高龄高血压合并糖尿病患者靶器官损害的临床研究

Target organ damage in very old hypertension patients complicated with diabetes mellitus

目的研究高龄高血压合并糖尿病患者靶器官损害的特征,为靶器官损害的防治提供依据。方法118例高龄住院患者,平均年龄(86±6)岁,分为高血压病组(EH,35例)、糖尿病组(DM,39例)、高血压合并糖尿病组(EH+DM,44例),比较3组患者颈动脉阻力指数、颈总动脉内膜-中膜厚度、左心室重量指数、尿微量白蛋白、肌酐清除率等检测结果。结果与EH组、DM组比较,EH+DM组颈动脉阻力指数均显著升高,颈总动脉内膜-中膜厚度明显增厚。EH+DM组患者斑块指数明显高于单纯EH组、DM组。DM、EH及EH+DM组患者左心室重量指数(LV-MI)、收缩期升主动脉内径(AOD)有显著差异,其中EH+DM组患者LVMI、AOD高于其余2组;EH+DM组尿微量蛋白高于EH组和DM组,内生肌酐清除率低于EH组和DM组。结论高龄高血压合并糖尿病患者,靶器官损害危险性明显增加。

Objective To study the characteristics of target organ damage in very old hypertension patients complicated with diabetes mellitus （DM） and provide reference information for the control of target organ damage. Methods Totally 118 very old inpatients（mean age 86±6） were divided into 3 groups： essential hypertension group （EH, n=35）, diabetes mellitus group （DM, n=39） and EH complicated with DM group （EH＋DM, n=44）. Carotid resistance index, intima-media thickness, left ventricular mass index （LVMI）, urine microprotein, and creatinine clearance rate （Ccr） were compared between the 3 groups. Results Carotid resistance index and intima-media thickness in the EH ＋ DM group were significantly increased compared with the EH and DM groups. Plaque index in EH＋DM group was obviously higher than that in EH and DM groups. The LVMI and systolic aortic inner diameter （AO） were remarkably different among the DM, EH and EH-？DM groups, and LVMI and AO were higher in EH＋DM group than in the other 2 groups. The microalbuminuria in EH＋DM group was higher, while Ccr was lower than that in EH and DM groups. Conclusion The risk of target organ damage increases significantly in very old EH patients complicated with DM.