2型糖尿病长期治疗后合并冠心病及脑梗死的多因素分析

Multivariate analysis of coronary heart disease and cerebral infarction after long-term treatment of type 2 diabetes

目的研究2型糖尿病长期治疗后合并冠状动脉粥样硬化性心脏病(简称冠心病)、脑梗死病变的患病率及相关危险因素。方法收集广西医科大学第二附属医院前后两次住院时间间隔4~12年的2型糖尿病患者185例。第一次住院185例为A组,前后两次住院时间间隔5年左右(4~7年)的85例为B组,前后两次住院时间间隔10年左右(8~12年)的100例为C组。收集所有研究对象前后两次住院的临床资料,包括血压、血糖、糖化血红蛋白(HBA1c)、血脂、心肌酶学、心电图、冠状动脉造影、头颅CT或MRI检查。比较冠心病及脑梗死的患病率,对冠心病及脑梗死与各危险因子做回归分析。结果患者第一次住院与5~10年左右再次住院比较,收缩压(DBP)、空腹血糖(FBG)、餐后2h血糖(PBG2h)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)均较第一次住院时有所下降,冠心病及脑梗死患病率随着病程延长而增高。10年左右后返回住院,冠心病患者中的脑梗死患病率比无冠心病患者中的脑梗死患病率显著增高(P<0.05)。分别以冠心病和脑梗死为因变量的Logistic回归分析显示,DBP和FBG是脑梗死的危险因素,年龄是冠心病的危险因素,HDL-C是冠心病的保护性因素。结论 2型糖尿病合并的冠心病和脑梗死患病率随着病程的延长而增高,治疗10年左右冠心病与脑梗死患病率呈现出显著相关性。

Objective To study the prevalence and related risk factors of type 2 diabetes with coronary heart disease（CHD） and cerebral infarction after long-term treatment. Methods Two hundred and eighty-five patients with type 2 diabetes who had a hospitalization interval for four to twelve years between the first and second hospital stays were included in group A.Among them,85 patients （about 4 to 7 years） with a hospitalization interval about 5 years （4 to 7 years） between the first and second hospital stays（group B）.100 patients with a hospitalization interval about 10 years （8 to 12 years） between the first and second hospital stays（group C）.Blood pressure,blood glucose,HbA1c,blood lipids,myocardial enzymology,electrocardiogram,coronary angiography,cranial CT or MRI were tecorded. The prevalence of CHD and cerebral infarction were compare,regression analysis was conducted between coronary heart disease,cerebral infarction and the risk factors. Results DBP,FBG,PBG2h,TC,LDL-C of the second hospitalization were significantly lower than those of the first hospitalization.The morbidity of CHD and cerebral infarction increased along with the extension of the course.The morbidity of cerebral infarction in CHD patients were significantly higher than those in non-CHD patients with the interval about 10 years.Logistic regression analysis proved that age was risk factor and HDL-C was protective factor of CHD,SBP,FBG were risk factors of cerebral infarction. Conclusion The morbidity of CHD and cerebral infarction increased along with the extension of the course and there were significantly relationship between CHD and cerebral infarction in T2DM patients after about 10 years treatment.