不同类型高血压间2型糖尿病患者动脉硬化的变化

Impact of different types of hypertension on arteriosclerosis in diabetic patients

目的采用无创动脉硬化检测装置评估不同类型高血压对2型糖尿病患者动脉硬化程度的影响。方法将173例2型糖尿病患者按高血压不同类型分组,分别为血压正常组(n=55),单纯收缩期高血压组(n=60),收缩压(SBP)和舒张压(DBP)均升高组(n=58)。无创动脉硬化检测装置测定踝肱指数(ABI)、肱踝脉搏波传导速度(baPWV),同时测定体质指数(BMI)、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、血脂等指标,分析ABI、baPWV的影响因素。结果合并高血压2型糖尿病患者的baPWV和ABI分别高于和低于血压正常的2型糖尿病者(均P<0.05)。3组中合并单纯收缩期高血压的2型糖尿病者baPWV最高、ABI最低(均P<0.05)。3组中合并单纯收缩期高血压的2型糖尿病者脉压最大(P<0.05)。校正年龄、性别因素后,baPWV与高血压病程、糖尿病病程、LDL-C、HbA1c、脉压和hs-CRP呈正相关(均P<0.05)。多元逐步回归分析显示,baPWV与年龄、LDL-C、HbA1c、脉压和hs-CRP呈正相关(均P<0.05)。Lo-gistic回归分析显示,与ABI有关的危险因素是HbA1c和hs-CRP(均P<0.05)。结论高血压加重2型糖尿病患者的动脉硬化程度。血糖、血压和血脂的长期合理控制有利于改善2型糖尿病患者的动脉硬化。

Objective To investigate the impact of different types of hypertension on arteriosclerosis in type 2 diabetic patients using a non-invasive vascular screening device.Methods 173 diabetic patients were assigned to 3 groups：group A（without hypertension,n=55）,group B（systolic hypertension,n=60）and group C（both systolic and diastolic hypertension,n=58）.Arterial stiffness was measured by brachial-ankle pulse wave velocity（baPWV）and ankle-brachial index（ABI）.Body mass index（BMI）,Glycosylated hemoglobin（HbA1c）,high-sensitivity C-reactive protein（hs-CRP）,plasma lipid levels were measured.Results baPWV in group B and group C was significantly higher than that in group A（P〈0.05）,while ABI in group B and group C was lower than that in group A（P〈0.05）.baPWV in group B was highest among 3 groups（P〈0.05）,while ABI in group B was lowest（P〈0.05）.Pulse pressure in group B was highest among 3 groups（P〈0.05）.Correlation analysis after adjustment for age and sex showed that course of hypertension,course of diabetes,LDL-C,HbA1c,pulse pressure and hs-CRP were significantly related to baPWV（P〈0.05 for all）.A stepwise multiple regressive analysis demonstrated that age,LDL-C,HbA1c,pulse pressure and hs-CRP were predisposed factors for higher baPWV（P〈0.05 for all）.Logistic regressive analysis displayed that HbA1c and hs-CRP were risk factors for lower ABI（P〈0.05 for all）.Conclusions Hypertension aggravates arteriosclerosis in type 2 diabetic patients.Reasonable and long-term administration of hyperglycaemia,hypertension and hyperlipemia would contribute to ameliorate arteriosclerosis in type 2 diabetic patients.