本文選題：2型糖尿病 + 糖尿病心臟自主神經(jīng)病變　； 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：研究背景:2型糖尿病的中國(guó)最新流行學(xué)調(diào)查顯示,我國(guó)2型糖尿病總?cè)藬?shù)超過9200萬(wàn),20歲以上人群的糖尿病的患病率已高達(dá)9.7%。糖尿病周圍神經(jīng)病變是糖尿病慢性并發(fā)癥之一,其中糖尿病心臟自主神經(jīng)病變(diabetic cardiac autonomic neuropathy,DCAN)是糖尿病周圍神經(jīng)病變之一,關(guān)于其發(fā)病機(jī)制尚無(wú)統(tǒng)一定論,可能與代謝異常,氧化應(yīng)激,微血管病變,神經(jīng)營(yíng)養(yǎng)因子缺乏等多因素有關(guān)。糖尿病心臟自主神經(jīng)病變具有起病隱匿、漸進(jìn)發(fā)展、癥狀出現(xiàn)早、較少自行緩解的臨床特征,可引發(fā)無(wú)痛性心肌缺血、心肌梗死、惡性心律失常甚至心源性猝死等。高尿酸血癥則被認(rèn)為是代謝異常的一種標(biāo)記,高尿酸血癥(Hyperuricemia,HUA)與高血壓病、高脂血癥、糖尿病腎病、糖尿病周圍神經(jīng)病變密切相關(guān)[1]。有試驗(yàn)證實(shí),在2型糖尿病患者中,糖尿病周圍神經(jīng)病變患者其高尿酸血癥的患病率高于非糖尿病周圍神經(jīng)病變患者;糖尿病周圍神經(jīng)病變患者血尿酸平均水平高于非糖尿病周圍神經(jīng)病變患者[2]。研究目的:本項(xiàng)研究將采用SUDOSCAN糖尿病并發(fā)癥探測(cè)儀(eZscan儀)篩查糖尿病患者的心臟主神經(jīng)病變(DCAN),并觀察符合條件的2型糖尿病患者血尿酸及相關(guān)血生化、臨床資料,利用糖尿病患者eZscan儀所測(cè)得的心臟自主神經(jīng)病變風(fēng)險(xiǎn)值(DCAN%),并根據(jù)心臟自主神經(jīng)病變風(fēng)險(xiǎn)值是否≥25%分組:2型糖尿病心臟自主神經(jīng)風(fēng)險(xiǎn)組與非心臟自主神經(jīng)風(fēng)險(xiǎn)組,比較兩組血尿酸等相關(guān)生化指標(biāo),從而探討2型糖尿病患者糖尿病心臟自主神經(jīng)病變與血尿酸等生化指標(biāo)的關(guān)系,為2型糖尿病患者心臟自主神經(jīng)病變的預(yù)防提供依據(jù)。研究方法:選擇2016年10月至2017年2月在我院治療的已確診平均年齡(60±10)歲的146例2型糖尿病患者。記錄患者性別、年齡、體重指數(shù)等一般資料。采集患者血清進(jìn)行血尿酸、總膽固醇、甘油三酯、低密度脂蛋白、糖化血紅蛋白、空腹血糖、血肌酐、空腹胰島素c肽、尿微量白蛋白等多項(xiàng)生化指標(biāo);采用sudoscan糖尿病并發(fā)癥探測(cè)儀(ezscan儀)檢測(cè)所得心臟自主神經(jīng)病變風(fēng)險(xiǎn)值(dcan%),并根據(jù)心臟自主神經(jīng)病變風(fēng)險(xiǎn)值是否≥25%分為2型糖尿病心臟自主神經(jīng)病變風(fēng)險(xiǎn)組與2型糖尿病非心臟自主神經(jīng)病變風(fēng)險(xiǎn)組,另?yè)?jù)患者性別以及血糖情況分組,分別進(jìn)行比較。納入比較的指標(biāo)包括收集的患者一般臨床資料及實(shí)驗(yàn)室生化、尿微量蛋白等,所有數(shù)據(jù)懫用spss22.0軟件進(jìn)行統(tǒng)計(jì)分析。研究結(jié)果:1、一般資料:共146例平均年齡(60±10)歲的2型糖尿病患者,男女比例隨機(jī),納入研究,其中男性患者83例,女性患者63例,另2型糖尿病心臟自主神經(jīng)病變風(fēng)險(xiǎn)組98例,2型糖尿病非心臟自主神經(jīng)病變風(fēng)險(xiǎn)組48例。2、sudoscan檢測(cè)技術(shù)發(fā)現(xiàn)2型糖尿病心臟自主神經(jīng)病變風(fēng)險(xiǎn)組與2型糖尿病非心臟自主神經(jīng)風(fēng)險(xiǎn)組在年齡、體重指數(shù)(bmi)、血清肌酐方面存在顯著統(tǒng)計(jì)學(xué)差異(p0.001,p=0.017,p0.001)。3、sudoscan檢測(cè)技術(shù)發(fā)現(xiàn)在2型糖尿病女性患者組中,心臟自主神經(jīng)病變與年齡、體重指數(shù)、血糖、糖化血紅蛋白、血肌酐存在統(tǒng)計(jì)學(xué)差異(p0.001,p=0.001,p=0.017,p=0.04,p=0.024)。sudoscan檢測(cè)技術(shù)發(fā)現(xiàn)在2型糖尿病男性患者組中,心臟自主神經(jīng)病變與年齡存在統(tǒng)計(jì)學(xué)差異(P0.01)。4、根據(jù)糖尿病風(fēng)險(xiǎn)評(píng)估評(píng)分值是否≥25%,分為2型糖尿病心臟自主神經(jīng)病變風(fēng)險(xiǎn)組與2型糖尿病非心臟自主神經(jīng)病變風(fēng)險(xiǎn)組,SPSS多元logistic回歸分析發(fā)現(xiàn)年齡[OR=1.213(1.123-1.311),P0.001]、體重指數(shù)BMI[OR=1.299(1.073-1.573),P=0.007]與DCAN發(fā)病風(fēng)險(xiǎn)密切相關(guān),而血尿酸、性別、血脂、血糖等無(wú)明顯統(tǒng)計(jì)學(xué)相關(guān)性。5、根據(jù)HbA1C目標(biāo)合理是7%為標(biāo)準(zhǔn)分為血糖達(dá)標(biāo)組及血糖不達(dá)標(biāo)組,發(fā)現(xiàn)兩組在年齡、空腹血糖、血清肌酐,空腹C肽方面存在顯著統(tǒng)計(jì)學(xué)差異(P=0.038,P=0.000,P=0.001,P=0.02)。研究結(jié)論:1、在2型糖尿病患者中,伴隨患者年齡、BMI指數(shù),血清肌升高,患者心臟自主神經(jīng)病變的發(fā)病風(fēng)險(xiǎn)增高。2、在2型糖尿病患者中,伴隨患者年齡、空腹血糖、血肌酐升高,患者糖化血紅蛋白達(dá)標(biāo)率越低。3、經(jīng)SUDOSCAN檢測(cè)技術(shù),并未發(fā)現(xiàn)血尿酸水平與2型糖尿病患者心臟自主神經(jīng)病變的顯著相關(guān)性。
