老年糖尿病患者慢性心力衰竭时发生心肾综合征的危险因素评估

Assessment of risk factors for cardiorenal syndrome in elderly diabetic patients with chronic heart failure

目的:回顾性分析糖尿病相关指标及其并发症是否可以作为老年糖尿病患者在慢性心力衰竭(CHF)时发生心肾综合征(CRS)的危险评估因素。方法:收集2010年1月~2020年1月358例老年CHF合并糖尿病患者的临床资料。按照是否发生CRS分为CRS组(n=62)和非CRS组(n=296),比较分析两组患者一般资料、实验室检查指标和辅助检查指标。用Logistic回归分析糖尿病相关指标和糖尿病并发症是否为老年慢性心力衰竭患者发生CRS的危险因素。结果:两组患者性别、年龄、体重指数、平均动脉压差异无统计学意义(P>0.05)。CRS组肾小球清除率(GFR)低于非CRS组,糖尿病患病年限长于非CRS组,糖尿病视网膜病变、糖尿病周围神经病变、糖尿病周围血管病变发病率高于非CRS组,24 h尿白蛋白>300 mg患者比例高于非CRS组,以上差异均有统计学意义(P<0.01)。CRS组空腹血糖(FBG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、尿素氮(BUN)、血肌酐(Scr)、尿酸(UA)、脑钠肽(BNP)高于非CRS组,血浆白蛋白(ALB)、左室射血分数(LVEF)低于非CRS组,以上差异均有统计学意义(P<0.01)。二分类Logistic回归分析发现,高糖尿病年限、高空腹血糖、高糖化血红蛋白、糖尿病视网膜病变、糖尿病周围神经病变、糖尿病周围血管病变、24 h尿白蛋白>300 mg是发生CRS的危险因素。结论:老年糖尿病心衰患者在高糖尿病年限、高空腹血糖、高糖化血红蛋白、24 h尿白蛋白>300 mg以及合并糖尿病并发症时更容易出现CRS。

Objective A retrospective analysis was conducted to determine whether diabetes-related indicators and their complications can be used as risk factors for cardiorenal syndrome syndrome(CRS)in elderly diabetic patients with chronic heart failure(CHF).Method Clinical data of 358 elderly patients with CHF complicated with diabetes treated in our hospital from January 2010 to January 2020 were collected.According to the occurrence of CRS,the patients were divided into CRS group(62 cases)and non-CRS group(296 cases),and the general data,biochemical and auxiliary examination indexes of the two groups were compared and analyzed.Logistic regression was used to analyze whether diabetes-related indicators and diabetic complications were risk factors for CRS in elderly patients with chronic heart failure.Results There were no statistically significant differences in gender,age,body mass index or mean arterial pressure between the two groups(P>0.05).The glomerular clearance rate(GFR)of CRS group was lower than that of non-CRS group.The years of diabetes were longer than those in the non-CRS group.The incidence of diabetic retinopathy,diabetic peripheral neuropathy and diabetic peripheral vascular disease was higher than that of the non-CRS group.24-hour urinary albumin>300 mg;The proportion of 300 mg patients was higher than that of non-CRS group(P<0.01).Fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),triglyceride(TG),urea nitrogen(BUN),serum creatinine(Scr),UA and brain natriuretic peptide(BNP)were higher in the CRS group than in the non-CRS group.Plasma albumin(ALB)and left ventricular ejection fraction(LVEF)were lower than those of non-CRS group(P<0.01).The results of binary logistic regression analysis showed that high diabetic years,high fasting blood glucose,high glycated hemoglobin,diabetic retinopathy,diabetic peripheral neuropathy,diabetic peripheral vascular disease,24-hour urinary albumin>300 mg was a risk factor for CRS.Conclusion Elderly patients with diabetic heart failure are more likely to develop CRS in the presence of high years of diabetes,high fasting glucose,high glycosylated hemoglobin,24-hour urinary albumin>300 mg and complications of diabetes.