老年高血压人群发生糖代谢异常风险的10年队列研究

Risks of type 2 diabetes mellitus and impaired glucose regulation among elderly patients with essential hypertension： a 10-years cohort study

目的 观察老年高血压（HT）及非高血压（NHT）人群糖代谢异常的发生情况及其危险因素.方法 采用前瞻性队列研究方法,研究对象为1999至2009年在解放军总医院体检的60岁以上老年人,除外基线时已确诊2型糖尿病（T2DM）及糖调节受损（IGR）者.观察在10年中发生DM及IGR的情况及影响因素,应用COX风险比例模型分析相关危险因素,Kaplan-Meier法分析累计发病率.结果 （1） 1999年调查人数为1 136人,纳入糖耐量正常582人,其中HT组384例,NHT组198人.随访10年后,HT组发生T2DM显著高于NHT组（27.6％比18.7％,P＜0.05）,HR（ 95％ CI）为1.48（1.07～2.04）；两组DM发病密度分别为33.8‰和20.6‰.HT组与NHT组的IGR发生率差异无统计学意义（P＞0.05）；新发HT组与NHT组相比,DM及IGR的发生率差异无统计学意义（P＞0.05）.（2）血脂紊乱及HT是发生T2DM的独立危险因素,HR（95％CI）分别为1.459（1.027～2.072）及1.516（1.039～2.212）；同时也是发生糖代谢异常的独立危险因素,HR （95％ CI）分别为1.545（1.087～2.195）及1.524（1.044 ～2.224）；HT与NHT人群T2DM及糖代谢异常的累积发生率差异均有统计学意义（均P ＜0.05）.结论 老年人群合并HT后其糖尿病风险增加,是非NHT人群的1.52倍.血脂紊乱也是T2DM及糖代谢异常的独立危险因素.

Objective To explore the incidence of type 2 diabetes mellitus （T2DM） and impaired glucose regulation （IGR） among elderly patients with and without hypertension during a follow-up period of 10 years. Methods The subjects were elderly patients （ 〉 60 years old） undergoing annual health examinations at our hospital.And the previously diagnosed T2DM and IGR patients were excluded.And the incidence and risk factors were analyzed by Kaplan-Meier method and COX＇s proportional hazard.Results Among a total of 1136 subjects,582 were enrolled.They were divided into essential hypertension group （ HT,n =384） and non-essential hypertension greoup （ NHT,n =198） （ including new-onset 67 subjects）.During a 10-year follow-up,the incidence of new-onset diabetes was 27.6% in HT group and 18.7% in NHT group （HR =1.48; 95% CI： （1.07- 2.04）,P 〈 0.05 ）.And the incidence density of T2DM were33.8‰ and 20.6‰ respectively in two groups.There was no difference in the prevalence of IGR among HT and NHT groups and no difference was found in the prevalence of T2DM or IGR among new-onset HT and NHT groups.The independent risk factors of T2DM was dyslipidemia （ HR =1.459; 95% CI： 1.027 -2.072,P 〈 0.05 ） and hypertension （ HR =1.516 ; 95% CI： 1.039 - 2.212,P 〈 0.05 ） based upon the COX＇s proportional hazard analysis. Dyslipidemia （ HR =1.545 ; 95% CI： 1.087 - 2.195,P 〈 0.05 ） and hypertension （ HR =1.524; 95% CI： 1.044 - 2.224,P 〈 0.05 ） were also independent risk factors of abnormal glycometabolism （T2DM and IGR ）. Kaplan-Meier analysis indicated that the accumulative incidence of DM and abnormal glycometabolism was different between the HT and NHT groups.Conclusion The DM risk is 1.516 folds higher in elderly patients with HT than in those without. According to multivariate analysis,hypertension and dyslipidemia are independent risk factors of T2DM and abnormal glycometabolism （T2DM and IGR）.