上海市某社区成人2型糖尿病及其合并肾功能不全流行现况及相关因素

郁雨婷; 赵琦; 王娜; 姜永根; 张越; 周晓燕; 王瑞平; 赵根明

doi:10.16462/j.cnki.zhjbkz.2019.08.013

上海市某社区成人2型糖尿病及其合并肾功能不全流行现况及相关因素

doi: 10.16462/j.cnki.zhjbkz.2019.08.013

1.
200032 上海, 复旦大学公共卫生学院公共卫生安全教育部重点实验室
2.
201600 上海, 上海市松江区疾病预防控制中心

基金项目:

国家重点研发计划精准医学重点专项 2017YFC0907001

详细信息

通讯作者:
赵根明. E-mail: gmzhao@shmu.edu.cn

中图分类号: R587.1;R181
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出版历程
- 收稿日期: 2019-03-13
- 修回日期: 2019-06-29
- 刊出日期: 2019-08-10

Epidemiology investigation of type 2 diabetes mellitus and its associated renal insufficiency in a community-based population in Shanghai

1.
School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
2.
Songjiang District Center for Disease Control and Prevention, Shanghai 201600, China

Funds:

National Key R & D Program of China 2017YFC0907001

More Information

Corresponding author: ZHAO Gen-rming, E-mail: gmzhao@shmu.edu.cn

摘要

摘要: 目的了解上海市某社区2型糖尿病（type 2 diabetes mellitus，T2DM）及其合并肾功能不全的流行情况，探讨其相关的因素。方法采用随机整群抽样的方法抽取上海市某社区20~75岁的常住居民9 257名，进行T2DM、肾功能不全等患病情况及相关因素的问卷调查、体格检查及血尿常规和相关生化指标的检查，应用SPSS 19.0软件进行统计分析。结果 9 257名调查对象中，资料完整的共8 207名，女性占58.9%；45岁以上占75.8%。T2DM患病率为12.7%（95%CI：12.0%~13.4%），T2DM中合并肾功能不全的患病率15.4%（95%CI：12.3%~18.4%），其中早期（1~2期）肾功能不全患者占65.8%。T2DM患者中，肥胖者合并肾功能不全的患病率高于正常体重指数（body mass index，BMI）者；高龄（OR=1.35，95%CI：1.09~1.68）、中心性肥胖（OR=1.50，95%CI：1.05~2.15）、高尿酸血症（OR=2.51，95%CI：1.63~3.86）为T2DM合并肾功能不全主要相关因素。结论上海市某社区T2DM患者中合并肾功能不全的患病率较高，已成为该社区重要的公共卫生问题之一，需对高龄、肥胖、高尿酸血症的T2DM患者重点关注。
- 2型糖尿病 /
- 肾功能不全 /
- 患病率
Abstract: Objective To investigate the prevalence and related factors of type 2 diabetes mellitus(T2DM) and its associated renal insufficiency in adult residents of a community in Shanghai. Methods A total of 9 257 residents aged 20-75 years old in a community of Shanghai were selected by random cluster sampling. All participants were interviewed to complete questionnaires, physical examination, examination of blood, urine and common biochemical indicators for T2DM, renal insufficiency and other related factors. Then the SPSS 19.0 software was used for analysis. Results Of the 9 257 respondents, eligible data of 8 207 subjects were enrolled in the study. The prevalence of T2DM was 12.7% (95% CI: 12.0%-13.4%), and the prevalence of its associated renal insufficiency was 15.4% (95% CI: 12.3%-18.4%), and majority of patients (65.8%) were in the early stage. Among the T2DM patients in this survey, the prevalence of renal insufficiency in obese patients was higher than that in patient with the normal body mass index. Logistic regression analysis showed that elder (OR=1.35), central obesity (OR=1.50), hyperuricemia (OR=2.51) were independent risk factors related with renal insufficiency in T2DM patients. Conclusions Renal insufficiency has become one of the important public health problems in T2DM patients. It shows a more urgent need for early prevention and control of CKD to prevent the incidence of end-stage renal disease and related complications in T2DM patients with advanced age, obesity, and hyperuricemia.
- Type 2 diabetes mellitus /
- Renal insufficiency /
- Prevalence

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表 1 上海市某社区调查人群基本特征[n(%)]

Table 1. Characteristics of survey population of a community in Shanghai[n(%)]

