2型糖尿病神经病变相关因素患病危险性分析.doc

2型糖尿病神经病变相关因素患病危险性分析 　【摘要】 目的 分析与2型糖尿病有关的多种因素与周围神经病变的相关性，探讨这些因素对发生神经病变危险度。方法 连续收集病房与门诊2型糖尿病患者378例，正常对照31例，检查神经传导和心脏植物神经功能，结合患者一般情况与生理生化指标，统计分析这些资料的内在关系。结果 2型糖尿病神经病变与年龄、病程、身高、体重指数、吸烟、葡萄糖及胰岛素曲线下面积、空腹与餐后2 h、3 h的血糖和其同步的血浆胰岛素水平有一定的相关性；发生神经病变危险度较高的因素有年龄、HbA1c、餐后3 h血糖、吸烟、病程、舒张压，而胰岛素曲线下面积有保护作用（相对危险度为0.9935）。结论 2型糖尿病患者应积极控制血糖、血压与戒烟，要严格控制餐后血糖，并适当提早用胰岛素降糖。 【关键词】 糖尿病神经病变;糖尿病，2型;神经传导速度 Analysis of factors associated with neuropathy in type 2 diabetes mellitus and their related risk ［Abstract］ Objective Many diabetic related factors were analyzed to reveal their association and risk to diabetic neuropathy in type 2 diabetes mellitus.Methods 378 cases of type 2 diabetic patients were collected continuously at outpatient and ward department,and 31 normal controls were grouped with matched sex and age.The patients were examined clinically to get their materials including physiological and biochemical marks,nerve conductive velocity,and cardiac autonomic nerve function.Results The neuropathic changes were associated with age,diabetic period,body height,BMI,smoking,GAUC,IAUC,plasma glucose and insulin concentration of 2 hours and 3 hour after meal.The high risk factors to diabetic neuropathy were age,HbA1c,plasma glucose level of 3 hour after meal,smoking,diabetic period,diastolic blood pressure.On contrast,the IAUC had protective effect to neuropathy （associated risk was 0.9935）.Conclusion Patients with type 2 diabetes mellitus should strictly control their plasma glucose （especially postmeal glucose）,blood pressure,give up smoking,and apply insulin early and properly. ［Key words］ diabetic neuropathy;diabetes mellitus，type 2;nerve conductive velocity 糖尿病神经病变与血糖、血管因素关系密切，与糖尿病的其他因素，如血脂、体重、吸烟等的关系，文献论述在逐渐增多［1］。有关糖尿病神经病变危险因素，糖代谢方面通过1型糖尿病的相关因素分析，较好地反映糖尿病因素对神经病变的影响，2型糖尿病有些特点与1型糖尿病有差别，如年龄、血管等因素，这些对糖尿病神经病变的影响程度有的已经有一些研究，有些如内源性胰岛素还有待于进一步证实明确［2］。另外，不同的人群由于基因背景、生活方式不一样，可能也会有差别。本文收集2型糖尿病患者的糖尿病、心血管病变等有关资料，研究糖尿病神经病变发生情况以及它们之间的关系、危险性。 1 对象与方法 1.1 研究对象 1.1.1 2型糖尿病组 收集2005年内我院内分泌代谢病病房与门诊明确为2型糖