[Abstract]:Background: the latest epidemiological survey of type 2 diabetes in China shows that the total number of type 2 diabetes in China is more than 92 million. The prevalence of diabetes in people over 20 years old is as high as 9.7%. diabetic peripheral neuropathy is one of the chronic complications of diabetes, and the diabetes heart is diabetic cardiac autonomic neuropathy, DCAN) is one of the diabetic peripheral neuropathy. There is no certain theory about its pathogenesis. It may be related to many factors such as metabolic abnormality, oxidative stress, microvascular disease, and neurotrophic factor deficiency. Diabetes heart autonomic neuropathy is characterized by insidious onset, progressive development, early symptoms and less self relieving clinical features. Painless myocardial ischemia, myocardial infarction, malignant arrhythmia and even sudden cardiac death. Hyperuricemia is considered to be a marker of metabolic abnormalities. Hyperuricemia (Hyperuricemia, HUA) is closely related to hypertension, hyperlipidemia, diabetic nephropathy, and diabetic nephropathy, and [1]. has been confirmed in patients with type 2 diabetes. In patients with diabetic peripheral neuropathy, the prevalence of hyperuricemia is higher than that of non diabetic peripheral neuropathy. The average level of blood uric acid in patients with diabetic peripheral neuropathy is higher than that of non diabetic peripheral neuropathy patients with [2]. research. This study will be used to screen sugar by the SUDOSCAN diabetic complication detector (eZscan instrument). Cardiac autonomic neuropathy (DCAN) in patients with urinary disease, and observation of blood uric acid and related blood biochemistry in patients with type 2 diabetes, clinical data, risk values of cardiac autonomic neuropathy (DCAN%) measured by eZscan in diabetic patients, and whether the risk value of cardiac autonomic neuropathy is more than 25%: cardiac autonomic deity of type 2 diabetes mellitus The relationship between the two groups of blood uric acid and other biochemical indexes was compared between the risk group and the non cardiac autonomic nerve risk group. The relationship between the diabetic cardiac autonomic neuropathy and the biochemical indexes of blood uric acid was discussed in the patients with type 2 diabetes mellitus, and the basis for prevention of cardiac autonomic neuropathy in type 2 diabetic patients was studied. The methods of study were selected from October 2016 to 2017. In February, 146 patients with type 2 diabetes, aged (60 + 10), were treated in our hospital. General data of sex, age and body mass index were recorded. Serum uric acid, total cholesterol, triglycerides, low density lipoprotein, glycated hemoglobin, fasting blood glucose, serum creatinine, fasting insulin C peptide, microalbuminuria, etc. were collected from the patients' serum. Multiple biochemical indexes; the risk value of cardiac autonomic neuropathy (dcan%) measured by the sudoscan diabetes complication detector (ezscan instrument), and the risk group of type 2 diabetic cardiopathy based on the risk value of cardiac autonomic neuropathy and risk group of type 2 diabetic non cardiac autonomic neuropathy, according to the risk group of type 2 diabetes, according to the patient sex Spss22.0 software was used for statistical analysis. 