[2型糖尿病门诊患者微血管和大血管慢性并发症的患病率及其危险因素]

[Prevalence of micro and macroangiopatic chronic complications and their risk factors in the care of out patients with type 2 diabetes mellitus].

作者信息

Scheffel Rafael Selbach, Bortolanza Desirê, Weber Cristiane Seganfredo, Costa Luciana Abarno da, Canani Luís Henrique, Santos Kátia Gonçalves dos, Crispim Daisy, Roisenberg Israel, Lisbôa Hugo Roberto Kurtz, Tres Glaucia Sarturi, Tschiedel Balduíno, Gross Jorge Luiz

机构信息

Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS.

出版信息

Rev Assoc Med Bras (1992). 2004 Jul-Sep;50(3):263-7. doi: 10.1590/s0104-42302004000300031. Epub 2004 Oct 21.

DOI:10.1590/s0104-42302004000300031

PMID:15499476

Abstract

BACKGROUND

Type 2 diabetes (DM2) has been related to the development of macroangiopatic [coronary heart disease (CHD), peripheral vascular disease (PVD) and stroke] and microangiopatic [retinopathy, nephropathy, and distal sensory neuropathy (DSN)] complications. The aims of this study were to analyze prevalence of complications in DM2 patients and to estimate their associated risk factors.

METHODS

Cross-sectional study, including 927 out patients with DM2 from three medical centers in Rio Grande do Sul: Hospital de Clinicas de Porto Alegre (n = 475), Grupo Hospitalar Conceicao (n = 229) and Hospital Sao Vicente de Paula (n = 223). Of the patients 42% were male, mean age was 59 +/- 10 years and the median known duration of DM2 was 11 (5-43) years. Retinopathy was identified by direct fundoscopy; CHD by WHO questionnaire and/or abnormal ECG and/or perfusion abnormalities on myocardial scintigraphy; DSN by compatible symptoms and absent sensation on 10 g monofilament and/or tune fork; PVD by the presence of claudication and absent foot pulses; stroke by presence of sequels and history; and nephropathy by the urinary albumin excretion rate (>20 microg/min). Hypertension was defined by blood pressure (>140/90 mmHg) and/or use of antihypertensive drugs. Body mass index (BMI, kg/m2) and waist-to-hip ratio (WHR) were calculated.

RESULTS

CHD was present in 36% and PVD in 33% of the patients. Among the microvascular, 37% had nephropathy (12% with macroalbuminuria); 48% retinopathy (15% proliferative retinopathy). DSN was present in 36%. Seventy three percent of the patients presented arterial hypertension. Cholesterol levels were >200 mg/dl in 64% and BMI > 30 kg/m2 in 36%. Twenty two percent of patients were smokers and 21% ex-smokers.

CONCLUSION

Diabetic complications are frequent among out patients referring to general hospitals. Almost all patients presented at least one risk factor for cardiovascular disease, justifying the efforts for identification and adequate control.

摘要

背景

2型糖尿病（DM2）与大血管病变[冠心病（CHD）、外周血管疾病（PVD）和中风]及微血管病变[视网膜病变、肾病和远端感觉神经病变（DSN）]并发症的发生相关。本研究的目的是分析DM2患者并发症的患病率，并评估其相关危险因素。

方法

横断面研究，纳入了巴西南部三个医疗中心的927例DM2门诊患者：阿雷格里港临床医院（n = 475）、康塞桑医院集团（n = 229）和圣维森特·德·保拉医院（n = 223）。患者中42%为男性，平均年龄为59±10岁，DM2的已知病程中位数为11（5 - 43）年。通过直接检眼镜检查确定视网膜病变；通过WHO问卷和/或异常心电图和/或心肌闪烁显像的灌注异常确定CHD；通过相符的症状以及10 g单丝和/或音叉感觉缺失确定DSN；通过间歇性跛行和足部脉搏消失确定PVD；通过后遗症和病史确定中风；通过尿白蛋白排泄率（>20微克/分钟）确定肾病。高血压定义为血压（>140/90 mmHg）和/或使用抗高血压药物。计算体重指数（BMI，kg/m2）和腰臀比（WHR）。

结果

36%的患者患有CHD，33%患有PVD。在微血管病变中，37%患有肾病（12%为大量白蛋白尿）；48%患有视网膜病变（15%为增殖性视网膜病变）。DSN的患病率为36%。73%的患者患有动脉高血压。64%的患者胆固醇水平>200 mg/dl，36%的患者BMI>30 kg/m2。22%的患者吸烟，21%为既往吸烟者。