基线收缩压水平对糖尿病人群新发心脑血管事件的影响

Effect of baseline systolic blood pressure on new-onset cardio-and cerebrovascular events in diabetic population

目的探讨基线收缩压水平对糖尿病人群新发心脑血管事件的影响。方法本研究以参加2006-07-2007-10健康查体的101 510名开滦集团职工中的8306例空腹血糖≥7.0或〈7.0 mmol/L但已确诊为糖尿病,正在使用降糖药物的人群作为观察对象,随访38-53（48.1±3.1）月,随访期间每半年收集一次新发心脑血管事件情况。分析基线收缩压水平对糖尿病人群新发心脑血管事件的影响。结果随着基线收缩压水平增高,糖尿病人群的平均年龄、体质量指数、三酰甘油、高密度脂蛋白胆固醇、总胆固醇、低密度脂蛋白胆固醇水平逐渐增高（P〈0.01或P〈0.05）。与基线收缩压〈120组、120-〈130组和≥140组相比,130-〈140 mm Hg组总心脑血管事件、脑梗死事件、心肌梗死事件和脑出血事件发生率最低,其中总心脑血管事件和脑梗死事件发生率的差异有统计学意义（P〈0.05）。Cox比例风险回归分析显示,在糖尿病合并高血压人群中,与基线收缩压130-〈140组相比,〈120组、120-〈130组和≥140 mm Hg组发生总心脑血管事件的RR值分别为5.37（95%CI2.24-12.87,P〈0.01）、2.41（95%CI1.11-5.22,P〈0.05）和2.43（95%CI1.35-4.36,P〈0.01）;与基线收缩压130-〈140组相比,〈120组和≥140 mm Hg组发生脑梗死的RR值分别为6.16（95%CI2.05-18.55,P〈0.01）和2.65（95%CI1.24-5.70,P〈0.01）。结论基线收缩压水平可影响糖尿病人群心脑血管事件发生率,糖尿病合并高血压人群中收缩压130-139 mm Hg组总心血管事件和脑梗死事件发生率最低。

Objective To study the effect of baseline systolic blood pressure（SBP）level on new-onset cardio-and cerebrovascular events in diabetic patients.Methods This was a prospective cohort study.In a total of 101 510 employees of Kailuan Group who had received a physical examination in the period from Jul.2006 to Oct.2007,8306 subjects who had a fasting plasma glucose level of≥7.0 mmol/L or who had been diagnosed with diabetes despite a fasting plasma glucose concentration of 7.0 mmol/L were selected and thus were taking insulin or hypoglycemic drugs.In the 38-53（48.1±3.1） months of follow-up,we collected the cardio-cerebrovascular events every six months for the investigation of the effect of the baseline SBP on new-onset cardio-cerebrovascular events in the diabetic population were collected.Results With the increased level of baseline SBP,the mean age,BMI,TG,and HDL-C level significantly increased gradually in the diabetic population（P〈0.01）,and so did the TC and LDL-C level（P〈0.05）.Compared with baseline SBP120 mm Hg group,baseline SBP 120-130 mm Hg group and baseline SBP≥140 mm Hg group,SBP 130-140 mm Hg group had the lowest incidence regarding cardio/cerebral vascular events,cerebral infarction events,myocardial infarction,and cerebral hemorrhage events,with the first two respects presenting significant differences（P〈0.05）.A multivariate Cox＇s proportional hazards regression analysis indicated that after adjustment for other risk factors,in the diabetic subjects complicated with hypertension,compared with baseline SBP 130-140 mm Hg group,the RR for cardio-cerebrovascular events in SBP120 mm Hg group,SBP 120-130 mm Hg group and SBP≥140 mm Hg group were 5.37（95% CI 2.24-12.87,P〈0.01）, 2.41（95% CI 1.11-5.22,P〈0.05） and 2.43（95% CI 1.35-4.36,P〈0.01）,respectively;the RR for cerebral infarction events in SBP120 mm Hg group and SBP≥140 mm Hg group were 6.16（95% CI 2.05-18.55,P〈0.01）and 2.65（95% CI 1.24-5.70,P〈0.05）.Conclusion The level of baseline SBP may affect the incidence of cardio/cerebral vascular events in diabetic population.In diabetic patients complicated with hypertention,those with SBP of approximately 130 to 140 mm Hg have the lowest incidence of cardio-cerebrovascular events and cerebral infarction events.