高龄2型糖尿病患者下肢动脉硬化闭塞症的危险因素研究

Risk Factors of Lower Extremity Atherosclerotic Occlusive Disease in Elderly Patients with Type 2 Diabetes Mellitus

目的探讨高龄2型糖尿病患者下肢动脉硬化闭塞症(LEAOD)的危险因素。方法选取2014年10月—2015年10月在重庆医科大学附属第一医院老年病科住院的高龄2型糖尿病患者187例,根据踝臂指数(ABI)检查结果分为LEAOD组(ABI≤0.9,n=85)和非LEAOD组(ABI>0.9,n=102)。比较两组的一般资料,包括基本情况、合并症/并发症、血压及实验室检查指标。影响因素分析采用多因素Logistic回归分析。结果 LEAOD组年龄、病程及血尿酸、胱抑素C、总胆固醇、糖化血红蛋白水平高于非LEAOD组,血红蛋白、清蛋白水平低于非LEAOD组,差异有统计学意义(P<0.05);而两组身高、体质量、BMI及收缩压、舒张压、脉压、血肌酐、三酰甘油、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、空腹血糖水平间差异无统计学意义(P>0.05)。两组男性、吸烟史、饮酒史比例及脑卒中、冠心病、糖尿病肾病、视网膜病变、蛋白尿发生率间差异无统计学意义(P>0.05);而LEAOD组高血压、颈动脉硬化、周围神经病变发生率高于非LEAOD组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,病程、糖化血红蛋白、高血压是高龄2型糖尿病患者发生LEAOD的独立危险因素(P<0.05),而清蛋白是高龄2型糖尿病患者发生LEAOD的独立保护因素(P<0.05)。结论高龄2型糖尿病患者LEAOD发生率较高,长病程、高糖化血红蛋白水平、合并高血压、低蛋白血症是其危险因素,应加强血糖监控及早期综合治疗,以期阻止LEAOD的发生和恶化。

Objective To explore the risk factors for lower extremity atherosclerotic occlusive disease（ LEAOD） in elderly patients with type 2 diabetes mellitus（ T2DM）.Methods We performed a retrospective analysis of 187 elderly patients with T2 DM who were hospitalized in Department of Geriatrics,the First Affiliated Hospital of Chongqing Medical University,between October 2014 and October 2015.These patients were divided into two groups based on the value of ankle brachial index（ ABI） ： LEAOD group（ ABI≤0.9,n = 85） and non-LEAOD group（ ABI 〉0.9,n = 102）.Comparisons of general data,including basic situation,complication / inheritance,blood pressure and laboratory examination indexes were made between the two groups.Risk factors for LEAOD were analyzed by multivariate Logistic regression.Results Compared with the patients in the non-LEAOD group,patients in the LEAOD group were older,and they had longer duration of disease,higher levels of blood uric acid,cystatin C,total cholesterol,glycosylated hemoglobin（ Hb A1c）（ P〈0.05）,but lower levels of hemoglobin and albumin（ P〈0.05）.The differences in height,body mass,BMI,levels of systolic and diastolic blood pressure,pulse pressure,serum creatinine,triacylglycerol,high-density lipoprotein（ HDL） and low-density lipoprotein（ LDL） and fasting plasma glucose between the two groups showed no statistical significance（ P〉0.05）.No statistically significant differences were found in the proportion of males,proportion of patients with smoking history,proportion of patients with drinking history,incidences of stroke,coronary heart disease,diabetic nephropathy,retinopathy and albuminuria between the two groups（ P〈0.05）.Patients in the LEAOD group had higher incidences of hypertension,carotid atherosclerosis,peripheral neuropathy than those in the non-LEAOD group did（ P〈0.05）.Multivariate Logistic regression analysis revealed that course of disease,Hb A1 cand hypertension were the independent risk factors while albumin was the independent protective factor for LEAOD occurring in elderly patients with T2DM（ P〈0.05）.Conclusion The morbidity of LEAOD is significantly higher in the elderly patients with T2 DM.For elderly patients with T2 DM,especially those with long course of disease,high Hb A1 clevel,hypertension,or hypoproteinemia,we should enhance controlling blood glucose level and early comprehensive treatment,in order to prevent the occurrence and deterioration of LEAOD.