前瞻性分析强化降糖和降压治疗对2型糖尿病大血管病变的影响

Influence of strengthened hypoglycemic and antihypertensive treatment on macrovascular in patients with type 2 diabetes

目的探讨强化降糖、降压治疗对2型糖尿病大血管病变的影响。方法以本院2010年12月至2014年12月收治的2型糖尿病患者120例为研究对象，将其随机分为A、B、C、D组，各30例；A组给予强化降糖降压治疗，B组给予单纯强化降糖治疗，C组给予单纯强化降压治疗，D组给予一般性降糖降压治疗；比较分析各组大血管病变发生情况。结果A组血糖各项指标及IMT与治疗前比较差异均有统计学意义（t=5．171、6．299、6．448、4．557，均P〈0．01）；A组、C组患者的收缩压、舒张压与治疗前比较均明显改善（t=13．587、9．117、10．694、7．013，均P〈0．01），分别与B组、D组比较差异均有统计学意义（t=12．229、11．023、10．694、9．859、6．843、6．386、5．988、5．806，均P〈0．01）；A组、c组治疗后血压总达标率分别为83．3％和86．7％，均明显高于B组和D组（χ2=19．461、24．093、21．991、26．786，均P〈0．01）；A组有1例（3．3％）患者发生轻微大血管病变，D组15例（50％），B组、C组分别为10例（33．3％）和9例（30．0％），A组发生率与D组、B组、C组比较差异均有统计学意义（χ2=16．705、9．017、7．680，均P〈0．01），B组与C组比较差异无统计学意义（χ2=0．077，P〉0．05）。结论相比于单纯强化降糖或降压治疗以及一般降压降糖治疗，强化降糖降压治疗2型糖尿病，能有效预防患者大血管病变的发生，具有较高的临床应用价值。

Objective To investigate the influence of strengthened hypoglycemic and antihypertensive treatment on macrovascular in patients with type 2 diabetes. Methods 120 with patients type 2 diabetes treated at our hospital from December, 2010 to December, 2014 were set as study objects and were randomly divided into group A, group B, group C, and group D, 30 for each group. Group A was given intensive hypoglycemic and antihypertensive treatment, group B intensive glycemic therapy, group C strengthened antihypertensive treatment, and group D general hypoglycemie and antihypertensive treatment. The occurrences of macrovascular disease of the groups were compared and analyzed. Results There were statistical differences in blood glucose indexes and IMT in group A between before and after treatment （t = 5.171, 6.299, 6.448, 4.557, P 〈 0.01）. There were statistical differences in systolic and diastolic blood pressures in group A and group C between before and after treatment （ t = 13.587, 9.117, 10.694, 7.013, P 〈 0.01 ） and between those in group A and group C and those in group B and group D after treatment （t = 12.229, 11.023, 10.694, 9.859, 6.843, 6.386, 5.988, 5.806, P 〈 0.01）. The target-blood-pressure-achieved rate was 83.3% in group A and was 86.7% in group C, which were higher than those in group B and group D （ X 2=19.461, 24.093, 21.991, 26.786, P 〈 0.01 ） . 1 case （3.3%） got mild vascular disease in group A, 15 （50.0%） in group D, 10 （33.3%） in group B, and 9 （30.0%） in group C, with statistical the differences between that in group A and those in group B, C, and D （χ2= 16.705,9.017,7.680, P 〈 0.01） but no between group B and group C （X 2= 0.077, P 〉 0.05）. Conclusions Intensive hypoglyeemic and antihypertensive treatment for type 2 diabetes is more effective than hypoglycemic or antihypertensive treatment and general hypoglyeemic and antihypertensive therapy a d can effectively prevent the occurrence of maerovascular disease, so it has high clinical application value.