二级预防对糖尿病高血压患者发生大血管并发症的影响:3年510例随访观察  

Effects of second-level prevention on macrovascular complications of patients with diabetes and hypertension:Follow-up of 510 patients in 3 years

作　　者：于世鹏[1] 班博[1] 孙琳[1] 孙海玲[1] 张梅[1] 李萍[1] 

机构地区：[1]济宁医学院附属医院内分泌科,山东省济宁市272029

出　　处：《中国临床康复》2006年第24期4-6,共3页Chinese Journal of Clinical Rehabilitation

基　　金：济宁市科技局资助课题(2001YW-25)~~

摘　　要：目的:通过对糖尿病和/或高血压患者进行对照观察,提供血压、糖代谢所致大血管并发症的直接证据,明确二级预防中降压和控制血糖的意义。方法:选择2000-02/12在济宁医学院附属医院内分泌科住院的2型糖尿病患者180例、2型糖尿病合并高血压患者130例、在本院体检中心进行健康体检的单纯高血压患者120例及正常对照者110例,总计540例,进行3年随访。均签署知情同意书。制定统一调查表格,专人询问糖尿病、高血压、脑血管病变、心血管病变、下肢血管病变及其他疾病的相关临床情况,记录有关病史;并负责查体及相关检查。各组均测定空腹血糖和C肽、餐后2h血糖和C肽、糖化血红蛋白、血脂谱。对高血压患者(2型糖尿病合并高血压组和单纯高血压组)制定目标血压:①血压<130/80mmHg。②130/80mmHg<血压<160/100mmHg。采用钙拮抗剂非洛地平5～10mg/d为主的治疗方案,按阶梯治疗加用血管紧张素转换酶抑制剂、β阻滞剂和利尿剂,使所有观察对象血压达上述目标值。2型糖尿病合并高血压组严格控制血糖。随诊3年观察大血管并发症发生情况。结果:进行3年随访,其中30例失访。共有510例观察对象进入结果分析,2型糖尿病组168例,单纯高血压组112例,2型糖尿病合并高血压组120例,正常对照组110例。①3年随访大血管并发症发生率比较:大血管并发症在对照组中无发生,在其余各组中的发生率相比差异有显著性意义(χ2=19.097,P<0.01),以2型糖尿病合并高血压组最著,其次为2型糖尿病组、单纯高血压组。②高血压患者不同治疗目标3年随诊大血管并发症发生率比较:共计232例高血压患者入组时平均基础血压为(160±11)mmHg/(102±11)mmHg,大血管并发症患病率为24.57%(57/232)。治疗后目标血压达到:血压<130/80mmHg者78例,130/80mmHg<血压<160/100mmHg者154例。随诊3年,大血管并发症发生率前者为0,后者为10.39AIM： To provide direct evidence for high macrovascular complications induced by blood pressure and glycometabolism through control-observation of patients with diabetes and/or hypertension, and identify the significance of decompression and blood-glucose control in second-level prevention. METHODS：A total of 540 patients were selected including 180 inpatients with type 2 diabetes and 130 inpatients with type 2 diabetes accompanied by hypertension in the Department of Endocrinology, Affiliated Hospital of Jining Medical College, 120 patients with simple hypertension who rec eived health examination in the Medical Examination Center of Hospital and 110 normal controls from February to December 2000. A 3-year follow-up was conducted and all subjects signed the informed consent. An uniform questionnaire was designed for investigation, and special personnel were assigned to inquire clinical conditions such as diabetes, hypertension, cerobrovascular disease, cardiovascular disease and vascular disease of lower limbs etc, record relevant medical history and conduct physical examinations as well as corresponding check-ups. The levels of fasting blood glucose and Cpeptide, blood glucose, C-peptide, glycosylated hemoglobin and blood-fat spectra of patients at 2 hours after meals were measured. Target blood pressure was designed for patients with hypertension （type 2 diabetes accompanied by hypertension group and simple hypertension group）：. ①Blood pressure 〈 130 /80 mm Hg. ②130/80 mm Hg 〈 blood pressure 〈 160/100 mm Hg. Calcium antagonist felodipine was given to patients （.5-10） mg each day for treatment, and angiotensin-converting enzyme inhibitor （ACEI）, 15 blocker and diuretics were adopted to enable all subjects reach the above target value according to step by step treatment. Patients in the type 2 diabetes accompanied by hypertension group were strictly controlled of the blood glucose, and macrovascular complications were observed in 3-year follow-up. RESULTS： There were 30 patients

关 键 词：糖尿病 高血压 血管疾病/并发症 

分 类 号：R544.1[医药卫生—心血管疾病]