| Objective : To explore the prevalence and the changes of risk factors of diabetic kidney disease(DKD)in hospitalized patients with type 2 diabetes mellitus(T2DM)during 2008 to2018,so as to provide reference for the selection of DKD prevention and treatment plan for clinical DKD patients.Methods : Choose 888 patients with type 2 diabetes hospitalized to Department of Endocrinology from 2007 to 2008 as well as 1014 patients in 2018 as research objects,and the review research method was adopted.The clinical data of subjects were collected,including age,height,weight,course of disease,blood sugar,glycosylated hemoglobin,blood lipid and complications and complications of diabetes.According to the presence or absence of diabetic kidney disease,the patients were divided into two groups: uncomplicated type 2diabetes group and diabetic kidney disease group,both in the two parts of before and after 10 years.The data between the two groups were compared respectively in the two parts of the subjects before and after 10 years,to find the risk factors of diabetic kidney disease.The risk factors of diabetic kidney disease were compared before and after 10 years to find the changes.Comparing the counting data among groups by chi square test,and comparing the measuring data by t test.Multivariate logistic regression analysis was carried out.The changes of the prevalence and independent risk factors of diabetic kidney disease were discussed,according to the results of multivariate logistic regression analysis.Outcomes:1 Comparison of general clinical data of T2 DM patients before and after 10 yearsIn this study,a total of 888 subjects were enrolled 10 years ago,including 373 males(42%),515 females(58%),61.88 ± 12.01 years old,9.58 ± 7.03 years of diabetes history,and8.29 ± 2.11% of HemoglobinA1c(HbA1c).Ten years later,a total of 1014 subjects were enrolled,including 517 males(51%),497 females(49%),63.58 ± 11.34 years old,12.57 ±7.85 years of diabetes history,and 8.41 ± 1.92% of HbA1 c.After 10 years,fasting C-Peptide(C-P0h)(2.03± 1.30 vs 2.75±2.04),1-hour postprandial C Peptide(C-P1h)(3.07±2.04 vs 4.99±3.67),2-hour postprandial C Peptide(C-P2h)(3.84±2.48 vs 6.23±5.15),Diastolic Blood Pressure(DBP)(77.54±11.46 vs 80.06±11.59),Fasting Blood Glucose(FBG)(7.17±2.56 vs 8.41±2.57),High Density Lipoprotein Cholesterol(HDL-C)(1.15±0.32 vs 1.21±0.27)and Total Cholesterol(TC)(4.56±1.24 vs 4.94±1.28)of T2 DM patients was lower than that of 10 years ago,and the other indexes were higher than that of 10 years ago.Furthermore the control rate of the waistline(15.67% vs 38.86%),SBP(28.63% vs31.10%),HbA1c(24.64% vs 31.59%),HDL-C(61.93% vs 79.27%)as well as Triglyceride(TG)(42.86% vs 51.87%)of T2 DM patients was lower than that in 10 years ago.After 10 years,the comprehensive standard rate of blood lipid(TC < 4.5mmol/l,TG < 1.7mmol/l,HDL-C > 1.0mmol/l in man,> 1.3mmol/l in female),blood glucose(FBG 4.4mmol/l to7.0mmol/l,HbA1 c < 7.0%),blood pressure(< 130 / 80mmHg)in T2 DM patients was also lower than that before 10 years(1.48% vs 2.25%).2 The proportion of T2 DM patients complicated with DKD before and after 10 years and the comparison of clinical data of DKD patientsAmong the 888 subjects 10 years ago,there were 629 T2 DM patients and 259 DKD patients.The proportion of DKD patient was 29.17%.Ten years later,there were 707 T2 DM patients and 307 DKD patients in 1014 subjects.The proportion of DKD patient was 30.28%.Pearson chi square test showed that ? 2= 0.279,P = 0.597 > 0.05,without statistical difference.Compared with patients with DKD 10 years ago,patients with DKD 10 years later had longer history of diabetes(14.90±7.58 vs 12.15±7.14),larger waist circumference(98.94±9.81 vs 96.64±11.79),greater hip circumference(102.61±8.20 vs 100.70±10.16),higher HbA1c(8.88±1.94 vs 8.53±2.05),and higher TG(2.29±2.54 vs 1.94±1.61),higher Uric Acid(UA)(364.47±100.6 vs 335.16±98.80),higher proportion of smoking(22.10% vs14.30%),higher proportion of drinking(74.50% vs 9.30%),but lower TC(4.77±1.42 vs 5.24±1.47),lower HDL-C(1.18 ±0.33),lower DBP(78.63 ±11.81 vs 80.67 ±11.11),lower c-p0h(2.10±1.41 vs 2.71±2.05),lower c-p1h(2.83±2.19 vs 4.75±3.40),lower c-p2h(3.34±2.11 vs 6.05±5.02),lower Low Density Lipoprotein Cholesterol(LDL-C)(2.83±1.13 vs 3.07±1.07),lower FBG(7.40±2.75 vs 8.71± 2.69),the difference was statistically significant(P < 0.05).3 Comparison of general clinical data,complications and coexisted diseases between T2 DM group and DKD group 10 years agoIn this study,10 years ago,the comparison of general clinical data,complications and coexisted diseases between T2 DM group and DKD group showed that DKD group ' s hypertension