糖尿病合并高血压患者血糖、血压水平与动脉硬化的相关性研究

Relationship between Arterial Stiffness and Blood Glucose/Blood Pressure in Diabetic Patients with Hypertension

目的探讨糖尿病合并高血压患者血糖血压水平与动脉硬化的关系。方法以北京某农村社区40岁及以上糖尿病合并高血压患者为研究对象,对患者进行问卷调查、体格检查、肱踝脉搏波传导速度(ba PWV)检测和血样检测。根据患者糖化血红蛋白(Hb A1c)、收缩压(SBP)及舒张压(DBP)水平进行分组,采用Logistic回归模型分析血糖血压水平与动脉硬化的关系。结果共纳入1214例患者,其中动脉硬化异常(ba PWV≥1700cm/s)有637人,占52.47%。相关性分析显示ba PWV与Hb A1c(r_s=0.174,P=0.000)、SBP(r_s=0.481,P=0.000)及DBP(r_s=0.167,P=0.000)均呈正相关。Logistic回归分析显示,调整其他危险因素后,Hb A1c和SBP每增加1个四分位数间距动脉硬化异常风险分别为1.41倍(95%CI:1.16~1.70)和3.71倍(95%CI:2.80~4.91)。结论糖尿病合并高血压患者ba PWV与Hb A1c及SBP显著相关,同时控制血糖和血压可能有利于降低动脉硬化异常发生风险。

Objective To investigate the relationship between arterial stiffness and blood glucose or blood pressure in community pa- tients with diabetes mellitus and hypertension. Methods Diabetic patients with hypertension aged 40 or above were enrolled from rural communities of Beijing. Every patient completed a standardized questionnaire and underwent physical examinations, braehial - ankle pulse wave velocity （baPWV） measurements, blood tests. Patients were divided into groups according to the level of glycated hemoglobin （HbAle） , systolic blood pressure （SBP） and diastolic blood pressure （DBP）. Analyses were performed by using multiple logistic regres- sion model to explore the relationship between baPWV and blood glucose/blood pressure. Results Among 1214 patients enrolled, the detection rate of arterial stiffness （baPWV〉 1700cm/s） was 52.47%. Correlation analysis showed baPWV was positively associated with HbAle （r =0.174, P=0.000）, SBP （r =0.481, P=0.000） and DBP （r =0.167 P=0.000）. Aftermultivariable adjustment, an increase of one IQR （from 25th to the 75th percentile） in the HbA1 c and SBP was associated with greater risk of arterial stiffness [ HbA1 c （ an increase of 2% ） ： OR=1.41 （95% CI： 1.16-1.70）; SBP （an increase of 23mmHg）： OR=3.71 （95% CI： 2.80-4.91）]. Conclusion The blood glucose/blood pressure was associated with baPWV among diabetic patients with hypertension. Combined efforts to improve both blood pressure and glycemie control may help to reduce the risk of arterial stiffness.