成人糖尿病患者心血管病危险分层及其意义

Risk stratification and significance of adult diabetic patients with cardiovascular disease

目的 探讨成人糖尿病患者可能发生心血管病的相关危险因素.方法 收集2008年1月至2013年12月在我院住院治疗,病历资料完整的年龄≥20岁的糖尿病患者557例.根据心血管病危险评估的主要危险因素对每一个体应用弗雷明汉风险评分方法进行评分及分层,＜10％为低危、10％～20％为中危、＞20％为高危.分析未来10年发生心血管病的相关危险因素.结果 最终纳入调查研究 的糖尿病患者共557例,全部为汉族,其中男275例,女282例;1型糖尿病患者79例（14.18％）,2型糖尿病患者478例（85.82％）.10年总体心血管病风险概率评估发现低危者103例（低危组）,占18.5％、中危者91例（中危组）,占16.3％、高危者195例（高危组）,占35.0％,以前有心血管病者168例为心血管病组,占30.2％.（1）不同危险分层发生心血管病的危险因素特征：①糖尿病患者代谢综合征的患病率较高,甚至在低危组也达37.9％,高危组达60.5％;②高危组年龄（65.3 ±11.7）岁高于低危组（50.3±15.4）岁;③高危组收缩压（143.4±18.1）mmHg高于低危组（125.7±13.2） mmHg;④高危组血压达标者较少（32.3％）;⑤高危组慢性肾病的患病率（21.5％）大大高于中危组（7.7％）和低危组（7.8％）.（2）2型糖尿病（高危组31.6％）发生心血管病的整体风险高于1型糖尿病（高危组16.4％）.（3）70～79岁范围高危组比例高达39.2％.结论 2型糖尿病患者整体发生心血管病的风险增大,代谢因素可能是增加长期风险的原因,对糖尿病患者的风险评估有利于增加针对性治疗的强度.

Objective To explore the related risk factors between adults with diabetes and cardiovascular disease risk.Methods Five hundred and fifty-seven patients whose age were over 20 years with diabetes mellitus were hospitalized in the First People＇s Hospital of Shangqiu from Jan.2008 to Dec.2013.According to the major risk factors of cardiovascular risk assessment,Framingham cardiac risk score was use to assess and stratify patients;and then graded as low risk group（〈 10%）,intermediate risk group（10% to 20%） and the high risk group（〉 20%）.Predicted the next 10 years the probability of the risk of cardiovascular disease.Results Among 557 patients,275 cases were male and 282 cases were female,79 cases （14.18%） were type Ⅰ diabetes mellitus and 478 cases （85.82%） were type Ⅱ diabetes mellitus.Meanwhile,10 years the probability of the risk of cardiovascular disease showed that there were 103 cases of low risk group（18.5%）,91 cases of intermediate risk group （16.3%）,195 cases of high risk group （30.2%） and 168 cases of cardiovascular disease group who had cardiovascular disease （30.2%）.（1） Characteristics of risk factors for cardiovascular disease of risk stratification：①There was high incidence of metabolic syndrome in patients with diabetes mellitus,which was up to 37.9% even in low risk group and 60.5% in high risk group.②The average age of high risk group was （63.5 ± 11.7） years old which was higher than the low risk group （（50.3 ± 15.4） years old）.③Systolic pressure of high risk group was （143.4 ± 18.1） mmHg,higher than that of the low risk group （（125.7 ± 13.2） mmHg）.④It was hard to control the blood pressure in high risk group,so as a few cases（32.3%） were up to the standard.⑤The incidence of chronic kidney disease in high risk group was 21.5%,which was significant higher than that in intermediate risk group（7.7%） and low risk group（7.8%）.（2） In high risk groupn,type Ⅱ diabetes mellitus＇s incidence was 31.6% which was higher than type Ⅰ diabetes mellitus＇s（16.4%）.（3）In high risk group,the proportion of age range from 70 to 79 years old was up to 39.2%.Conclusion The overall risk of cardiovascular disease increases in patients with type Ⅱ diabetes.Metabolic factors may be the main risk.The risk assessment of diabetic patients will help to increase the intensity of treatment.