收缩压和脉压及其变异性对2型糖尿病视网膜病变的影响

Effects of variability in systolic blood pressure and pulse pressure for the development of diabetes retinopathy in patients with type 2 diabetes mellitus

目的评估2型糖尿病患者收缩压和脉压变异性对糖尿病视网膜病变(DR)的影响。方法选择2002至2014年就诊于中国台湾李氏联合诊所的3 275例基线时无DR的2型糖尿病患者纳入研究,年龄(65.53±12.24)岁,随访3~10年。收集患者一般资料及实验室检查指标。根据患者记录的收缩压和脉压所有测量值计算其均值和标准差。根据收缩压均值130 mmHg(1 mmHg=0.133 kPa)和收缩压标准差11.16 mmHg,将患者分为四组:Q1(收缩压均值<130 mmHg,收缩压标准差<11.16 mmHg)、Q2(收缩压均值<130 mmHg,收缩压标准差≥11.16 mmHg)、Q3(收缩压均值≥130 mmHg,收缩压标准差<11.16 mmHg)和Q4(收缩压均值≥130 mmHg, 收缩压标准差≥11.16 mmHg)。同理再根据脉压均值80 mmHg和脉压标准差6.53 mmHg,患者被重新分为Q1′~Q4′四组。采用Cox回归分析研究不同血压变量与DR发展之间的关系。结果 Cox回归分析中,校正年龄、性别、病程后,结果显示收缩压均值、标准差,脉压均值、标准差是影响DR的危险因素。Q4组患者发生DR风险最高[风险比(HR)=1.980,P<0.01],而Q1组患者最低。另外,Q3组患者(HR=1.409,P<0.01)发生DR的风险高于Q2组患者(HR=1.353,P<0.01)。Q2′组患者发生DR风险最高(HR=2.086,P<0.01),而Q1′组患者最低。另外,Q4′组患者发生DR的风险(HR=1.507,P<0.01)高于Q3′组患者(HR=1.289,P<0.01)。结论收缩压和脉压变异性是影响2型糖尿病患者DR的危险因素,收缩压变异性和脉压变异性比平均收缩压和脉压更能预测DR的发生。

Objective To investigate the relationship among systolic blood pressure(SBP),pulse pressure(PP)variability and diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM).Methods According to the results of dilated funduscopic examination in patients with T2DM,a total of 3275 patients without DR in Lee′s Joint Clinic in Taiwan from 2002 to 2014 were included as baseline in the study,mean age was(65.53±12.24)years,with an follow-up of 3-10 years.Intrapersonal mean and SDs of all recorded SBP and PP measurements were calculated.SBP-SD and PP-SD represented the measure of SBP variability and PP variability.Participants were divided into four quartiles based on their SBP-Mean(130 mmHg,1 mmHg=0.133 kPa)and SBP-SD(11.16 mmHg):Q1(SBP-Mean<130 mmHg,SBP-SD<11.16 mmHg);Q2(SBP-Mean<130 mmHg,SBP-SD≥11.16 mmHg);Q3(SBP-Mean≥130 mmHg,SBP-SD<11.16 mmHg);Q4(SBP-Mean≥130 mmHg,SBP-SD≥11.16 mmHg).Participants were reclassified into quartiles based on their PP-Mean(80 mmHg)and PP-SD values(6.53 mmHg).Cox regression analysis was used to assess the relationship between blood pressure variables and DR.Results Adjusted for age,sex and diabetes duration,cox regression revealed that SBP and PP variability were the risk factors for DR.Patients in Q4 group had the highest DR prevalence[hazard ratio(HR)=1.980,P<0.01]while Q1 group had the lowest.In addition,patients in Q3 group(HR=1.409,P<0.01)had a higher risk of DR than those in Q2 group(HR=1.353,P<0.01).After stratification of participants by PP,it was found that patients in Q2′group had the highest risk of DR(HR=2.086,P<0.01)while Q1′group had the lowest.In addition,patients in Q4′group(HR=1.507,P<0.01)had a higher risk of DR than those in Q3′group(HR=1.289,P<0.01).Conclusion SBP and PP variability are the predictors of DR in patients with T2DM.They may play greater roles in DR development than mean SBP and PP do.