老年高血压和糖尿病患者动脉僵硬度的影响因素分析

Influencing factors of arterial stiffness in the elderly patients with hypertension and type 2 diabetes mellitus

目的评价老年高血压和（或）糖尿病患者动脉僵硬度及其影响因素。方法320例老年患者分为4组：对照组、糖尿病组、高血压组、高血压并存糖尿病组（联合患病组）。收集年龄、体质指数、性别、吸烟、血压、脉压及平均动脉压，测定血清空腹血糖、血脂、糖化血红蛋白、超敏C反应蛋白等；并应用COLIN-VP1000动脉硬化测定仪测量人选者踝臂脉搏波传导速度（baPWV）以评价对动脉硬化的影响。结果联合患病组、糖尿病组、高血压组、对照组baPWV值分别为（2165．9±479．9）cm／S、（2158．6±386．9）cm／s、（1881．2±383．8）cm／S和（1667．2±279．3）cm／s，联合患病组、高血压组及糖尿病组的baPWV水平与对照组比较，差异均有统计学意义（F=8．473，P〈0．05），联合患病组与糖尿病组的baPWV值比较，差异无统计学意义，高血压组与糖尿病组及联合患病组的baPWV值比较，差异有统计学意义（均P〈0．05）。联合患病组脉压、超敏C反应蛋白最高，与对照组比较，差异有统计学意义（均P〈O．05）。多元线性回归分析结果显示，血清空腹血糖、平均动脉压、脉压、超敏C反应蛋白、低密度脂蛋白胆固醇与baPWV水平呈正相关（均P〈0．05）。结论糖尿病、高血压是老年人动脉僵硬度增高的影响因素，而高血糖对老年人动脉僵硬度的影响可能起了更重要的作用。血糖、平均动脉压、脉压、超每C反应蛋白、低密度脂蛋白胆固醇均是影响动脉僵硬度的独立危险因素。

Objective To evaluate arterial stiffness and its influencing factors in the elderly patients with hypertension and （or） type 2 diabetes mellitus. Methods Totally 320 elderly patients were divided into four groups： control, diabetes mellitus, hypertension, coexisting hypertension and diabetes mellitus. Arterial stiffness in ankle and brachial artery was determined by brachial ankle pulse wave velocity （baPWV）. Other factors affecting baPWV were also collected and measured, including age, body mass index （BMI）, sex, smoking, blood pressure, pulse pressure, mean arterial pressure, serum fasting blood glucose, lipid profile, glycosylated hemoglobin and hypersensitive C reactive protein （hsCRP）. Results baPWV in the four groups were （1667.2 ± 279.3 ） cm/s, （2158.6 ± 386.9）cm/s, （1881.2±383.8） cm/s and （2165.9±479.9）cm/s, respectively. The baPWV value was higher in groups of hypertension, diabetes mellitus, and the coexisting diseases than in controls （F=8. 473,P〈0.05）. Diabetic patients had a higher baPWV levels than those without diabetes. There was no difference in baPWV levels between diabetic patients with or without hypertension. Pulse pressure and hsCRP were higher in coexisting diseases group than in control group （P^0.05）. Stepwise backward regression analysis showed that fasting blood glucose, pulse pressure, mean blood pressure, hsCRP and low density lipoprotein cholesterin （LDI. C） were positively related to baPWV P〈0.05）. Conclusions Hypertension and （or） type 2 diabetes mellitus are important influencing factors for higher arterial stiffness. Hyperglycemia might play more important role in the elderly arterial stiffness. Serum fasting blood glucose, pulse pressure, mean blood pressure, hsCRP, LDL-C may be the independent risk factors of arterial stiffness.