目的糖尿病發(fā)病率逐年增加,糖尿病腎病作為糖尿病最常見的微血管并發(fā)癥之一,因發(fā)病率高、治療效果不佳給患者和社會帶來沉重的負擔。近年來研究發(fā)現(xiàn)減重手術(shù)除可以明顯降低肥胖患者體重外,還能夠有效改善術(shù)后患者血糖水平及糖尿病腎病及糖尿病其他相關(guān)并發(fā)癥。本文研究糖尿病腎病的相關(guān)危險因素,并對減重手術(shù)對肥胖合并2型糖尿病患者糖尿病腎病及糖尿病視網(wǎng)膜病變的影響和預后予以研究。方法入組219例糖尿病患者,根據(jù)有無糖尿病腎病將其分為單純糖尿病組和糖尿病腎病組,比較兩組患者各臨床資料之間的差異以分析糖尿病患者發(fā)生糖尿病腎病的危險因素。同時對于127例行減重手術(shù)的肥胖合并2型糖尿病患者進行前瞻性研究,隨訪時間為一年,比較術(shù)后一年患者體重、血糖水平、糖尿病腎病、及糖尿病微血管并發(fā)癥的差異和術(shù)后轉(zhuǎn)歸的預測因子,以評估減重手術(shù)對此類患者的治療效果。結(jié)果糖尿病腎病組患者與單純糖尿病組患者相比,糖尿病病程、BMI、收縮壓、舒張壓、糖化血紅蛋白、腎小球濾過率、甘油三酯、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇、糖尿病視網(wǎng)膜病變存在明顯差異,對糖尿病腎病的多因素二元logistic回歸分析顯示,長糖尿病病程、肥胖、高血壓、高... 

【文章頁數(shù)】：129 頁

【學位級別】：博士

【文章目錄】：
摘要
abstract
中英文縮寫詞
中文部分
    第一部分 糖尿病腎病相關(guān)危險因素的分析
        1.1 引言
        1.2 對象及方法
            1.2.1 研究對象
            1.2.2 排除標準
            1.2.3 體格及生化指標采集
            1.2.4 眼底檢查
            1.2.5 糖尿病腎病定義
        1.3 數(shù)據(jù)分析
            1.3.1 軟件應(yīng)用
            1.3.2 統(tǒng)計方法
        1.4 結(jié)果
            1.4.1 基本情況
            1.4.2 DN組腎功能與DM組無顯著差異
            1.4.3 DN組血壓和血脂顯著高于DM組
            1.4.4 DN組糖尿病視網(wǎng)膜病變發(fā)病率顯著高于DM組
            1.4.5 DN相關(guān)危險因素的多因素二元logistic回歸分析
        1.5 討論
        1.6 結(jié)論
    第二部分 減重手術(shù)對肥胖合并2型糖尿病患者的糖尿病腎病和視網(wǎng)膜病變的影響和預后研究
        2.1 引言
        2.2 對象及方法
            2.2.1 研究對象
            2.2.2 排除標準
            2.2.3 終止隨訪標準和終點事件
            2.2.4 病史及術(shù)前指標采集
            2.2.5 眼底檢查
        2.3 統(tǒng)計學方法
            2.3.1 軟件應(yīng)用
            2.3.2 統(tǒng)計方法
        2.4 結(jié)果
            2.4.1 全體糖尿病患者基本情況
            2.4.2 全體糖尿病患者生化指標
                2.4.2.1 患者血糖水平明顯下降
                2.4.2.2 患者尿蛋白及腎臟超濾過明顯改善
                2.4.2.3 患者血脂紊亂明顯改善
                2.4.2.4 患者糖尿病視網(wǎng)膜病變無明顯改變
            2.4.3 術(shù)前合并有糖尿病腎病患者的亞組分析
                2.4.3.1 術(shù)前合并糖尿病腎病患者的基本情況
                2.4.3.2 術(shù)前合并糖尿病腎病患者生化指標轉(zhuǎn)歸
                    2.4.3.2.1 血糖水平顯著下降
                    2.4.3.2.2 糖尿病腎病明顯緩解
                    2.4.3.2.3 血脂紊亂明顯改善
                    2.4.3.2.4 糖尿病視網(wǎng)膜病變未見明顯改善
            2.4.4 糖尿病腎病緩解的預測因子比較
        2.5 討論
        2.6 結(jié)論
    總結(jié)與展望
        一、研究工作與總結(jié)
        二、本研究的創(chuàng)新性及臨床價值
        三、本研究的局限和不足
英文部分
    Part Ⅰ The research of risk factors of diabetic nephropathy
        1.1 Introduction
        1.2 Objects and methods
            1.2.1 Study subjects
            1.2.2 Exclusion standard
            1.2.3 Physical and biochemical data collection
            1.2.4 Diabetic retinopathy examination
            1.2.5 Definition of diabetic nephropathy
        1.3 Data analysis
            1.3.1 Software Application
            1.3.2 Statistical methods
        1.4 Results
            1.4.1 Basic characteristics
            1.4.2 No significant differences between DM group and DN group in kidney function
            1.4.3 Blood pressure and blood lipids are higher in DN group than DM group
            1.4.4 Incidence of diabetic retinopathy are higher in DN group
            1.4.5 Multivariate binary logistic regression analysis of risk factors for DN
        1.5 Discussion
        1.6 Conclusion
    Part Ⅱ The research of the effect and prognosis of weight loss surgery on diabetic nephropathy and retinopathy of obese patients with T2DM
        2.1 Introduction
        2.2 Objects and methods
            2.2.1 Study subjects
            2.2.2. Exclusion standard
            2.2.3 Follow-up and end-point events
            2.2.4 Physical and biochemical data collection before surgery
            2.2.5 Diabetic retinopathy examination
        2.3 Data analysis
            2.3.1 Software Application
            2.3.2 Statistical methods
        2.4 Results
            2.4.1 Basic characteristics of all diabetic patients
            2.4.2 Biochemical characteristics of all diabetic patients
                2.4.2.1 Blood sugar and Hb A1c showed significant decrease
                2.4.2.2 Proteinuria and hyperfiltration improved significantly in all patients
                2.4.2.3 Blood lipid decreased significantly
                2.4.2.4 Diabetic retinopathy showed no significant changes
            2.4.3 Subgroup analysis of patients with diabetic nephropathy at baseline
                2.4.3.1 Basic characteristics of patients with diabetic nephropathy at baseline
                2.4.3.2 Biochemical characteristics of patients with DN at baseline
                    2.4.3.2.1 Blood sugar and Hb A1c showed significant decrease
                    2.4.3.2.2 Albuminuria and hyperfiltration improved significantly
                    2.4.3.2.3 Blood lipid decreased significantly
                    2.4.3.2.4 Diabetic retinopathy showed no significant changes
            2.4.4 Comparison of preoperative factors of DN remission
        2.5 Discussion
        2.6 Conclusions
    Summarize and Expectation
        1.Summary of the research
        2. Innovation of the research
        3.Limitation of the research
參考文獻
致謝
學術(shù)論文和科研成果目錄
八年制學位論文要求


【參考文獻】：
期刊論文
[1]肥胖型2型糖尿病減重手術(shù)篩選與術(shù)前評估[J]. 張曉娟,程中,田浩明.  藥品評價. 2013(09)



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