高血压及糖尿病合并血脂异常的老年患者5年生存情况分析

The 5-year Survival of Elderly Hypertension and Diabetes Patients Combined with Dyslipidemia

背景随着中国人口老年化加剧,老年人慢性病共病发病率逐年上升,高血压及糖尿病或血糖升高、血脂异常是目前中国老年人慢性病共病最常见的模式,但这种慢性病共病最常见模式的生存情况及影响因素目前尚不明确。目的探讨高血压及糖尿病合并血脂异常的老年患者5年生存情况及其常见危险因素。方法采用回顾性队列分析方法,选取2016年在广州医科大学附属第二医院西院区进行健康体检的老年患者(≥60岁)为研究对象,通过患者健康档案信息系统、医保信息网、患者死亡信息网、患者健康管理信息登记平台及电话访视收集研究对象相关信息,主要包括人口学特征、疾病相关情况、就诊记录等基线资料,以及随访情况及死亡信息等。根据研究对象的生存情况分为生存组和死亡组;根据是否患有高血压及糖尿病,分为无高血压及糖尿病组、高血压病组、糖尿病组、高血压合并糖尿病组;根据是否存在血脂异常分为血脂正常组、混合型高脂血症组、高甘油三酯血症组、高胆固醇血症组、单纯脂蛋白紊乱组;根据是否患有高血压及糖尿病及是否合并血脂异常分为正常组、高血压和/或糖尿病组、非单纯脂蛋白紊乱组、非单纯脂蛋白异常+高血压和/或糖尿病组、单纯脂蛋白紊乱组,单纯脂蛋白紊乱+高血压和/或糖尿病组,采用Log-rank检验比较不同组别老年患者5年粗生存率的差异,进一步采用多因素Cox比例风险回归分析探讨高血压及糖尿病合并血脂异常老年体检患者5年生存情况的影响因素。结果共收集资料完整且诊断明确的老年患者3463例,其中,男1486例(42.91%),女1977例(57.09%),至随访截止日期共死亡287例(8.29%);生存组老年体检患者的性别、体育锻炼情况、高血压及糖尿病患病情况、血脂情况、BMI、腰围、空腹血糖水平、红细胞水平、血红蛋白水平、白细胞水平、血小板水平、血清丙氨酸氨基转移酶水平、血清肌酐水平、血尿氮素水平与死亡组比较,差异有统计学意义(P<0.05)。无高血压及糖尿病组、高血压病组、糖尿病组、高血压合并糖尿病组老年体检患者的5年粗生存率比较,差异有统计学意义(χ^(2)=15.730,P=0.001);血脂正常组、混合型高脂血症组、高甘油三酯血症组、高胆固醇血症组、单纯脂蛋白紊乱组老年体检患者的5年粗生存率比较,差异有统计学意义(χ^(2)=29.290,P<0.001);正常组、高血压和/或糖尿病组、非单纯脂蛋白紊乱组、非单纯脂蛋白异常+高血压和/或糖尿病组、单纯脂蛋白紊乱组、单纯脂蛋白紊乱+高血压和/或糖尿病组老年体检患者的5年粗生存率比较,差异有统计学意义(χ^(2)=42.400,P<0.001)。多因素Cox比例风险回归分析结果显示,日常体育锻炼情况、BMI、腰围、空腹血糖水平、红细胞计数、血红蛋白水平、血清天冬氨酸氨基转移酶水平及血清肌酐水平是高血压及糖尿病合并血脂异常老年体检患者5年生存情况的影响因素(P<0.05)。结论相对于普通人群,高血压及糖尿病合并有血脂异常的人群5年的粗生存率更低,特别是存在脂蛋白异常的人群,生活方式、营养状况、肝肾功能也对5年生存情况产生明显影响;在进行高血压、糖尿病及血脂异常等慢性病的管理时,除积极降压、降糖及减低胆固醇、三酰甘油外,还要关注患者的脂蛋白水平、营养状况、肝肾功能及生活方式的改善。

