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糖尿病作為一種慢性代謝性疾病，通常不會在患者身上獨立存在，而常與其他諸多非健康狀態(tài)或疾病并存，在這個“數(shù)病齊發(fā)”的過程中糖尿病往往扮演著“助攻手”的角色，今天就讓我們展開一次大盤點，細數(shù)糖尿病都會給我們帶來怎樣的疾病風(fēng)險……

糖尿病是白內(nèi)障的危險因素^[1]，年齡與白內(nèi)障密切相關(guān)，在老年人中白內(nèi)障是最主要的致盲原因^[2]。

糖尿病患者的青光眼風(fēng)險較非糖尿病更高^[3]。

干眼癥是最常見的眼部疾病^[4]，糖尿病與干眼癥的風(fēng)險顯著相關(guān)^[5]

糖尿病患者口腔疾病的患病率、病程和嚴重程度均較非糖尿病人群明顯增加^[6]。牙周炎是糖尿病的常見伴發(fā)疾病之一，糖尿病是牙周炎的重要危險因素，糖尿病患者與非糖尿病人群相比，牙周炎的發(fā)生風(fēng)險增加近3倍。

糖尿病腎臟病變、、是我國慢性腎臟病的主要原因^[7]。

糖尿病神經(jīng)病變是糖尿病常見的慢性并發(fā)癥之一，是一組具有多種臨床表現(xiàn)的異質(zhì)性疾病，病變可累及中樞神經(jīng)和周圍神經(jīng)。

遠端對稱性多發(fā)性神經(jīng)病變：是最常見的糖尿病周圍神經(jīng)病變，約占糖尿病神經(jīng)病變的 75%，是糖尿病足潰瘍的重要危險因素，也是跌倒及骨折的重要原因^[8]。

糖尿病患者的骨折風(fēng)險明顯超過非糖尿病人群^[9]。

老年糖尿病患者發(fā)生抑郁的風(fēng)險高于非糖尿病的老年人^[10]。

糖尿病患者腫瘤風(fēng)險增加，包括肝細胞癌、肝膽管癌、胰腺癌、乳腺癌、卵巢癌、子宮內(nèi)膜癌和胃腸道惡性腫瘤等多種癌癥^[11]。

心血管疾病：糖尿病病人比正常人更容易產(chǎn)生動脈粥樣硬化，而且發(fā)展迅速，從而導(dǎo)致冠心病、腦血管意外等。在T1DM患者中冠心病（CHD）、心肌梗死、心力衰竭、房顫的患病率明顯升高^[12]。

心臟自主神經(jīng)病變：血糖變異性大的糖尿病患者更有可能出現(xiàn)心臟自主神經(jīng)病變^[13]。

腦血管疾病：糖尿病是中風(fēng)最重要的危險因素之一。單獨患有2型糖尿病（T2DM）會使中風(fēng)的風(fēng)險增加1.5到4倍；T2DM和較高的HbA1c水平與任何缺血性中風(fēng)，大動脈中風(fēng)和小血管中風(fēng)的風(fēng)險較高相關(guān)^[14]。

糖尿病患者下肢動脈病變通常是指下肢動脈粥樣硬化性病變（lower extremity atherosclerotic disease，LEAD）。中國DIALEAD研究顯示，我國50歲以上T2DM中LEAD的總患病率為21.2%，且患病率隨著年齡、糖尿病病程增加而升高^[15]。在患LEAD的T2DM患者中，心肌梗死、腦卒中、冠心病導(dǎo)致的死亡風(fēng)險均增加^[16]。

糖尿病足是指糖尿病患者因下肢遠端神經(jīng)病變和血管病變導(dǎo)致的足部感染、潰瘍，甚至深層組織破壞，是糖尿病嚴重的慢性并發(fā)癥之一，嚴重者可以導(dǎo)致截肢和死亡。我國糖尿病足患者的總截肢率為19.03%^[17]。

感染：糖尿病與多種感染的風(fēng)險增加有關(guān)，包括：皮膚和軟組織感染、呼吸道感染、泌尿生殖道感染、血液感染、頭頸部感染、胃腸道感染、骨感染等^[18]。

肝臟疾病：與非糖尿病患者相比，糖尿病患者肝脂肪變性的概率更高，與其內(nèi)臟脂肪組織（VAT）面積相關(guān)^[19]；此外，非酒精性脂肪肝病（NAFLD）可以進展為晚期纖維化，尤其是在2型糖尿病患者中^[20]。

