2型糖尿病合并高血压患者空腹血糖控制相关因素研究

Study on influencing factors of fasting blood glucose control among patients with diabetes complicated with hypertension

目的 了解无锡城乡社区2型糖尿病合并高血压患者临床指标特征,分析影响其血糖控制的因素.方法 采取分层整群抽样方法,分别在无锡市城市和农村中各抽取2个社区,对登记管理的927例2型糖尿病患者,开展问卷调查、体格检查和血生化检查,比较糖尿病血压正常组和糖尿病合并高血压组的相关信息和临床指标,以空腹血糖控制是否达标为应变量,进行Logistic回归分析影响血糖控制的因素.结果 2型糖尿病合并高血压组总并发症、大血管并发症和血脂异常患病比例分别为28.51％、21.00％和53.27％,均高于糖尿病血压正常组（分别为10.90％、5.45％和44.08％）,差异均有统计学意义（均有P＜0.05）;2型糖尿病合并高血压组血清尿酸、血清肌酐和体质指数均值均高于糖尿病血压正常组,差异均有统计学意义（均有P ＜0.05）.多因素Logistic回归分析显示,城市地区利于糖尿病合并高血压患者血糖控制（与农村地区相比,OR=0.50,95％ CI：0.27～0.93）,而糖尿病病程长（OR=1.66,95％ CI：1.18 ～2.34）、血压高（OR=1.51,95％ CI：1.16～1.96）不利血糖控制.结论 城乡社区2型糖尿病合并高血压患者的状况不容乐观,农村尤为严重,社区糖尿病患者管理需探索有效的适宜技术.

Objective To understand the characteristics of clinical indexes of patients with type 2 diabetes melli- tus complicated with hypertension and to explore the influencing factors of fasting blood glucose control. Methods The stratified cluster random sampling method was conducted to select 2 communities from urban and rural areas, respectively. 927 patients with type 2 diabetes managed by community health service centers were surveyed. The related information and clinical indexes between diabetes patients without and with hypertension were compared. The Logistic regression was used to analyze the factors which could influence the glucose control of diabetes complicated with hypertension. Results The prevalence rates of general complications, macrovascular complications and dyslipidemia were 28.51%, 21.00%, and 53.27% among patients with diabetes mellitus complicated with hypertension, which were significantly higher than those a- mong patients with diabetes without hypertension （being 10. 90%, 5.45%, and 44. 08%, respectively） （all P 〈 0. 05 ）. The levels of serum uric acid, serum creatinine and body mass index were significantly higher in diabetes with hypertension those than that in diabetes without hypertension （ all P 〈 0.05 ）. Multi-variables logistic regression showed that urban was beneficial to glucose control （ OR =0. 50, 95% CI： O. 27-0. 93）, whereas long course of diabetes （ OR = 1.66, 95% CI： 1.18-2. 34） and high blood pressure （OR = 1.51,95% CI： 1.16-1.96） were unfavorable factors. Conclusions The sit- uation of type 2 diabetes with hypertension in communities is not optimistic, especially in the rural area. The management of diabetes in communities needs effective and appropriate techniques