高血压患者衰弱分期及衰弱指数对新发糖尿病发生的影响

Influence of frailty status and frailty index on the development of new-onset diabetes mellitus in patients with hypertension

目的:探索衰弱分期及衰弱指数(frailty index,FI)对高血压患者新发糖尿病的影响。方法:本研究为单中心回顾性队列研究,入选符高血压患者953例。据FI将患者分为三组:衰弱组(FI>0.21)、衰弱前期组(0.10<FI≤0.21)、健康组(FI≤0.10)。研究的主要终点是新发糖尿病。通过多元Cox回归分析探究衰弱分期对新发糖尿病的影响,并绘制Kaplan-Meier曲线及限制性立方样条(RCS)曲线直观反映FI与新发糖尿病之间的关系,同时进行了亚组分析。结果:随着衰弱程度的加重,患者新发糖尿病的发生率显著增高(P<0.001)。Kaplan-Meier曲线表明衰弱组、衰弱前期组患者新发糖尿病的风险显著高于无衰弱组。调整混杂因素后的多元Cox回归的结果显示,与无衰弱组相比,衰弱组(HR=3.14,95%CI:1.50~6.58,P=0.002)显著升高了患者新发糖尿病风险,是新发糖尿病的独立危险因素;而衰弱前期组(HR=1.88,95%CI:0.95~3.74,P=0.071)差异无统计学意义。RCS曲线表明FI与新发糖尿病的关系是线性的,新发糖尿病风险随着FI的上升而增加。亚组分析结果表明各亚组与衰弱分期之间对结局的影响并无显著的交互作用。结论:在高血压患者中,衰弱是新发糖尿病的独立危险因素,FI与新发糖尿病风险呈线性正相关。

Objective:The aim of this study was to explore the effect of frailty status and frailty index(FI)on the development of new-onset diabetes mellitus in patients with hypertension.Methods:This was a retrospective cohort study,enrolling 953 patients with hypertension.Patients were grouped according to FI:frail group(FI>0.21),prefrail group(0.10<FI≤0.21),and healthy group(FI<0.10).The primary endpoint was the occurrence of new-onset diabetes.The effect of frailty status on new-onset diabetes was explored by multivariate Cox regression analyses,and the results were expressed using hazard ratios(HR)and 95%confidence intervals(CI).Kaplan-Meier curves and restricted cubic spline(RCS)were also plotted to visualize the relationship between FI and new-onset diabetes.Subgroup analyses were also performed.Results:The incidence of new-onset diabetes mellitus was significantly higher in patients as the degree of frailty worsened(healthy group vs.prefrail group vs.frail group:12,4.2%vs.34,8.5%vs.38,14.2%,P<0.001).The Kaplan-Meier curves indicated that patients in the prefrail and the frail groups had a significantly higher risk of new-onset diabetes mellitus than those in the healthy group.The results of multivariate Cox regression after adjusting for confounders showed that the frail group significantly elevated the risk of new-onset diabetes in the patients compared to the healthy group(HR=3.14,95%CI:1.50-6.58,P=0.002),which was an independent risk factor for new-onset diabetes,whereas there was no such effect in the prefrail group(HR=1.88,95%CI:0.95-3.74,P=0.071).The results of the RCS curve showed that the relationship between FI and new-onset diabetes was linear,indicating an increased risk of developing diabetes with higher levels of FI.The results of the subgroup analyses showed no significant interaction between the subgroups and frailty status.Conclusions:In patients with hypertension,frailty status was an independent risk factor for new-onset diabetes,and FI was linearly and positively associated with the risk of new-onset diabetes.