老年2型糖尿病下肢动脉病变与糖化血红蛋白的相关性研究

Relationship between peripheral artery disease and glycosylated hemoglobin in elderly patients with type 2 diabetes mellitus

目的探讨老年2型糖尿病(T2DM)病人糖化血红蛋白(HbA1c)水平与下肢动脉病变(PAD)之间的关系。方法将年龄≥60岁的357例住院T2DM病人为研究对象(男192例,女165例),以HbA1c水平四分位法分为Q1(HbA1c<7.5%)、Q2(7.5%≤HbA1c<9.1%)、Q3(9.1%≤HbA1c<11.2%)、Q4(HbA1c≥11.2%)4组。采用彩色多普勒超声检测下肢动脉,将双下肢动脉任一节段狭窄率≥50%或闭塞定义为PAD,分析HbA1c与PAD的相关性。结果 (1)老年T2DM病人PAD的患病率为21.6%(77/357)。4组病人的PAD患病率依次为13.8%(12/87)、16.1%(14/87)、24.7%(23/93)、31.1%(28/90),差异有统计学意义(P<0.05)。(2)PAD组的年龄、吸烟率、高血压患病率、口服降压药物、收缩压(SBP)、空腹血糖(FPG)、HbA1c及尿微量白蛋白/尿肌酐比值(UACR)均高于非PAD组(P<0.05或P<0.01),PAD组估算的肾小球滤过率(e GFR)低于非PAD组(P<0.01)。(3)Logistic回归分析校正年龄、性别、FPG、糖尿病病程、血压、血脂、e GFR、UACR、口服他汀类降脂药百分比等混杂因素后,结果显示:HbA1c是老年糖尿病病人PAD患病的独立危险因素。以Q1组发生PAD为1,OR(95%CI)依次为:Q2组1.57(0.58~4.27),Q3组3.46(1.38~8.65),Q4组3.67(1.46~9.24)(P<0.05)。结论随着HbA1c水平的升高,老年T2DM病人PAD患病率升高。

Objective To explore the relationship between peripheral artery disease（PAD） and glycosylated hemoglobin（HbA1c） in elderly patients with type 2 diabetes（T2DM）. Methods A total of357 patients with T2DM aged 60 and older were hospitalized（192 males and 165 females）,the groups were divided into Q1（HbA1c7. 5%）,Q2（〈7. 5%≤HbA1c〈9. 1%）,Q3（9. 1%≤HbA1c〈11. 2%）,Q4（HbA1c≥11. 2%） group according to the HbA1c quartile. It was defined as PAD when the stenosis was more than50% in any arterial segment of lower limbs based on the ultrasonic artery scan. The association between HbA1c and PAD was analyzed. Results There were 77 patients suffering from PAD among the 357 patients. The incidence rate of PAD in Q1,Q2,Q3,Q4 groups was 13. 8%（12/87）,16. 1%（14/87）,24. 7%（23/93） and 31. 1%（28/90） respectively. The age,smoking,hypertension,oral antihypertensive drugs,systolic blood pressure,fasting glucose,HbA1c,urine albumin-to-creatinine ratio（UACR） in PAD group were higher than those in Non-PAD group（P〈0. 05 or P〈0. 01）,and estimated glomerular filtration rate（e GFR） in PAD group was lower than that in Non-PAD group（P〈 0. 01）. The Logistics analysis suggested that adjusting for the confounder factors such as sex,age,fasting plasma glucose,diabetic duration,blood pressure,lipids,e GFR,UACR,statins lipid-lowering drugs taking,HbA1c was the independent risk factor of PAD. The risk ratio of the Q2 group was 1. 57（0. 58-4. 27）,Q3 group 3. 46（1. 38-8. 65）,Q4 group 3. 67（1. 46-9. 24） when compared with Q1 group（P〈0. 05）. Conclusions The risk of PAD will increase with the elevating of HbA1c in elderly patients with T2DM.