血糖正常的老年高血压患者左心室重构与糖化血红蛋白的关系

Relationship between left ventricular remodeling and glycosylated hemoglobin in normoglycemic elderly hypertensive patients

目的:探讨老年高血压患者糖化血红蛋白(HbA1c)水平与左心室重构的关系。方法:回顾性选取2018年6月—2021年2月我院收治的血糖水平正常的高血压老年患者229例,按照是否存在左心室重构分为重构组(72例)和非重构组(157例)。检测患者HbA1c水平,并按照四分位数分为Q1组(HbA1c≤5.31%),Q2组(5.32%~5.69%),Q3组(5.70%~6.10%)和Q4组(6.11%~6.49%)4组,观察不同HbA1c水平与左心室重构的关系。结果:与非重构组比较,重构组患者年龄更高,收缩压(SBP)、左室舒张末期内径(LVEDd)、室间隔厚度(IVS)、左室后壁厚度(LVPW)、左室质量指数(LVMI)、甘油三酯(TG)、血清尿酸、血清肌酐、空腹血糖(PFG)、HbA1c水平均更高,上述差异均具有统计学意义(P<0.05)。按照HbA1c分组,组间比较发现,LVEDd、IVST、LVPWT、LVMI等指标均有显著统计学差异(P<0.05),Q4组和Q3组LVEDd、IVS均高于Q1组和Q2组(P<0.05),Q4组LVPW显著高于Q1组和Q2组(P<0.05),Q4组LVMI显著高于其他3组(P<0.05),Q3组LVMI高于Q1组及Q2组(P<0.05)。多因素logistic回归分析显示HbA1c是血糖正常的老年高血压患者发生左心室肥厚的独立危险因素(OR=1.940,95%CI:1.378~4.598,P=0.006)。结论:对于血糖水平正常的老年高血压患者,HbA1c水平变化可能是影响左心室重构发生的独立危险因素之一。

Objective:To investigate the relationship between glycosylated hemoglobin(HbA1 C)level and left ventricular remodeling in elderly hypertensive patients.Methods:From June 2018 to February 2021,229 elderly hypertensive patients with normal blood glucose levels who were admitted to our hospital were retrospectively selected.All patients were divided into remodeling group(n=72)and non remodeling group(n=157).The HbA1 C level of the patients was detected and divided into Q1 group(HbA1 C≤5.31%),Q2 group(5.32%-5.69%),Q3 group(5.70%-6.10%)and Q4 group(6.11%-6.49%).We observed the relationship between different HbA1 c levels and left ventricular remodeling.Results:Compared with the non-remodeling group,systolic blood pressure(SBP),left ventricular end-diastolic diameter(LVEDd),interventricular septum thickness(IVS),left ventricular posterior wall thickness(LVPW),left ventricular Quality index(LVMI),triglyceride(TG),serum uric acid,serum creatinine,fasting blood glucose(PFG),and HbA1 C levels were higher significantly in the remodeling group(P<0.05).The LVEDd,IVST,LVPWT,LVMI and other indicators were significantly different in different HbA1 c groups(P<0.05).The LVPW of Q4 group was significantly higher than that of Q1 and Q2 groups(P<0.05).The LVMI of Q4 group was significantly higher than those of the other three groups(P<0.05),and the LVMI of Q3 group was higher than those of Q1 and Q2 groups(P<0.05).Multivariate Logistic regression analysis showed that HbA1 C was an independent risk factor for left ventricular hypertrophy in normoglycemic elderly hypertensive patients(OR=1.940,95%CI:1.378-4.598,P=0.006).Conclusion:For elderly hypertensive patients with normal blood glucose level,the change of HbA1 c level may be one of the independent risk factors for left ventricular remodeling.