history(77.60% vs 63.00%),Diabetic Retinopathy(DR)(69.90% vs 50.10%)and cardiovascular disease ratio(60.20% vs 46.30%)were higher,with statistical significance(P < 0.05).DKD group 's smoking history ratio(14.30% vs 20.70%)was lower,with statistical significance(P < 0.05).4 Comparison of general clinical data,complications and coexisted diseases between T2 DM group and DKD group 10 years laterIn this study,10 years later,the comparison of general clinical data,complications and coexisted diseases between T2 DM group and DKD group showed that DKD group ' s hypertension history(65.80% vs 50.80%),DR(50.20% vs 31.70%)and cardiovascular disease ratio(61.90% vs 48.40%)were higher,with statistical significance(P < 0.05).5 Comparison of general clinical data and biochemical indexes between T2 DM group and DKD group 10 years agoIn this study,10 years ago,the comparison of general clinical data and biochemical indexes between T2 DM group and DKD group showed that DKD group ' s waist circumference(96.64±11.79 vs 92.58±11.16),weight(73.08±13.06 vs 70.88±12.12),hip circumference(100.70±10.16 vs 98.58±10.57),diabetes history(12.15±7.14 vs 8.53±6.70),SBP(148.72±23.42 vs 137.51±20.57),FBG(8.71±2.69 vs 8.26±2.49),HbA1c(8.53±2.05 vs 8.18±2.13),TC(5.24±1.47 vs 4.81±1.16),LDL-C(3.07±1.07 vs 2.81±0.79),UA(335.16±98.80 vs 284.47±72.50)were higher,with statistically significant(P< 0.05).DKD group's hemoglobin(Hb)(122.23±19.33 vs 128.47±15.68)was lower,with statistically significant(P < 0.05).6 Comparison of general clinical data and biochemical indexes between T2 DM group and DKD group 10 years laterIn this study,10 years later,the general clinical data and biochemical indexes between T2 DM group and DKD group showed that T2 DM group's diabetes history(14.90±7.58 vs11.57±7.75),age(64.84±12.34 vs 63.03±10.84),weight(74.69±12.00 vs 72.64±13.01),waist circumference(98.94±9.81 vs 95.33±10.50),hip circumference(149.93±20.52 vs100.57±8.18),DBP(78.63±11.81 vs 77.07±11.27),TG(2.29±2.54 vs 1.78±1.71),SBP(148.72±23.42 vs 138.35±18.66),HbA1c(8.88±1.94 vs 8.21±1.88),TC(4.77±1.42 vs 4.47±1.44),LDL-C(2.83±1.13 vs 2.61±0.89),UA(364.47±100.6 vs 321.27±83.59)were lower,with statistically significant(P < 0.05).DKD group's C-P1h(2.83±2.19 vs 3.16±1.97)?C-P2h(3.34±2.11 vs 4.04±2.58)?Hb(119.22±21.85 vs 132.20±14.49)?HDL-C(1.18±0.33 vs 1.24±0.30)were lower,with statistically significant(P < 0.05).7 Multivariate logistic regression analysis of risk factors of DKD 10 years agoThe multivariate logistic regression analysis was used to analyze the data of 10 years ago with the forward method,taking whether the patients were combined with DKD as the dependent variable and DR,UA,SBP,HbA1 c,Hb,HDL-C,LDL-C,TC,TG,cardiovascular history,course of diabetes,smoking history,age,weight,hip circumference,and history of hypertension as the independent variables.The results showed that the risk factors of DKD were HbA1c(1%)(P < 0.01,OR = 1.150),SBP(20mmhg)(P < 0.01,OR = 1.678),UA(100umol / L)(P < 0.01,OR = 1.513),Dr(P < 0.01,OR = 1.813),diabetes history(5 years)(P< 0.01,OR = 1.190).8 Multivariate logistic regression analysis of risk factors of DKD after 10 yearsThe multivariate logistic regression analysis was used to analyze the data after 10 years with the forward method,taking whether the patients were combined with DKD as the dependent variable and DR,HbA1 c,SBP,DBP,Hb,HDL-C,LDL-C,UA,TC,TG,hypertension,waist circumference,smoking history,diabetes family history,diabetes history,cardiovascular history,age,weight and hip circumference as independent variables.The results showed that the risk factors of DKD were HbA1c(1%)(P < 0.01,OR = 1.284),SBP(20mmhg)(P < 0.01,OR = 1.636),UA(100umol / L)(P < 0.01,OR = 1.477),Dr(P < 0.01,OR = 1.655),TC(1mmol / L)(P < 0.01,OR = 1.219),waist circumference(10cm)(P < 0.01,OR = 1.296),hypertension(P < 0.05,OR = 1.535).The protective factors of DKD were HB(20g)(P < 0.01,OR = 0.417),HDL-C(0.5mmol / L)(P < 0.05,OR = 0.569).Conclusion:1.There was no significant difference in the proportion of type 2 diabetes mellitus patients with DKD before and after 10 years,and the situation of DKD prevention and control was still severe.2.The same risk factors of DKD were HbA1 c,SBP,UA and DR.It is suggested that the management of blood glucose,blood pressure,blood uric acid and DR is still the key to the prevention and treatment of DKD.3.The contribution of diabetes duration to DKD in T2 DM patients decreased,but the contribution of TC increased,waist circumference increased,HDL-C,Hb decreased to DKD increased.More attention should be paid to the above aspects in DKD prevention and control. |
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