老年2型糖尿病患者大血管病变的特点及相关危险因素分析

The analyses for macrovascular diseases in elderly T2DM patients

目的 探讨老年 2型糖尿病患者大血管病变的特点及相关危险因素。 方法 14 5例老年 2型糖尿病患者分为大血管病变 (MA)组 92例 ,其中缺血性心脏病 (IHD)患者 4 6例、脑血管病变 (CVD)患者 2 9例、周围血管病变 (PVD)患者 6 0例 ;非大血管病变 (非MA)组 5 3例 .对患者的临床数据进行比较及回归分析。 结果 (1)与非MA组相比MA组的年龄 (70 6± 5 8、6 7 6± 5 5 )、高血压患病比率 (73 9%、5 6 6 % )、尿微量白蛋白排泄率 (UAER)异常比 (4 1 3%、2 0 8% )明显增高 (P<0 0 1或 <0 0 5 ) ;MA组中的 3个亚组与非MA组的比较也有相似的趋势。 (2 )回归分析显示 ,年龄、高血压是老年 2型糖尿病患者总的大血管病变的独立危险因素 ,同时也是IHD的独立危险因素 ;另外 ,年龄、UAER增高、高甘油三酯血症与PVD独立相关 ,年龄、高血压、高甘油三酯血症是CVD的独立危险因素 (P <0 0 5或 <0 0 1)。 结论 对于老年 2型糖尿病患者 ,年龄、高血压是大血管病变的独立危险因子 ,积极控制血压可能对减少其临床大血管事件的发生有重要意义。

Objective To study the characteristic features of risk factors for macroangiopathy (MA) in elderly patients with type 2 diabetes. Methods 145 T2DM patients aged over 60 years with and without MA were registered from in-patient department. 92 subjects were identified to have any form of MA, including 46 with ischemic heart disease (IHD), 29 with cerebrovascular disease (CVD), 60 with peripheral vascular disease (PVD). All clinical data were compared and logistic regression analysis was used to reveal the risk factors for MA, IHD, CVD and PVD. Results (1)The old age(70.6±5.8 vs 67.6±5.5), hypertension(73.9% vs 56.6%) and abnormality of UAER(41.3% vs 20.8%)were more common in patients with MA compared with patients without MA (P<0.01 or <0.05), the similar results were observed in IHD, CVD and PVD. (2) With stepwise multivariate logistic regression analysis, old age and hypertension were identified as significant and independent risk factors for MA and IHD;the older age , abnormality of UAER and hypertriglyceridemia for PVD; the old age and hypertension for CVD respectively ( P<0.05 or <0.01). Conclusions In elderly T2DM patients, the older age and hypertension are found to be risk factors for MA. It seems to be crucial to give them tight blood pressure control for the prevention of MA in elderly T2DM patients.