高血压合并2型糖尿病患者残余胆固醇与血压变异性的相关性分析

Correlation between residual cholesterol and blood pressure variability in hypertensive patients with type 2 diabetes mellitus

目的探讨高血压合并2型糖尿病患者残余胆固醇(RC)与血压变异性的关系。方法收集2017年1月至2020年12月在湖北省恩施土家族苗族自治州中心医院住院诊断为高血压病的490例患者的临床资料进行回顾性分析,其中合并2型糖尿病者177例。根据患者血压昼夜节律分为杓型组(168例)、非杓型组(154例)和反杓型组(168例)。对比各组一般临床资料,采用Logistic回归方法分析RC与血压节律异常的关系,并进行亚组分析。采用受试者工作特征(ROC)曲线分析RC对合并糖尿病的高血压患者血压节律异常的预测价值。结果杓型组、非杓型组、反杓型组糖化血红蛋白水平及合并糖尿病患者的比例逐渐增加,3组间差异有统计学意义(均P<0.05)。我们将反杓型血压及非杓型血压定义为节律异常,将杓型血压定义为正常节律。通过Logistic回归分析发现,调整性别、年龄、空腹血糖、糖化血红蛋白等诸多协变量后,RC与高血压患者血压节律异常仍具有强相关性(比值比=1.417,95%置信区间:1.114~1.799,P=0.036),尤其是合并糖尿病的高血压患者(比值比=1.633,95%置信区间:1.219~1.876,P=0.048)。此外,亚组分析还发现血糖控制欠佳的糖尿病患者,RC与血压节律异常相关性更强(比值比=2.103,95%置信区间:1.289~2.413,P=0.006)。ROC曲线分析发现,合并糖尿病的高血压患者RC预测血压节律异常的曲线下面积为0.795(大于总体高血压患者的0.715),95%置信区间:0.750~0.840,P<0.001,RC的最佳截断值为0.87 mmol/L,敏感度和特异度分别为83.3%和76.2%。结论在高血压合并糖尿病的患者中,RC与血压变异性相关,尤其对于血糖控制不佳的患者。监测RC可能对于高血压合并糖尿病患者减少不良事件、改善远期预后具有重要意义。

Objective To investigate the correlation between residual cholesterol(RC)and blood pressure variability in hypertensive patients with type 2 diabetes mellitus.Methods The clinical data of 490 patients with hypertension admitted to the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Hubei Province from January 2017 to December 2020 were collected and analyzed retrospectively,including 177 patients with type 2 diabetes mellitus.According to the circadian rhythm of blood pressure,patients were divided into dipper group(168 cases),non-dipper group(154 cases),and reverse dipper group(168 cases).The general clinical data of each group were compared,the relationship between RC and abnormal blood pressure rhythm was analyzed by Logistic regression method,and subgroup analysis was carried out.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of RC for abnormal blood pressure rhythm in hypertensive patients with diabetes mellitus.Results The level of glycosylated hemoglobin and the proportion of patients with diabetes mellitus increased gradually in dipper group,non-dipper group and reverse dipper group(both P<0.05).We defined reverse dipper and non-dipper blood pressure as abnormal rhythm,and dipper blood pressure as normal rhythm.Through Logistic regression analysis,it was found that after adjusting covariates such as gender,age,fasting blood glucose and glycosylated hemoglobin,RC was still strongly correlated with abnormal blood pressure rhythm in patients with hypertension(odds ratio=1.417,95%confidence interval:1.114-1.799,P=0.036),especially in patients with hypertension combined with diabetes mellitus(odds ratio=1.633,95%confidence interval:1.219-1.876,P=0.048).In addition,subgroup analysis also found that the correlation between RC and abnormal blood pressure rhythm was stronger in diabetic patients with poor blood glucose control(odds ratio=2.103,95%confidence interval:1.289-2.413,P=0.006).ROC curve analysis showed that the area under the curve of RC predicting abnormal blood pressure rhythm in hypertensive patients with diabetes mellitus was 0.795(greater than 0.715 of the total hypertensive patients),95%confidence interval:0.750-0.840,P<0.001,the best cut-off value of RC was 0.87 mmol/L,and the sensitivity and specificity were 83.3%and 76.2%respectively.Conclusions In patients with hypertension combined with diabetes mellitus,RC is associated with blood pressure variability,especially for poor glycemic control.Monitoring RC may be of great significance for reducing adverse events and improving long-term prognosis in hypertensive patients with diabetes mellitus.