老年2型糖尿病患者并发冠心病的危险因素分析

Analysis on the major risk factors of elderly type 2 diabetes mellitus complicated by coronary heart disease

目的应用主成分分析法（principal component analysis，PCA）分析老年2型糖尿病患者并发冠心病的主要危险因素。方法回顾性分析我院住院行冠状动脉（冠脉）造影检查的60岁以上老年2型糖尿病患者503例临床资料，测定糖尿病患者尿白蛋白排泄率（urinary albuminexcretion rate，UAER）等指标，采用Gensini系统对冠脉血管病变程度进行评分。结果第1～7主成分的特征值均大于1，累计贡献率为64．6％；第1～4主成分分别为UAER、血脂、血压、尿酸，贡献率分别为14．1％、11．8％、10．2％、8．7％；第5～7主成分均属血糖，累计贡献率为19．8％。结论UAER是老年2型糖尿病患者并发冠心病最主要的危险因素，伴微量白蛋白尿的老年2型糖尿病患者冠心病患病风险增加，且严重程度增加；UAER与老年2型糖尿病患者冠心病的发生及冠脉病变严重程度呈正相关，为其独立影响因素。

Objective To analyze the major risk factors of elderly type 2 diabetes mellitus （T2DM） complexing with coronary heart disease（CHD） via principal component analysis （PCA）. Methods The clinical data of 503 subjects aged 〉 60 years with T2DM were retrospectively analyzed. Urinary albumin excretion rate（UAER） from urine collected from 10：00 PM to 6：00 AM was measured by chemiluminescence. The degree of angiostegnosis was evaluated by Judkins coronary arteriography and Oensini score. According to UAER level, the patients were divided into microalbuminuria group （20 mg/L〈UAER〈200 rag/L, n= 226） and normal urinary albumin group （UAER〈20 rag/L, n=277）. PCA was used to discuss the major risk factors to affect T2DM patients with CHD in the elderly. Results Characteristic values of the principal component from first to seventh were all more than 1, their cumulative rate was 64.7%. The first to fourth principal components and their variances were UAER（14.1%）, blood fat （11.8%）, blood pressure（10.2%） and uric acid（8.7%）, respectively. The fifth to seventh principal components were all blood glucose and the cumulative variance was 19.8%. The numbers of angiostegnosis were 36.5 % single, 34.7 double and 28.9% three in patients with normal urinary albumin, while 10. 20% single, 27.9% double and 61.9 % three in patients with microalbuminuria, respectively（P〈0.05）. The Gensini scores was increased in microalbuminuria group （50.7±35.8） as compared with normal urinary albumin group （19.7±23.0） （P〈0.05）. UAER was independently related to Gensini scores （β= 0. 442, P= 0. 000）. Conclusions UAER is the most important factor of elderly T2DM complexing with CHD and positively correlated with severity of CHD as its independent factor.