目的：探讨老年2型糖尿病慢性并发症发病时间及其影响因素。方法选取2010年7月—2013年4月于郑州大学第一附属医院老年内分泌科住院治疗的老年2型糖尿病患者110例为研究对象，收集患者一般资料和实验室检查结果。以患者首次经医院明确诊断为2型糖尿病为观察起点，首次诊断为2型糖尿病合并视网膜病变、肾病、周围神经病变、心血管病变、脑血管病变、颈部或下肢血管病变、糖尿病足中的任何1种慢性并发症为观察终点，两者之间的时间间隔视为“生存时间”，进行生存分析。结果老年2型糖尿病患者1、3、5、10、15、20年生存率分别为60.9％、50.9％、40.9％、16.1％、8.2％、0，总生存时间为0～20.0年，中位生存时间为4.0年。Log - Rank 检验结果显示，有糖尿病家族史与无糖尿病家族史、高密度脂蛋白胆固醇（ HDL - C）水平正常与异常、血脂水平正常与异常的老年2型糖尿病患者生存率不同，差异有统计学意义（P ＜0.05）。有糖尿病家族史、无糖尿病家族史患者中位生存时间分别为7.5、2.5年；HDL - C 水平正常、异常患者中位生存时间分别为5.0、1.0年；血脂水平正常、异常患者中位生存时间分别为5.0、2.0年。Cox 比例风险回归模型分析显示，糖化血红蛋白〔HbA1c ，β＝0.473，Wald χ2＝4.113，HR ＝1.605，95％ CI（1.016，2.538），P ＝0.043〕和 HDL - C〔β＝0.585，Wald χ2＝4.552，HR ＝1.794，95％ CI（1.049，3.067），P ＝0.033〕进入回归方程，是2型糖尿病慢性并发症发生的危险因素。结论随着时间的延长，糖尿病慢性并发症的发生风险随之增加，HbA1c 升高和 HDL - C 降低使老年2型糖尿病慢性并发症的发生时间提前。%Objective To investigate the onset time of elderly T2DM chronic complications and its influencing factors. Methods The general data and laboratory results of 110 elderly patients with T2DM hospitalized in the First Affiliated Hospital of Zhengzhou University from July 2010 to April 2013 were collected. Taking the first diagnosis of T2DM as the observation start point,taking the first diagnoses of T2DM complicated by retinopathy, nephropathy, peripheral neuropathy ( PN ), cardiovascular heart disease,cerebrovascular disease(CVD),neck or lower extremity vascular disease and diabetic food,any chronic complication of which as observation end point,taking the interval between the two as survival time,a survival analysis was performed. Results The 1 - year,3 - year,5 - year,10 - year,15 - year,20 - year survival rates of elderly T2DM patients were 60. 9% ,50. 9% ,40. 9% ,16. 1% ,8. 2% ,0,respectively,the overall survival time 0 - 20 years,median survival time 4. 0 years. Log - Rank test showed that the survival rates were different between patients with diabetes family history and those without,between those with normal HDL - C levels and those with abnormal,between those with normal blood lipid levels and those with abnormal,the difference was significant( P < 0. 05). The median survival time of patients with family histories and those without was 7. 5 years,2. 5 years,respectively;that of patients with normal HDL - C levels,those with lower were 5. 0 years,1. 0 year,respectively;that of patients with normal blood lipid levels,those with abnormal were 5. 0 year,2. 0 years,respectively. Cox proportional hazards regression analysis showed that glycosylated hemoglobin〔 HbA1c ,β =0. 473,Wald χ2 = 4. 113,HR = 1. 605,95% CI(1. 016,2. 538),P = 0. 043〕and HDL - C〔 β = 0. 585,Wald χ2 =4. 552,HR = 1. 794,95% CI(1. 049,3. 067),P = 0. 033〕,entering the regression equation,were risk factors of T2DM chronic complication development. Conclusion With time going on,the risks of T2DM chronic complications increase,high HbA1c and low HDL - C bring forward the occurrence time of elderly T2DM chronic complications.
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