膽囊結(jié)石：與沒有糖尿病的患者相比，患有2型糖尿病的患者發(fā)生膽囊結(jié)石的風(fēng)險增加^[21]。

貧血：貧血是糖尿病成年患者中的中度公共衛(wèi)生問題，性別、糖尿病持續(xù)時間、糖尿病并發(fā)癥的存在和糖尿病合并癥被確定為與貧血相關(guān)的因素。其中，貧血的發(fā)生在女性比男性糖尿病患者更多；糖尿病≥5年的患者比糖尿病病程為1-5年的患者更容易發(fā)生貧血；有合并癥的糖尿病患者比沒有合并癥的糖尿病患者更容易貧血^[22]。  

甲狀腺疾病：糖尿病患者的甲狀腺疾病患病率是非糖尿病患者的2-3倍^[23]；特別是自身免疫性甲狀腺炎^[24]。

電解質(zhì)紊亂：糖尿病患者發(fā)生酮癥酸中毒時，出現(xiàn)嚴重電解質(zhì)紊亂，其血清鉀、鈉、磷、鎂含量和有效滲透壓明顯升高^[25]。

癡呆：2型糖尿病輕度認知障礙患者較非糖尿病患者更易轉(zhuǎn)化為癡呆，2型糖尿病是輕度認知障礙患者癡呆轉(zhuǎn)化的獨立危險因素[26]。

還有很多疾病都因糖尿病而導(dǎo)致患病率上升，或者因糖尿病而加重。所以我們在臨床工作中必須注意糖尿病的防治。

參考文獻：

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[7]Zhang L, Long J, Jiang W, et al. Trends in chronic kidney disease in China[J]. N Engl J Med, 2016, 375(9):905906. DOI: 10.1056/NEJMc1602469.

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[12]Xingming Cai, Jiayong Li, Wenting Cai, et al.Meta-analysis of type 1 diabetes mellitus and risk of cardiovascular disease. Journal of Diabetes and its Complications. 2021, 45(4),107833.

[13]Nyiraty S, Pesei F, Orosz A, et al. Cardiovascular autonomic neuropathy and glucose ariability in patients with type 1 diabetes: is there an association? [J]. Front Endocrinol (Lausanne), 2018, 9: 174. DOI: 10.3389/ fendo.2018.00174.

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[15] Zhang X, Ran X, Xu Z, et al. Epidemiological characteristics of lower extremity arterial disease in Chinese diabetes patients at high risk: a prospective, multicenter, crosssectional study[J]. J Diabetes Complications, 2018, 32(2):150156. DOI: 10.1016/j.jdiacomp.2017.10.003.

[16] Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease[J]. N Engl J Med, 1992, 326(6):381386.

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[19]Sohrab Nobarani, Fariba Alaei-Shahmiri, Rokhsareh Aghili, et al. Visceral Adipose Tissue and Non-alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes.Dig Dis Sci. 2021 Mar 31. doi: 10.1007/s10620-021-06953-z.

[20]Nabil Noureddin, Mazen Noureddin, Amandeep Singh, Naim Alkhouri.Progression of Nonalcoholic Fatty Liver Disease-Associated Fibrosis in a Large Cohort of Patients with Type 2 Diabetes.Dig Dis Sci. 2021 Mar 29. doi: 10.1007/s10620-021-06955-x.

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[22]Teshome Tujuba, Behailu Hawulte Ayele, Sagni Girma Fage, Fitsum Weldegebreal .Anemia among Adult Diabetic Patients Attending a General Hospital in Eastern Ethiopia: a Cross-sectional Study.Diabetes Metab Syndr Obes. 2021;14:467-476. doi: 10.2147/DMSO.S289298.

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[25]Dongyun Su, Jing Li, Manli Guo, et al. Clinical Analysis of Electrolyte Disorders in Patients with Diabetic Ketoacidosis.Clin Lab. 2021 Jan 1;67(1). doi: 10.7754/Clin.Lab.2020.200309.

[26]Andreea Ciudin,Ana Espinosa, et al.Type 2 diabetes is an independent risk factor for dementia conversion in patients with mild cognitive impairment.J Diabetes Complications. 2017 Aug;31(8):1272-1274.

（來源：醫(yī)學(xué)界內(nèi)分泌頻道，作者：朱益麗、于一江，單位：淮安市中醫(yī)院）