心力衰竭合并糖尿病住院患者临床特点的回顾性分析及意义

Retrospective analysis of clinical characteristics and the significance of hospitalized patients with heart failure complicated with diabetes

目的分析对比心力衰竭合并糖尿病住院患者的临床特点和两者的联系,并揭示其临床意义。方法收集兰州大学第二医院2017-2021年出院诊断中包括“心力衰竭”的患者(6039例)病例资料,分析非糖尿病和糖尿病心力衰竭患者以及糖尿病心力衰竭伴并发症和不伴并发症患者的临床特征差异,探索心力衰竭和糖尿病之间的联系。结果与非糖尿病心力衰竭患者相比,糖尿病心力衰竭患者年龄较大;入院时平均血压较高;心率较低;射血分数降低性心力衰竭比例较低;使用钠-葡萄糖共转运体2抑制剂比例较高(P<0.05)。糖尿病心力衰竭患者主要并发症包括糖尿病肾病(39.1%)、糖尿病性周围神经病(11.4%)、糖尿病性视网膜病变(9.5%)和糖尿病周围血管病(5.9%)。与糖尿病心力衰竭不伴并发症患者比较,糖尿病心力衰竭伴并发症的患者入院时血压较高,住院时间较长,射血分数降低性心力衰竭和美国纽约心脏病协会(NYHA)分级Ⅱ级比例较低(P<0.05)。收缩压(OR=1.016,95%CI:[1.009,1.023],P<0.001)和NYHA分级(OR=1.303,95%CI:[1.043,1.628],P=0.020)是糖尿病心力衰竭伴并发症患者的影响因素。结论糖尿病心力衰竭患者年龄较大,主要病因为高血压和冠心病,多为左心室射血分数保留的舒张功能障碍,治疗药物中钠-葡萄糖共转运体2抑制剂的使用率较高;伴有糖尿病并发症的心力衰竭患者病情较重,收缩压和NYHA级别越高,心力衰竭合并糖尿病患者越容易发生糖尿病并发症。

Objective To analyze and compare the clinical characteristics of hospitalized patients with heart failure complicated with diabetes mellitus and the association between them,and to reveal their clinical significance.Methods The case data of patients discharged from The Second Hospital of Lanzhou University with a diagnosis including"heart failure"(6039 cases)from 2017 to 2021 were collected to analyze the differences in clinical characteristics between heart failure patients with/without diabetes mellitus and heart failure patients with/without diabetes mellitus complications,and the associations between heart failure and diabetes mellitus were further explored.Results Heart failure patients with diabetes mellitus were older,and had a higher mean blood pressure at admission,lower heart rate,lower proportion of heart failure with reduced ejection fraction,and a higher proportion of sodium-glucose co-transporter 2 inhibitors(P<0.05).The main complications in heart failure patients with diabetes mellitus included diabetes nephropathy(39.1%),diabetes peripheral neuropathy(11.4%),diabetes retinopathy(9.5%)and diabetes peripheral vascular disease(5.9%).Heart failure patients with diabetes mellitus complications had a higher blood pressure at admission,longer hospitalization days,and a lower proportion of heart failure with reduced ejection fraction and New York Heart Association(NYHA)classⅡ(P<0.05).Systolic blood pressure(OR=1.016,95%CI:[1.009,1.023])and NYHA(OR=1.303,95%CI:[1.043,1.628])were independent risk factors for heart failure patients with diabetes mellitus complications(P<0.05).Conclusions Heart failure patients with diabetes mellitus are older in age.The main diseases are hypertension and coronary heart disease.They tend to have diastolic dysfunction reserved by left ventricular ejection fraction.And the use rate of sodium-glucose co-transporter 2 inhibitors in treatment drugs is higher.The heart failure patients with diabetes mellitus complications are more serious,and,the higher the level of systolic blood pressure and NYHA,the more prone for heart failure patients to have diabetes mellitus complications.