2型糖尿病心脏自主神经病变合并视网膜病变和肾病的临床研究

A clinical study of cardiac autonomic neuropathy with retinopathy and nephropathy in patients with type 2 diabetes mellitus

摘要:

目的 探讨2型糖尿病心脏自主神经病变合并视网膜病变和肾病的患病率及危险因素。方法 选取2022年5月至2023年5月于云南省第一人民医院内分泌科住院的2型糖尿病（type 2 diabetes mellitus，T2DM）患者203例，以心血管反射试验（cardiovascular autonomic reflex tests，CARTs）结合评分判定糖尿病心脏自主神经病变（diabetic cardiac autonomic neuropathy，CAN），按照是否合并糖尿病视网膜病变（diabetic retinopathy，DR）、糖尿病肾脏病变（diabetic kidney disease，DKD）分为单纯CAN组、CAN合并DR组、CAN合并DKD组及CAN合并DR、DKD组，收集所有受试者的临床相关资料。采用SPSS 26.0软件进行统计学分析。结果 ①203例T2DM患者中，CAN的患病率为58.62%，CAN合并DR、CAN合并DKD及CAN合并DR、DKD的患病率分别为10.08%、7.56%、10.92%。②在4组中年龄、糖化血红蛋白（glycosylated hemoglobin，HbA1c）、估算肾小球滤过率（estimated glomerular filtration rate，eGFR）、乳酸脱氢酶（lactate dehydrogenase，LDH）、直接胆红素（direct bilirubin，DBIL）、72 h动态血糖葡萄糖在目标范围内时间（72 hours dynamic blood glucose within the target range of time，TIR）等因素差异有统计学意义（P<0.05）。③Logistic回归分析结果：HbA1c（OR=2.948，95%CI=1.015~8.560，P=0.047）、LDH（OR=1.151，95%CI=1.035~1.280，P=0.010）为CAN合并DR、DKD发生发展的促进因素；DBIL（OR=0.057，95%CI=0.005~0.658，P=0.022）、eGFR（OR=0.700，95%CI=0.513~0.955，P=0.025）、TIR（OR=0.877，95%CI=0.775~0.992，P=0.037）、年龄（OR=0.550，95%CI=0.349~0.868，P=0.010）的水平与CAN合并DR、DKD的发生发展相关。结论 较低的eGFR、TIR、DBIL、年龄与CAN合并DR、DKD的发生呈负相关，较高的HbA1c、LDH与CAN合并DR、DKD的发生呈正相关，故在eGFR、TIR、DBIL、年龄相对偏低和（或）HbA1c、LDH相对偏高的糖尿病人群中需更注重CAN合并DR、DKD的筛查。

Abstract:

Objective To investigate the prevalence of cardiac autonomic neuropathy（CAN） with retinopathy and nephropathy in patients with type 2 diabetes mellitus（T2DM） and associated risk factors.Methods A total of 203 patients with T2DM who were hospitalized in the Department of Endocrinology of The First People’s Hospital of Yunnan Province from May 2022 to May 2023 were included. CAN was determined based on the scores of cardiovascular autonomic reflex tests. According to the presence or absence of diabetic retinopathy（DR） and diabetic kidney disease（DKD），the patients with CAN were divided into CAN alone group，CAN+DR group，CAN+DKD group，and CAN+DR+DKD group. The clinical data of all subjects were collected for statistical analysis using SPSS 26.0 software.Results Among the 203 patients with T2DM，the prevalence rate of CAN was 58.62%，with the prevalence rate of CAN+DR，CAN+DKD，CAN+DR+DKD being 10.08%，7.56%，and 10.92%，respectively. There were significant differences between the four groups in age，glycosylated hemoglobin（HbA1c），estimated glomerular filtration rate（eGFR），lactate dehydrogenase（LDH），direct bilirubin（DBIL），and the amount of time for blood glucose levels in the target range over 72 hours（TIR）（P<0.05）. The logistic regression analysis showed that HbA1c（odds ratio［OR］=2.948，95%CI=1.015-8.560，P=0.047） and LDH（OR=1.151，95%CI=1.035-1.280，P=0.010） were factors promoting the development and progression of CAN with DR and DKD； and DBIL（OR=0.057，95%CI=0.005-0.658，P=0.022），eGFR（OR=0.700，95%CI=0.513-0.955，P=0.025），TIR（OR=0.877，95%CI=0.775-0.992，P=0.037），and age（OR=0.550，95%CI=0.349-0.868，P=0.010） were significantly associated with the development and progression of CAN with DR and DKD.Conclusion Lower eGFR，TIR，DBIL，and age are negatively correlated with the occurrence of CAN with DR and DKD，while higher HbA1c and LDH are positively correlated with the occurrence of CAN with DR and DKD. Therefore，more attention should be paid to screening for CAN with DR and DKD in patients with T2DM with low eGFR，TIR，DBIL，age and/or high HbA1c and LDH.