1 型糖尿病患儿在苏丹儿童糖尿病中心就诊时的早期糖尿病肾病和视网膜病变。
Early Diabetic Nephropathy and Retinopathy in Patients with Type 1 Diabetes Mellitus Attending Sudan Childhood Diabetes Centre.
机构信息
Department of Paediatric and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
Department of Ophthalmology, Jabir Abu Eliz Diabetes Centre, Khartoum, Sudan.
出版信息
J Diabetes Res. 2020 Nov 24;2020:7181383. doi: 10.1155/2020/7181383. eCollection 2020.
OBJECTIVE
Data on microvascular complications in children and adolescents with type 1 diabetes mellitus (T1DM) in Sudan are scarce. This study was aimed at determining the prevalence of diabetic nephropathy (DN) and retinopathy (DR) and their relationship to certain risk factors in children with T1DM attending the Sudan Childhood Diabetes Centre. . A clinic-based cross-sectional study of 100 patients with T1DM aged 10-18 years. Patients with disease duration exceeding 5 years if the onset of diabetes was prepubertal and 2 years if it was postpubertal were included. Relevant sociodemographic, clinical, and biochemical information was obtained. Blood pressure was measured. The patients were screened for DN and DR using urinary microalbumin estimation and fundus photography, respectively.
RESULTS
The frequency of microalbuminuria and diabetic retinopathy was 36% and 33%, respectively. Eleven percent had both retinopathy and microalbuminuria. Seven percent of the patients were found to be hypertensive. Patients with diabetic retinopathy had significantly higher HbA1c levels ( = 0.009) and longer diabetes duration ( = 0.02) than patients without retinopathy. Logistic regression showed that high HbA1c (odds ratio (OR) 0.83, confidence interval (CI) 0.68-1.00, = 0.04), but not age, duration, ethnic group, BMI, blood pressure, and presence of nephropathy, was an independent risk factor for retinopathy. Likewise, high blood pressure (OR 6.89, CI 1.17-40.52, = 0.03), but not age, duration, ethnic group, BMI, HbA1c, and presence of retinopathy, was a predictor for nephropathy.
CONCLUSION
High prevalence of incipient DN and early stages of DR were observed in this study. Longer diabetes duration and higher HbA1c were associated with the presence of diabetic retinopathy. High blood pressure was a risk factor for DN. So regular screening for these complications and optimization of glycemic control are needed.
目的
苏丹儿童患有 1 型糖尿病（T1DM），目前有关其微血管并发症的数据十分匮乏。本研究旨在确定 10-18 岁 T1DM 患儿中糖尿病肾病（DN）和视网膜病变（DR）的患病率及其与某些危险因素的关系。
方法
对 100 例 T1DM 患儿进行了一项基于诊所的横断面研究，这些患儿的年龄在 10-18 岁之间。如果糖尿病发病在青春期前，那么病程超过 5 年的患儿；如果糖尿病发病在青春期后，那么病程超过 2 年的患儿，都包含在研究中。获取了相关的社会人口学、临床和生化信息。测量了血压。使用尿微量白蛋白测定和眼底摄影分别筛查了患者的 DN 和 DR。
结果
微量白蛋白尿和糖尿病视网膜病变的频率分别为 36%和 33%。11%的患者同时患有视网膜病变和微量白蛋白尿。7%的患者患有高血压。患有糖尿病视网膜病变的患者 HbA1c 水平显著更高（=0.009），且糖尿病病程更长（=0.02），与无视网膜病变的患者相比。Logistic 回归显示，高 HbA1c（比值比（OR）0.83，95%置信区间（CI）0.68-1.00，=0.04），但不是年龄、病程、种族、BMI、血压和肾病的存在，是视网膜病变的独立危险因素。同样，高血压（OR 6.89，95%CI 1.17-40.52，=0.03），但不是年龄、病程、种族、BMI、HbA1c 和视网膜病变的存在，是肾病的预测因素。
结论
本研究观察到早期糖尿病肾病和早期糖尿病视网膜病变的发病率较高。较长的糖尿病病程和较高的 HbA1c 与糖尿病视网膜病变的存在有关。高血压是糖尿病肾病的危险因素。因此，需要定期筛查这些并发症并优化血糖控制。
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