【摘要】 目的 了解社区管理2型糖尿病（T2DM）患者的慢性肾病（CKD）患病率及影响因素，为防治慢性肾病，促进T2DM健康管理提供依据。方法 该研究基于“T2DM多种危险因素多中心临床干预与评价项目”基线调查，选择山东、福建、河南3个临床研究中心的2 914例糖尿病患者进行问卷调查、体格检查及实验室检测。使用SAS 9.4软件进行Pearson χ~2检验、Cochran-Armitage趋势检验、t检验和Wilcoxon秩和检验。采用非条件多因素logistic模型进行影响因素分析。结果 T2DM患者的CKD患病率为25.9%，其中男性CKD患病率为26.7%，女性为25.3%。T2DM病程<5、5～、≥10年者CKD患病率分别为20.8%、24.8%、31.6%，差异有统计学意义（P<0.01）。非条件多因素logistic回归分析显示，糖尿病病程5～年（OR=1.31,95%CI:1.02～1.68）、糖尿病病程≥10年（OR=1.75,95%CI:1.38～2.20）、高血压病程<5年（OR=2.01,95%CI:1.57～2.56）、5～年（OR=2.35,95%CI:1.71～3.22）及≥10年（OR=2.82,95%CI:2.17～3.67）、空腹C肽过高（OR=1.79,95%CI:1.19～2.69）、现在吸烟（OR=1.40,95%CI:1.10～1.78）、家庭收入1 500～元/月（OR=1.35,95%CI:1.07～1.70）、家庭收入<1 500元/月（OR=1.56,95%CI:1.25～1.95）均与CKD患病高风险相关；糖化血红蛋白达标（OR=0.49,95%CI:0.40～0.60）、甘油三酯达标（OR=0.68,95%CI:0.56～0.82）与CKD患病低风险相关。结论 社区管理糖尿病患者的CKD患病率高，降糖、控压、调脂、戒烟均有利于降低CKD患病风险，应进一步加强糖尿病病程长、共患高血压和空腹C肽高于正常水平者的CKD筛查，积极预防CKD发生，延缓疾病进展。更多还原

【Abstract】 Objective To understand the morbidity and influencing factors of chronic kidney disease（CKD） in patients with type 2diabetes mellitus（T2DM） managed by communities,provide the basis for the prevention and treatment of CKD,and promote the health management of T2DM. Methods Based on the baseline survey of "Multi-center Clinical Intervention and Evaluation of Multiple Risk Factors for Type 2 Diabetes",2 914 T2DM patients from three clinical research centers in Shandong,Fujian and Henan provinces were selected as the subjects,the investigation was performed with questionnaire,physical examination and laboratory tests. Pearson χ²test,Cochran-Armitage trend test,t test and Wilcoxon rank sum test were used to analyze the data.Unconditional multi-factor logistic regression model was used to analyze the influencing factors. The used software was SAS 9.4.Results The morbidity of CKD in T2DM patients was 25.9%,CKD morbidity（26.7%） in males was slightly higher than that（25.3%） in females. The morbidity rates of CKD in patients with T2DM disease duration <5 years,5-years and ≥10 years were20.8%,24.8% and 31.6% respectively（P<0.01）. Unconditional multi-factor logistic regression showed that T2DM disease duration of 5-years（OR=1.31,95%CI:1.02-1.68） and ≥10 years（OR=1.75,95%CI:1.38-2.20）,hypertension disease duration <5 years（OR=2.01,95%CI:1.57-2.56）,5-years（OR=2.35,95%CI:1.71-3.22）,and ≥10 years（OR=2.82,95%CI:2.17-3.67）,fasting Cpeptide（FCP）>normal value（OR=1.79,95%CI:1.19-2.69）,smoking（OR=1.40,95%CI:1.10-1.78）,family income between 1500-yuan/month（OR=1.35,95%CI:1.07-1.70）,and <1 500 yuan/month（OR=1.56,95%CI:1.25-1.95） were related to high risk of CKD;the low risk of CKD was related to glycated hemoglobin(HbA_1C) with normal value（OR=0.49,95%CI:0.40-0.60） and triglyceride（TG） with normal value（OR=0.68,95%CI:0.56-0.82）. Conclusion The morbidity of CKD is high among communitymanaged T2DM patients. Reducing blood glucose,controlling blood pressure,regulating blood lipid and quitting smoking are beneficial to reducing the risk of CKD. The screening for CKD in patients with long-term diabetes,coexisting hypertension,and fasting C-peptide levels above normal should be strengthened. CKD development should be prevented actively to delay the progression of CKD.更多还原