特征	总数	男	女
年龄(岁)
< 44	1 984	780(23.1)	1 204(24.9)
45~	2 315	875(26.0)	1 440(29.8)
55~	1 351	531(15.8)	820(17.0)
65~75	2 557	1 184(35.1)	1 373(28.4)
文化程度
小学及以下	593	118(3.5)	475(9.8)
初中	2 239	856(25.4)	1 383(28.6)
高中	436	196(58.2)	2 405(49.7)
大专及以上	1 009	435(12.9)	574(11.9)
婚姻
在婚	7 628	3 190(94.7)	4 438(91.8)
离婚	96	27(0.8)	69(1.4)
丧偶	297	60(1.8)	237(4.9)
未婚	186	93(2.8)	93(1.9)
BMI
正常	4 039	1 360(40.4)	2 679(55.4)
超重	3 029	1 497(44.4)	1 532(31.7)
肥胖	1 139	513(15.2)	626(12.9)
中心性肥胖
否	5 631	2 250(66.8)	3 381(69.9)
是	2 576	1 120(33.2)	1 456(30.1)

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表 2 上海市某社区T2DM患者中相关诊断指标及肾功能不全分期[n(%)]

Table 2. Relevant diagnostic indicators and renal insufficiency staging in T2DM patients in a community of Shanghai[n(%)]

项目	例数	无T2DM史	有T2DM史
T2DM	1 042	446(42.8)	596(57.2)
FBG≥7.0 mmol/L	321	98(30.5)	223(69.5)
HbA1c≥6.5%	851	430(50.5)	421(49.5)
FBG≥7.0 mmol/LHbA1c≥6.5%	286	82(28.7)	204(71.3)
HbA1c≥6.5%
肾功能不全分期	160	66(41.3)	94(58.8)
1期	68	31(45.6)	37(54.4)
2期	37	12(32.4)	25(67.6)
3期	47	21(44.7)	26(55.3)
4期	6	1(16.7)	5(83.3)
5期	2	1(50.0)	1(50.0)
肾损伤指标	124	49(39.5)	75(60.5)
蛋白尿	87	32(36.8)	55(63.2)
血尿	40	19(47.5)	21(52.5)
白细胞尿	9	4(44.4)	5(55.6)
肾功能下降	55	23(41.8)	32(58.2)

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表 3 上海市某社区T2DM患者肾功能不全共患特征及相关危险因素

Table 3. Symptoms of renal insufficiency and related risk factors in T2DM patients in a community of Shanghai

分类	合计	CKD共患		χ²值	P值	OR(95% CI)值
分类	合计	是(N=160)	否(N=882)	χ²值	P值	OR(95% CI)值
性别
男	481	63	418			1.00
女	561	97	464	3.50	0.037	1.39(0.98~1.96)
年龄(岁)
20~	275	31	244			1.00
55~	216	24	192	0.00	0.537	0.98(0.56~1.74)
65~75	551	105	446	8.08	0.003	1.85(1.20~2.85)
BMI(kg/m²)
< 24	279	33	246			1.00
24~	476	69	407	1.07	0.178	1.26(0.81~1.97)
≥28	287	58	229	7.36	0.005	1.89(1.19~3.00)
中心性肥胖
否	481	56	425			1.00
是	561	104	457	9.47	0.001	1.72(1.21~2.45)
每周体育锻炼
否	761	121	640			1.00
是	281	39	242	0.64	0.242	0.85(0.57~1.26)
吸烟
否	802	130	672			1.00
是	240	30	210	1.96	0.091	0.74(0.48~1.13)
饮酒
否	898	136	762			1.00
是	144	24	120	0.22	0.358	1.12(0.69~1.80)
T2DM家族史
否	852	134	718			1.00
是	190	26	164	0.50	0.280	0.87(0.58~1.28)
肾病家族史
否	1 032	159	873			1.00
是	10	1	9	0.22	0.531	0.65(.0.10~4.19)
高血压
否	267	24	243			1.00
是	775	136	639	11.19	< 0.001	2.16(1.36~3.41)
高尿酸血症
否	910	120	790			1.00
是	132	40	92	25.98	< 0.001	2.86(1.89~4.35)
高脂血症
否	625	82	543			1.00
是	417	78	339	6.00	0.009	1.52(1.09~2.14)

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表 4 上海市某社区人群T2DM合并肾功能不全相关危险因素的多因素Logistic分析

Table 4. Multivariate Logistic analysis of risk factors associated with renal insufficiency in T2DM of a community in Shanghai

因素	β	SE	Wald值	P值	OR(95% CI)值
年龄(岁)^a	0.30	0.11	7.48	0.006	1.35(1.09~1.68)
中心性肥胖^b	0.40	0.18	4.91	0.027	1.50(1.05~2.15)
高尿酸血症^b	0.92	0.22	17.63	< 0.001	2.51(1.63~3.86)
注：^a变量赋值：20~=0，55~=1，65~=2；^b变量赋值：无=0，有=1。

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