早发2型糖尿病临床特点及相关危险因素分析

目的探讨早发2型糖尿病的临床特点及相关危险因素。方法选取2010年9月—2011年9月辽宁医学院附属第三医院内分泌科住院患者,临床诊断为2型糖尿病,排除1型糖尿病、妊娠糖尿病、线粒体基因突变性糖尿病,共538例患者。诊断年龄≤40岁为早发组(103例),诊断年龄>40岁为晚发组(435例)。比较两组患者的临床资料,分析早发2型糖尿病患者临床特点和相关危险因素。结果早发组较晚发组男性、吸烟、糖尿病阳性家族史患者比例高,非酒精性脂肪性肝病、微血管病变患病率高,空腹血糖、三酰甘油、高密度脂蛋白胆固醇、血尿酸水平明显增高,差异均有统计学意义(P<0.05);年龄、诊断年龄低,高血压、大血管病变患病率低,餐后2 h胰岛素、胰岛β细胞功能指数(HOMA-β)水平明显降低,差异均有统计学意义(P<0.05)。早发组与晚发组口服药物、胰岛素或口服药物+胰岛素治疗方法比较差异有统计学意义(u=2.730,P=0.006)。早发组糖尿病家族史以母亲患有糖尿病为主,占47.1%。Logistic回归分析显示男性、非酒精性脂肪性肝病、天冬氨酸氨基转移酶是早发2型糖尿病的独立危险因素;高血压、吸烟、空腹C肽、糖化血红蛋白是早发2型糖尿病大血管病变的独立危险因素。结论早发2型糖尿病患者糖、脂代谢紊乱明显,胰岛β细胞功能损伤严重,糖尿病家族史比例高、只有母亲有糖尿病的患者比例高。早发2型糖尿病患者有多种糖尿病大血管病变危险因素共存。

Clinical Characteristics and Risk Factors of Early-Onset Type 2 Diabetes Mellitus

Objective To investigate the clinical characteristics and risk factors of early-onset type 2 diabetes mellitus(T2DM).Methods Totally 538 T2DM inpatients admitted to the Department of Endocrinology of the Third Affiliated Hospital of Liaoning College of Medicine from September 2010 to September 2011 were selected after excluding type 1 diabetes,gestational diabetes and mitochondrial gene mutation diabetes.Patients whose diagnosis age≤40 were enrolled in the early-onset group(n=103),and patients whose diagnosis age>40 were in late-onset group(n=435).Clinical data were compared and clinical features and risk factors of early-onset T2DM were analyzed.Results Compared with the late-onset group,the early-onset group had significantly higher proportion of male patients,smoking and positive family history,significantly higher prevalence of non-alcoholic fatty liver disease and microangiopathy,and significantly higher fasting blood levels of glucose,triglycerides,HDL-C,and uric acid(P<0.05).Compared with late-onset group,the early-onset group also had significantly younger age and younger diagnosis age,significantly lower hypertension prevalence,and significantly lower 2-hour postprandial plasma insulin and HOMA-β(P<0.05).The early-onset group had higher proportion of patients treated with both oral hypoglycemic agents and insulin(u=2.730,P=0.006).The family history of early-onset group were mainly mother having diabetes,accounting for 47.1%.Multivariate Logistic regression analysis showed that gender,non-alcoholic fatty liver disease,and AST were independent risk factors for early-onset T2DM.Hypertension,smoking,FC-P,and HbALc were independent risk factors for macrovascular diseases in the early-onset group.Conclusion Early-onset T2DM have more metabolism disorders of glucose and lipid,more severe dysfunction of pancreatic β cell,and higher proportion of patients having positive family history.The proportion of only mother having diabetes is high in these patients.They also have multiple risk factors for macrovascular diseases.