老年2型糖尿病合并早期慢性肾脏病亚临床动脉粥样硬化相关因素分析

Analysis of related factors of subclinical atherosclerosis of early chronic kidney disease in elderly type 2 diabetes mellitus

目的 分析老年2型糖尿病(T2DM)合并早期慢性肾脏病亚动脉粥样硬化的相关影响因素。方法 选择2019年1月~2022年8月就诊于青岛市城阳区人民医院≥60岁的T2DM患者2020例,其中无慢性肾脏疾病(CKD)(非CKD组)1380例,合并CKD(CKD组)640例,对两组患者的一般临床指标、生化检测指标、颈动脉内膜中层厚度(CIMT)、颈动脉斑块形成及肱踝脉搏波传导速度(baPWV)进行比较。结果 CKD组糖尿病(DM)病程长于非CKD组,高血压合并率、视网膜病变和周围神经病变合并率高于非CKD组,钠葡萄糖协同转运蛋白2(SGLT2)抑制剂使用率高于非CKD组(P<0.05);CKD组C反应蛋白(CRP)、收缩压(SBP)、甘油三酯(TG)水平及尿白蛋白/肌酐(UACR)高于非CKD组(均P<0.05);CKD组的baPWV、平均CIMT值、颈动脉斑块形成比均高于非CKD组(P<0.01);CRP、病程、SBP、TG和UACR为老年T2DM合并早期CKD亚临床动脉粥样硬化的危险因素(P<0.05)。结论 病程长的老年T2DM合并早期CKD的高血压合并率、视网膜病变和周围神经病变合并率高,更易于出现动脉粥样硬化指标的异常,发生动脉粥样硬化和心血管事件风险高,应注意控制血压、血脂,减少尿蛋白,控制炎症反应。

Objective To analyze the subatherosclerosis and related factors in elderly type 2 diabetes mellitus(T2DM)patients with early chronic kidney disease.Methods From January 2019 to August 2022,2020 patients with type 2 diabetes who were≥60 years old in Qingdao Chengyang District People's Hospital were studied,including 1380 patients without CKD(non CKD group)and 640 patients with CKD(CKD group).The general clinical indicators,biochemical detection indicators,carotid artery intima-media thickness(CIMT),carotid ar-tery plaque formation and brachial ankle pulse wave velocity(baPwV)of the two groups were compared.Results The duration of diabetes in CKD group was longer than that in non CKD group,the complication rate of hypertension,retinopathy and peripheral neuropathy was higher than that in non CKD group,and the SCLT2 inhibitor was higher than that in non CKD group(P<0.05);The levels of CRP,SBP,TG and UAER/CR in CKD group were higher than those in non CKD group(P<0.05);The baPWV,mean CIMT,carotid plaque formation ratio in CKD group were higher than those in non CKD group(P<0.O1);CRP,SBP,TG,UACR were risk factors for subclinical atherosclerosis in eld-erly type 2 diabetes patients with early chronic kidney disease(P<0.05).Conclusion The elderly type 2 diabetes mellitus(T2DM)with a long course of disease and early chronic kidney disease has a high complication rate of hypertension,retinopathy and peripheral neuropathy.It is more likely to have abnormal atherosclerosis indicators,and has a high risk of atherosclerosis and cardiovascular events.We should pay at-tention to the control of blood pressure,blood lipids,urinary protein,and inflammatory reaction.