老年2型糖尿病合并高血压患者的临床特征观察

Clinical Features in the Elderly with Diabetes Type 2 Complicated with Hypertension

目的探讨老年2型糖尿病合并高血压患者的临床特征,为2型糖尿病合并高血压提供诊断参考。方法选择2016年1月—2017年4月在华中科技大学同济医学院附属梨园医院就诊的老年2型糖尿病患者187例作为研究对象,根据是否合并高血压将患者分为观察组和对照组,观察组为糖尿病合并高血压患者,对照组为糖尿病未合并高血压患者。观察各组患者糖化血红蛋白(HbAlC)与N端前脑钠肽(NT-proBNP)水平、血糖值、血压值和左心功能等,并进行统计学分析。结果观察组HbAlC、空腹血糖、餐后2 h血糖、收缩压、舒张压和NT-proBNP水平均显著高于对照组(均P<0.05)。观察组LVMI显著高于对照组,LVEF和E/A显著低于对照组,差异均有统计学意义(均P<0.05)。Pearson相关分析显示,观察组HbAlC与LVMI和NT-proBNP均呈显著正相关(r=0.643、0.814,均P<0.05),与LVEF和E/A均呈显著负相关(r=-0.582、-0.614,均P<0.05);NT-proBNP与LVMI和HbAlC均呈显著正相关(r=0.695、0.814,均P<0.05),与LVEF和E/A均呈显著负相关(r=-0.654、-0.688,均P<0.05);空腹血糖与LVMI、HbAlC和NTproBNP均呈正相关(r=0.457、0.741、0.623,均P<0.05),与LVEF和E/A均呈负相关(r=-0.372、-0.482,均P<0.05);餐后2 h血糖与LVMI、HbAlC和NT-proBNP均呈正相关(r=0.508、0.809、0.704,均P<0.05),与LVEF和E/A均呈负相关(r=-0.433、-0.405,均P<0.05)。结论根据老年糖尿病合并高血压患者临床特征,发现NT-proBNP水平对老年糖尿病合并高血压患者左心室肥厚具有较高预测价值,糖化血红蛋白水平与NT-proBNP具有较高相关性,且检测方法简单,易于推广,可望用于糖尿病合并高血压患者左心功能筛查,具有一定的临床应用价值。

Objective To observe the clinical features in the elderly with diabetes type 2 complicated with hyperten-sion. Methods 187 elderly patients in Liyuan Hospital during the period from Jan., 2016 to April, 2017 were selected anddivided into2 groups： observation group （complicated with hypertension） and control group （with no hypertension）; thelevels of glycosylated hemoglobin （HbAlC）, NT-proBNP, blood glucose, blood pressure and left ventricular function of theelderly in both groups were observed and a statistical study was made. Results The HbAlC level, fasting blood glucose, 2hpostprandial blood glucose, systolic blood pressure, diastolic blood pressure and the NT-proBNP level of the elderly in ob-servation group were much higher than those of the elderly in control group（ 〈0.05）; the LVMI in observation group wasobviously higher but LVEF and E/A were obviously lower than those in control group, and the differences were of statisticalsignificance（ 〈0.05）; Pearson correlation analysis indicated that, in observation group, the level of HbAlC was in positivecorrelation with LVMI and NT-proBN （r=0.643,0.814, 〈0.05） but in negative correlation with LVEF and E/A （r=-0.582, -0.614, 〈0.05）; NT-proBNP was in obvious correlation with LVMI and HbAlC （r=0.695,0.814, 〈0.05） butin obvious negative correlation with LVEF and E/A （r=-0.654, -0.688, 〈0.05）; fasting blood glucose was positivelycorrelated to LVMI, NT-proBNP （r=0.457,0.741,0.623, 〈0.05） but negatively correlated to LVEF and E/A （r=-0.372, -0.482,（ 〈0.05）; 2h postprandial blood glucose was positively correlated to LVMI, HbAlC and NT-proBNP（r=0.508, 0.809, 0.704, 〈0.05） but negatively correlated to LVEF and E/A （r=-0.433, -0.405, 〈0.05）. ConclusionsThe level of NT-proBNP is of higher predictive value of left ventricular hypertrophy of the elderly with diabetes complicatedwith hypertension; the level of HbAlC is in higher correlation with that of NT-proBNP; the detection is simple and easy inperformance and wider application, and is expected to be used in left ventricular function screen in the elderly with diabetescomplicated with hypertension.