摘要
背景血糖变异性增大不仅会影响2型糖尿病患者血糖控制效果,还会导致2型糖尿病患者并发症发生风险升高、临床治疗效果变差,而目前关于老年原发性高血压合并2型糖尿病患者血糖变异性的研究报道较少。目的探讨老年原发性高血压合并2型糖尿病患者血糖变异性及其临床意义。方法选取2016年2月-2017年2月泰州市第三人民医院收治的老年原发性高血压合并2型糖尿病患者80例,根据72 h平均血糖(MBG)及血糖标准差(SDBG)分为A组(72 h MBG≤3倍SDBG,n=53)和B组(72 h MBG>3倍SDBG,n=27)。比较两组患者血糖相关指标[包括糖化血红蛋白(HbA1c)、空腹血糖(FPG)、SDBG]、血压相关指标[包括日间平均收缩压(DSBP)、日间平均舒张压(DDBP)、夜间平均收缩压(NSBP)、夜间平均舒张压(NDBP)、收缩压变异性(△SBP)、舒张压变异性(△DBP)]、血生化指标[包括总胆固醇(TC)、三酰甘油(TG)、血肌酐(Scr)]及心脑血管疾病发生情况;SDBG与老年高血压合并2型糖尿病患者心脑血管疾病之间的相关性分析采用Spearman秩相关分析,SDBG与老年高血压合并2型糖尿病患者HbA1c、FPG、△SBP、△DBP之间的相关性分析采用Pearson相关分析。结果 (1)A组患者HbA1c、FPG、SDBG高于B组(P<0.05)。(2)两组患者DSBP、DDBP比较,差异无统计学意义(P>0.05);A组患者NSBP、NDBP高于B组,△SBP、△DBP低于B组(P<0.05)。(3)两组患者TC、TG、Scr比较,差异无统计学意义(P>0.05)。(4)A组患者心脑血管疾病发生率为35.8%(19/53),高于B组的29.6%(8/27)(P<0.05)。(4)Spearman秩相关分析结果显示,SDBG与老年高血压合并2型糖尿病患者心脑血管疾病呈正相关(rs=0.340,P<0.05)。Pearson相关分析结果显示,SDBG与老年高血压合并2型糖尿病患者HbA1c(r=0.190)、FPG(r=0.001)呈正相关,与△SBP(r=-0.350)、△DBP(r=-0.370)呈负相关(P<0.05);亚组分析结果显示,SDBG与A组患者△SBP(r=-0.130)、△DBP(r=-0.090)无直线相关关系(P>0.05),与B组患者△SBP(r=-0.440)、△DBP(r=-0.340)呈负相关(P<0.05)。结论血糖变异性与老年原发性高血压合并2型糖尿病患者心脑血管疾病发生风险、血糖控制效果、2型糖尿病严重程度及血压变异性有关,尤其对72 h MBG>3倍SDBG者血压变异性影响较大,临床需加强对血糖变异及血糖管理的重视。
Background Increased glycemic variability not only affects the control effect of blood glucose,but also leads to increase of risk of complications and worse clinical effect,however there is few reports about the glycemic variability in elderly essential hypertension patients merged with type 2 diabetes mellitus. Objective To investigate the glycemic variability and its clinical significance in elderly essential hypertension patients merged with type 2 diabetes mellitus. Methods A total of 80 elderly essential hypertension patients merged with type 2 diabetes mellitus were selected in the Third People’s Hospital of Taizhou from February 2016 to February 2017,and they were divided into A group(with 72-hour MBG ≤ 3 times of SDBG,n=53)and B group(with 72-hour MBG>3 times of SDBG,n=27)according to the 72-hour MBG and SDBG. Blood glucose related indicators(including HbA1 c,FPG and SDBG),blood pressure related indicators(including DSBP,DDBP,NSBP,NDBP,△ SBP and △ DBP),blood biochemical index(including TC,TG and Scr)and incidence of cardiocerebral vascular disease were compared between the two groups;Spearman rank correlation was used to analyze the correlation between SDBG and vascular disease in elderly essential hypertension patients merged with type 2 diabetes mellitus,and Pearson correlation analysis was used to analyze the correlations of SDBG with Hb A1 c,FPG, △ SBP and △ DBP. Results (1)Hb A1 c,FPG and SDBG in A group were statistically significantly higher than those in B group(P<0.05).(2)No statistically significant difference of DSBP or DDBP was found between the two groups(P>0.05);NSBP and NDBP in A group were statistically significantly higher than those in B group,while △ SBP and △ DBP in A group were statistically significantly lower than those in B group(P<0.05).(3)No statistically significant difference of TC,TG or Scr was found between the two groups(P>0.05).(4)Incidence of cardiocerebral vascular disease in A group was 35.8%(19/53),which was statistically significantly higher than that of B group of 29.6%(8/27)(P<0.05).(4)Spearman rank analysis results showed that,SDBG was positively correlated with cardiocerebral vascular disease in elderly essential hypertension patients merged with type 2 diabetes mellitus(rs=0.340,P<0.05).Pearson analysis results showed that,SDBG was positively correlated with Hb A1 c(r=0.190)and FPG(r=0.001)in elderly essential hypertension patients merged with type 2 diabetes mellitus,respectively,but was negatively correlated with △ SBP(r=-0.350)and △ DBP(r=-0.370),respectively(P<0.05);subgroup analysis results showed that,SDBG was not linearly correlated with △ SBP(r=-0.130)or △ DBP(r=-0.090)in A group(P>0.05),but it was negatively correlated with △ SBP(r=-0.440)or △ DBP(r=-0.340)in B group(P<0.05). Conclusion Glycemic variability is significantly correlated with the risk of vascular disease,control effect of blood glucose,severity of type 2 diabetes mellitus and blood pressure variability in elderly essential hypertension patients merged with type 2 diabetes mellitus,respectively,moreover it may make a bigger impact on blood pressure variability in patients with 72-hour MBG>3 times of SDBG,thus we should pay more attention to the blood glucose variation and blood glucose management on clinic.
作者
陈建梅
CHEN Jianmei(Department of Cardiology,the Third People's Hospital of Taizhou,Taizhou 225300,China)
出处
《实用心脑肺血管病杂志》
2019年第12期42-46,共5页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
高血压
糖尿病
2型
血糖
老年人
Hypertension
Diabetes mellitus,type 2
Blood glucose
Aged