1, general data: a total of 146 patients with average age of age (60 + 10) years of age 2 diabetes, the proportion of men and women was random, The study included 83 male patients, 63 female patients, 98 patients with type 2 diabetic cardio neuropathy risk group, 48 non cardiac autonomic neuropathy risk group of type 2 diabetes mellitus (.2), sudoscan detection technique, and the risk group of type 2 diabetic cardiac autonomic neuropathy and the non cardiac autonomic nerve risk group of type 2 diabetes in age, body There were significant differences in weight index (BMI) and serum creatinine (p0.001, p=0.017, p0.001).3. Sudoscan detection techniques found that there were statistical differences between cardiac autonomic neuropathy and age, body mass index, blood sugar, glycated hemoglobin, and serum creatinine (p0.001, p=0.001, p=0.017, p=0.04, p=0.024) in the group of women with type 2 diabetes. The detection techniques found that in the male patients with type 2 diabetes, the cardiac autonomic neuropathy and age were statistically different (P0.01).4, according to whether the score of diabetes risk assessment was more than 25%, divided into the risk group of type 2 diabetic cardio neuropathy and the risk group of non cardiac autonomic neuropathy in type 2 diabetes mellitus, SPSS multivariate logistic regression score The age [OR=1.213 (1.123-1.311), P0.001], body mass index BMI[OR=1.299 (1.073-1.573), P=0.007] were closely related to the risk of DCAN, but the blood uric acid, sex, blood lipid, blood sugar and so on were not statistically significant.5. According to the HbA1C target, 7% were divided into standard blood glucose standard group and blood glucose level group, and the two groups were found in the age and empty stomach. There were significant differences in blood glucose, serum creatinine, and fasting C peptide (P=0.038, P=0.000, P=0.001, P=0.02). 1. In type 2 diabetic patients, the risk of cardiac autonomic neuropathy increased with age, BMI index, serum muscle increase, and.2 in patients with cardiac autonomic neuropathy, with patients age, fasting blood glucose, and blood in type 2 diabetic patients. The higher the creatinine, the lower the glycated hemoglobin standard rate was.3, and the SUDOSCAN detection technique did not find a significant correlation between the level of blood uric acid and the cardiac autonomic neuropathy in type 2 diabetic patients.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2

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