泰国糖尿病登记项目：糖尿病肾病患者的患病率、特征及治疗情况

Thailand diabetes registry project: prevalence, characteristics and treatment of patients with diabetic nephropathy.

作者信息

Ngarmukos Chardpraorn, Bunnag Pongamorn, Kosachunhanun Natapong, Krittiyawong Sirinate, Leelawatana Rattana, Prathipanawatr Thongchai, Plengvidhya Nattachet, Benjasuratwong Yupin, Suwanwalaikorn Sompongse, Deerochanawong Chaicharn, Chetthakul Thanya, Mongkolsomlit Sirima, Rawdaree Petch

机构信息

Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

出版信息

J Med Assoc Thai. 2006 Aug;89 Suppl 1:S37-42.

PMID:17715832

Abstract

OBJECTIVES

To identify the prevalence and characteristics of patients with Diabetic Nephropathy (DN) and to evaluate adequacy of glycemic and blood pressure control of these patients in the authors' registry.

MATERIAL AND METHOD

A cross-sectional, multicenter, hospital-based diabetic registry was carried out in diabetes clinics of 11 tertiary centers in Thailand. DN was defined as the presence of at least two out of three of these symptoms; positive microalbuminuria, positive dipstick proteinuria or creatinine levels equal to or greater than 2 mg/dl. One center that did not perform urine microalbumin measurement was excludedfrom the analysis. Overt nephropathy was defined as the presence of gross proteinuria or renal insufficiency.

RESULTS

The study included 4875 patients (females 63.8%) with a mean (SD) duration ofdiabetes of 12.8 (8.2) years. The prevalence of DN was 42.9% (microalbuminuria 19.7% and overt nephropathy 23.2%). There were 373 (7.7%) patients with renal insufficiency and 24 (0.47%) with end-stage renal disease. By multivariate analysis, factors associated with DN were age, duration of diabetes, male sex, smoking, blood pressure, HbA1c, dyslipidemia and presence of diabetic retinopathy. Prevalence of ischemic heart disease and cerebrovascular disease in patients with DN was 11.5% and 6.6% respectively. Mean (SD) HbA1c in patients with nephropathy was 8.2 (2.6)%. Only 25% of subject had HbA1c of less than 7%, 46% had blood pressure ofmore than 140/90 mmHg and 84% received at least one antihypertensive drug. However, the target blood pressure of less than 130/80 mmHg could be achieved in only 18% of these patients. The mean (SD) number of antihypertensive drugs was 1.7 (1.1). Nearly 60% of patients received either ACE inhibitors or ARBs.

CONCLUSION

DN was very common. The overall picture of DN in the present survey suggests the seriousness of the problem and prompts more aggressive intervention.

摘要

目的

确定糖尿病肾病（DN）患者的患病率及特征，并评估作者登记处中这些患者血糖和血压控制的达标情况。

材料与方法

在泰国11个三级医疗中心的糖尿病诊所开展了一项基于医院的横断面多中心糖尿病登记研究。DN定义为出现以下三种症状中的至少两种：微量白蛋白尿阳性、尿试纸法蛋白尿阳性或肌酐水平等于或高于2mg/dl。未进行尿微量白蛋白测量的一个中心被排除在分析之外。显性肾病定义为存在大量蛋白尿或肾功能不全。

结果

该研究纳入了4875例患者（女性占63.8%），糖尿病平均病程为12.8（8.2）年。DN的患病率为42.9%（微量白蛋白尿为19.7%，显性肾病为23.2%）。有373例（7.7%）患者存在肾功能不全，24例（0.47%）患有终末期肾病。多因素分析显示，与DN相关的因素有年龄、糖尿病病程、男性、吸烟、血压、糖化血红蛋白（HbA1c）、血脂异常和糖尿病视网膜病变。DN患者中缺血性心脏病和脑血管疾病的患病率分别为11.5%和6.6%。肾病患者的平均（标准差）HbA1c为8.2（2.6）%。只有25%的研究对象HbA1c低于7%，46%的患者血压高于140/90mmHg，84%的患者接受了至少一种降压药物治疗。然而，这些患者中只有18%能够将血压控制在目标值低于130/80mmHg。降压药物的平均（标准差）数量为1.7（1.1）。近60%的患者接受了血管紧张素转换酶抑制剂（ACEI）或血管紧张素Ⅱ受体拮抗剂（ARB）治疗。