京西地区无心血管病史2型糖尿病中老年人群患心血管疾病的危险因素分析

Cardiovascular risk factors in middle-aged and elderly people with type 2 diabetes without cardiovascular history in western Beijing

目的探讨京西地区无心血管疾病的中老年2型糖尿病(T2DM)人群的临床特点以及心血管疾病(CVD)危险因素分析。方法本研究为横断面研究。选取北京市石景山区某社区常住居民为研究对象,排除心血管疾病患者。调查内容包括问卷调查、体格检查和实验室检查;问卷调查内容包括人口学特征、行为、个人疾病史;体格检查包括身高、体重指数(BMI)和血压;实验室检查包括空腹血糖、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)、外周动脉张力测定、动脉硬度、心踝血管指数(CAVI)、踝-肱指数(ABI)、颈动脉内膜中层厚度(CIMT)等。组间比较采用t检验,计数资料比较采用χ2检验,采用多因素Logistic回归分析分析T2DM患者的CVD影响因素。结果共有效调查1575名受试者,其中糖尿病组308人(19.5%),无糖尿病组1267人(84.5%)。糖尿病组人群的年龄、BMI、空腹血糖和HbA1c均高于无糖尿病组者,糖尿病组受教育程度、TC、HDL-C、LDL-C水平低于无糖尿病组者。糖尿病组吸烟、饮酒、早发心脑血管疾病家族史、高脂血症、高血压、颈部血管硬化、斑块或狭窄占比均高于无糖尿病组者。多元逻辑回归分析显示,糖尿病与心血管疾病家族史、“TC”、“HDL-C”、“LDL-C”、“颈动脉超声正常”呈负相关,与“心率”、肱踝动脉脉搏波速度(BA-PWV)和“心-踝血管指数(CAVI)”呈正相关。即糖尿病组肱踝动脉较非糖尿病组偏硬,颈动脉内膜增厚、斑块多发在糖尿病组更多。结论糖尿病患者往往伴有多个心血管疾病危险因素。年龄、体重指数、吸烟、饮酒、早发CVD家族史、高脂血症、高血压、颈动脉硬化和糖尿病呈正相关,而患者受教育程度与糖尿病呈负相关。

Objective To investigate the clinical characteristics and risk factors of cardiovascular diseases(CVD)in middle-aged and elderly people with type 2 diabetes(T2DM)without a history of cardiovascular disease in western Beijing.Methods This study is a cross-sectional study.Permanent residents in a community in Shijingshan District of Beijing were selected as the research subjects,and patients with CVD were excluded.The survey content included questionnaire survey,physical examination,and laboratory tests.The questionnaire survey included demographic characteristics,behavior,and personal medical history.Physical examination included height,body mass index(BMI),and blood pressure.Laboratory tests included fasting blood glucose,glycated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),peripheral arterial tone measurement,arterial hardness,cardiovascular ankle index(CAVI),ankle brachial index(ABI),carotid intima-media thickness(CIMT),etc.The t-test was used for intergroup comparisons,and count data comparison was performed using theχ2 test.Multiple logistic regression analysis was performed to identify the influencing factors of CVD in T2DM patients.Results A total of 1575 valid subjects were investigated,including 308(19.5%)in the diabetes group and 1267(84.5%)in the non diabetes group.Age,BMI,fasting blood glucose,and HbA1c in the diabetes group were higher than those of the diabetes-free group.Educational level,TC,HDL-C,and LDL-C in the diabetes group were lower than those of the diabetesfree group.The percentages of subjects with smoking,drinking,family history of early cardiovascular and cerebrovascular diseases,hyperlipidemia,hypertension,cervical vascular sclerosis,plaque,or stenosis in the diabetes group were higher than those of the non-diabetes group.Multivariate logistic regression analysis showed that diabetes was negatively correlated with family history of cardiovascular disease,TC,HDL-C,LDL-C,and normal carotid ultrasound manifestations,and positively correlated with heart rate,brachial ankle artery pulse wave velocity(BA-PWV),and cardiac ankle vascular index(CAVI).That is,the brachial ankle artery in the diabetes group was harder than that in the non-diabetes group,and carotid artery intima thickening and plaque were more common in the diabetes group.Conclusion Patients with diabetes are often associated with multiple cardiovascular disease risk factors.Age,BMI,smoking,drinking,family history of early CVD,hyperlipidemia,hypertension,carotid atherosclerosis,and diabetes are positively correlated with diabetes,while patients'education level is negatively correlated with diabetes.