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目的了解上海市社区2型糖尿病患者糖尿病周围神经病变(DPN)患病率及其影响因素。方法采用整群随机抽样的方法,于2014年10月—2015年4月,对上海市浦东新区、杨浦区的6个社区的5 053例2型糖尿病患者进行问卷调查、体格检查及实验室检查,采用多伦多临床评分系统(TCSS)对患者进行DPN筛查,分为不存在DPN、轻度、中度及重度DPN。采用多因素Logistic回归分析影响DPN患病的因素。结果 DPN筛查的阳性率为16.0%(810/5 053),其中612例(12.1%)为轻度DPN,158例(3.1%)为中度DPN,40例(0.8%)为重度DPN。不同性别、腹型肥胖、吸烟者DPN患病率比较,差异均无统计学意义(P>0.05);不同年龄、病程、体质指数(BMI)者DPN患病率比较,差异均有统计学意义(P<0.001)。不同空腹血糖(FPG)水平、是否合并高血压者DPN患病率比较,差异均无统计学意义(P>0.05);不同餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平、尿微量清蛋白与肌酐比值(ACR)以及不同糖尿病视网膜病变(DR)严重程度者DPN患病率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥65岁、病程≥15年、Hb A1c≥8.5%、HDL-C≤0.9 mmol/L、并发中度或重度DR是2型糖尿病患者DPN的危险因素(P<0.05)。结论上海市社区2型糖尿病患者DPN患病率低,且以轻度病变为主。年龄≥65岁、病程≥15年、Hb A1c≥8.5%、HDL-C≤0.9 mmol/L、并发中度或重度DR是社区2型糖尿病患者DPN的危险因素。
Objective To investigate the prevalence and influencing factors of diabetic peripheral neuropathy (DPN) in community-type 2 diabetes mellitus in Shanghai. Methods A total of 5 053 type 2 diabetic patients in 6 communities in Pudong New Area and Yangpu District of Shanghai from October 2014 to April 2015 were surveyed by questionnaires, physical examination and laboratory tests Patients were DPN screened using the Toronto Clinical Scoring System (TCSS) and were divided into no DPN, mild, moderate, and severe DPN. Multivariate Logistic regression analysis of factors affecting the prevalence of DPN. Results The positive rate of DPN screening was 16.0% (810/5 053), of which 612 (12.1%) were mild DPN, 158 (3.1%) were moderate DPN and 40 (0.8%) were severe DPN. There was no significant difference in the prevalence of DPN between different sex, abdominal obesity and smoker (P> 0.05). The differences of DPN prevalence among different age, course of disease and body mass index (BMI) were statistically significant (P <0.001). There was no significant difference in the prevalence of DPN among different fasting blood glucose (FPG) levels and whether or not with or without hypertension (P> 0.05). The levels of 2 h PG, Hb A1c, LDL-C, HDL-C levels, urinary albumin to creatinine ratio (ACR), and the prevalence of DPN in different diabetic retinopathy (DR) The differences were statistically significant (P <0.05). Multivariate Logistic regression analysis showed that patients with age≥65 years, duration of disease≥15 years, Hb A1c≥8.5%, HDL-C≤0.9 mmol / L and moderate or severe DR were the risk factors of DPN in type 2 diabetic patients (P <0.05). Conclusion The prevalence of DPN in type 2 diabetes mellitus patients in Shanghai community is low, with mild disease predominance. Age ≥ 65 years, duration ≥ 15 years, Hb A1c ≥ 8.5%, HDL-C ≤ 0.9 mmol / L, moderate or severe DR is a risk factor for DPN in community-type 2 diabetes mellitus.