levels and the prevalence of coronary heart disease; use of Logistic regression analysis of diabetic nephropathy on the prevalence of coronary heart disease. Results The levels of Cr (97.17 vs 71.34), uMA (279.56 vs 14.56) in DN group were significantly higher than those in N-DN group and CCr was lower than that in N-DN group (94.82 vs 121.94) (P <0.01) . The prevalence of coronary heart disease in DN group was significantly higher than that in N-DN group (57.33% vs38.62%), diabetes duration, blood pressure, cholesterol, low density lipoprotein cholesterol, UA and FIB (P < 0.05). Logistic regression analysis showed that diabetic nephropathy was positively correlated with duration of diabetes, blood pressure, TC, LDL-C, UA and FIB. Multivariate logistic regression analysis showed that CCr (OR = 0.987, 95% CI 0.987 ~ 0.996), age (OR = 1.040, 95% CI: 1.015-1.065) and systolic blood pressure (OR = 1.017, 95% CI: 1.005-1.029) were independent risk factors for CHD. Conclusions The prevalence of coronary heart disease is high in patients with diabetic nephropathy. The decrease of CCr is an independent risk factor for type 2 diabetes mellitus with coronary heart disease.