2型糖尿病患者糖脂代谢的变化与长期预后的相关性

The correlation between changes of glucose and lipid metabolism and long-term prognosis in the type 2 diabetic patients

目的探讨2型糖尿病患者糖脂代谢的变化与长期预后的相关性。方法 2011年8月~2015年2月选择在我院内分泌科诊治的2型糖尿病患者240例,其中血脂异常80例作为观察组,血脂正常160例作为对照组,两组都进行糖脂代谢指标的检测,并进行长期预后的随访调查与相关性分析。结果两组的糖化血红蛋白与空腹血糖值比较差异无统计学意义（P〉0.05）,都处于2型糖尿病诊断标准范围内。观察组的甘油三酯、总胆固醇和低密度脂蛋白值明显高于对照组,而高密度脂蛋白值都明显低于对照组,差异有统计学意义（P〈0.05）。随访调查1年,观察组的死亡、严重心律失常、心衰、心源性休克等不良事件发生情况明显多于对照组（P〈0.05）。二分类多元Logistic逐步回归分析显示甘油三酯、低密度脂蛋白、空腹血糖、糖化血红蛋白为影响长期预后的主要危险因素（P〈0.05）。结论 2型糖尿病患者多伴随有血脂异常情况,血脂异常会增加预后心血管疾病的发生,糖脂代谢异常都会影响患者的长期预后。

Objective To investigate the correlation between changes of glucose and lipid metabolism and longterm prognosis in the type 2 diabetic patients. Methods 240 patients with type 2 diabetes who were in the endocrine department of our hospital from August 2011 to February 2015 were selected. Among them, 80 patients with abnormal blood lipid were assigned to observation group, and 160 patients with normal blood lipid were assigned to control group. In both two groups, glucose and lipid metabolism indexes were detected, and the follow-up survey of longterm prognosis and the correlation analysis were performed. Results There was no significant difference between the two groups of glycosylated hemoglobin and fasting blood glucose（P〈 0.05）, they were both in the range of diagnostic criteria of type 2 diabetes. In the observation group, the triglyceride, total cholesterol and low density lipoprotein were higher, while the high density lipoprotein was lower than those of the control group significantly. The differences were statistically significant（P〈 0.05）. During 1 years of follow-up investigation, the incidences of adverse event, such as death, severe arrhythmia, heart failure, cardiac shock, etc. in the observation group were significantly higher than those in the control group（P〈 0.05）. Two classification multivariate Logistic stepwise regression analysis indicated that triglyceride, low density lipoprotein, fasting blood glucose and glycosylated hemoglobin were the main risk factors for long-term prognosis（P〈 0.05）. Conclusion Type 2 diabetic patients usually suffer from abnormal blood lipids. Abnormal blood lipids may increase the prognosis of cardiovascular disease. The abnormal metabolism of glucose and lipid may affect the long-term prognosis of patients.