Koch M, Tschöpe W, Ritz E
Medizinische Universitätsklinik Heidelberg.
Dtsch Med Wochenschr. 1991 Oct 11;116(41):1543-8. doi: 10.1055/s-2008-1063786.
The cardiovascular risk profile was assessed in all 208 diabetics accepted for dialysis in 28 German dialysis centres from 1985-1987 (104 men, 104 women, mean age 60 [22-82] years). 71 patients had type 1 and 128 type 2 diabetes, and 9 maturity onset diabetes of the young. Of 169 patients, 164 (97%) had hypertension (median systolic blood pressure at start of dialysis 200 [120-280] mm Hg). Only 74 patients (44%) were on continuing anti-hypertensive medication. Median serum cholesterol was 225 (66-424) mg/dl, LDL-cholesterol 158 (43-335) mg/dl and HDL-cholesterol 32 (10-67) mg/dl. In patients with a history of myocardial infarction (n = 26) the median cholesterol concentration was 269 (126-424) mg/dl, while in those with no history of myocardial infarction (n = 132) it was 221 (66-280) mg/dl (P less than 0.05). Only 5% of the patients had received lipid lowering therapy. Out of 175 patients, 65 (37%) had a history of smoking, and 25 (14%) were still smokers at the start of dialysis. There was a strong association between smoking history and amputations. Only 98 of 208 patients (47%) had had a specialist ophthalmological examination in the 12 months preceding the start of dialysis. Proliferative retinopathy was present in 33 out of 53 (62%) type 1 and 15 out of 98 (15%) type 2 diabetics. Out of 22 patients with unilateral or bilateral blindness, 2 (10%) had received no photocoagulation. - This investigation reveals a need for better medical care of diabetics with pre-end-stage renal failure.
1985年至1987年期间，在德国28个透析中心接受透析的208例糖尿病患者均接受了心血管风险评估（104名男性，104名女性，平均年龄60岁[22 - 82岁]）。71例患者患有1型糖尿病，128例患有2型糖尿病，9例患有青年成熟期糖尿病。在169例患者中，164例（97%）患有高血压（透析开始时收缩压中位数为200[120 - 280]mmHg）。只有74例患者（44%）在持续服用抗高血压药物。血清胆固醇中位数为225（66 - 424）mg/dl，低密度脂蛋白胆固醇为158（43 - 335）mg/dl，高密度脂蛋白胆固醇为32（10 - 67）mg/dl。有心肌梗死病史的患者（n = 26）胆固醇浓度中位数为269（126 - 424）mg/dl，而无心肌梗死病史的患者（n = 132）为221（66 - 280）mg/dl（P < 0.05）。只有5%的患者接受过降脂治疗。在175例患者中，65例（37%）有吸烟史，25例（14%）在透析开始时仍在吸烟。吸烟史与截肢之间存在密切关联。在208例患者中，只有98例（47%）在透析开始前12个月内接受过专业眼科检查。53例1型糖尿病患者中有33例（62%）存在增殖性视网膜病变，98例2型糖尿病患者中有15例（15%）存在增殖性视网膜病变。在22例单侧或双侧失明的患者中，2例（10%）未接受过光凝治疗。——这项调查表明，对于处于终末期肾衰竭前期的糖尿病患者，需要提供更好的医疗护理。