Background With the aging of the Chinese population,the prevalence of chronic comorbidity among the elderly has been increasing by year.Hypertension,diabetes or hyperglycemia,and dyslipidemia are the most common patterns of chronic comorbidity among the elderly in China.However,the survival and influencing factors of this most common pattern of chronic comorbidity remain unclear.Objective To investigate 5-year survival of elderly hypertension and diabetes patients combined with dyslipidemia,and analyze the common risk factors.Methods Retrospective cohort analysis was used in this study.Elderly residents(≥60 years old)who underwent health examination in the West Campus of the Second Affiliated Hospital of Guangzhou Medical University in 2016 were selected as the study subjects,their relevant information was collected through the Resident Health Record Information System,Health Insurance Information Network,Resident Death Information Network,Resident Health Management Information Registry Platform and telephone interviews,mainly including baseline information such as demographic characteristics,disease-related conditions,medical records,as well as follow-up and death information.According to the survival of the study subjects,they were divided into survival and death groups;according to the presence of hypertension and diabetes,they were divided into no hypertension and diabetes group,hypertension group,diabetes group,hypertension combined with diabetes group;according to the presence of dyslipidemia,they were divided into normal dyslipidemia group,mixed hyperlipidemia group,hypertriglyceridemia group,hypercholesterolemia group,and simple lipoprotein disorder group;according to the presence of hypertension and diabetes mellitus and the presence or absence of combined dyslipidemia were categorized as normal group,hypertension and/or diabetes mellitus group,non-simple dyslipidemia group,non-simple dyslipidemia+hypertension and/or diabetes mellitus group,simple dyslipidemia group,and simple dyslipidemia+hypertension and/or diabetes mellitus group.Log-rank test was used to compare the difference in 5-year crude survival rate between different groups.Multivariate Cox proportional hazards regression analysis was used to explore the influencing factors of 5-year crude survival rate of elderly residents with hypertension and diabetes combined with dyslipidemia.Results A total of 3463 elderly residents with complete data and clear diagnosis were collected,including 1486 males(42.91%)and 1977 females(57.09%),and a total of 287(8.29%)died by the end of follow-up.There were significant differences in gender,physical exercise,prevalence of hypertension and diabetes,dyslipidemia,BMI,waist circumference,fasting blood glucose level,red blood cell count level,hemoglobin level,white blood cell count level,platelet level,serum alanine aminotransferase level,serum creatinine level,blood and urine nitrogen level between the survival group and death group(P<0.05).There was significant difference in 5-year crude survival rate of elderly physical examination residents among the no hypertension and diabetes group,hypertension group,diabetes group,and hypertension combined with diabetes group(χ^(2)=15.730,P=0.001).There was statistically significant difference in 5-year crude survival rates among the normal blood lipid group,mixed hyperlipidemia group,hypertriglyceridemia group,hypercholesterolemia group and simple lipoprotein disorder group(χ^(2)=29.290,P<0.001).In addition,there was significant difference in the 5-year crude survival rates among the normal group,hypertension and/or diabetes group,non-simple lipoprotein disorder group,non-simple lipoprotein disorder+hypertension and/or diabetes group,simple lipoprotein disorder group,simple lipoprotein disorder+hypertension and/or diabetes group(χ^(2)=42.400,P<0.001).Multivariate Cox proportional hazards regression analysis showed that daily physical exercise,BMI,waist circumference,fasting blood glucose level,red blood cell count level,hemoglobin level,serum aspartate aminotransferase level and serum creatinine level were the influencing factors of 5-year crude survival rate of elderly residents with hypertension and diabetes combined with dyslipidemia(P<0.05).Conclusion Compared with the general population,the 5-year crude survival rate of people with hypertension and diabetes combined with dyslipidemia is lower,especially those with lipoprotein disorders.At the same time,lifestyle,nutritional status,liver and kidney function also have a significant impact on the 5-year crude survival rate.In the management of chronic diseases such as hypertension,diabetes and dyslipidemia,it is necessary to pay attention to the improvement of lipoprotein level,nutritional status,liver and kidney function and lifestyle in addition to actively lowering blood pressure,blood glucose,cholesterol and triglyceride levels.