住院2型糖尿病患者短期血压控制及影响因素探讨  

Short-time intensified blood pressure control and its influencing factors in hospitalized patients with type 2 diabetes mellitus

作　　者：冉建民[1] 刘薇[1] 劳干诚[1] 张扬[1] 徐刚[1] 冯琼[1] 谢彬[1] 郭坚[1] 

机构地区：[1]广州市红十字会医院暨南大学第四附属医院内分泌科,广州510220

出　　处：《临床心血管病杂志》2009年第10期736-739,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨住院2型糖尿病(T2DM)患者短期血压控制效果及影响因素。方法:169例伴发高血压的T2DM患者给予降压等综合治疗,以出院时血压130/80mmHg(1mmHg=0.133kPa)为界限分为达标组(97例)及未达标组(72例),比较2组入院时临床及实验室指标,并通过回归分析观察各种因素对出院时平均动脉压(MAP)水平的影响。结果:全组T2DM入院时收缩压(SBP)为(143±15)mmHg,舒张压(DBP)为(78±8)mm-Hg,控制达标率仅17.8%;出院时血压达标率57.4%,降压药物种类平均增加0.8种。未达标组患者入院时SBP[(151±15)∶(137±12)mmHg,P<0.01]、DBP[(80±9)∶(77±7)mmHg,P<0.01]均高于达标组,且TC及24h尿白蛋白排泄率(UAE)显著升高。回归分析显示MAP与入院时SBP、DBP、TC及高血压病程显著正相关,与年龄呈负相关;MAP与UAE显著正相关(r=0.303,P<0.01)。并发糖尿病肾病(DN)患者随UAE增多而SBP显著升高,大量蛋白尿者需要多种降压药物联合且血压难以控制。结论:T2DM患者门诊血压控制达标率低,住院短期治疗明显改善了血压控制水平;住院T2DM患者血压控制受入院时血压水平、高血压病程、高胆固醇血症、高UAE等因素影响;UAE增加可能是并发DN患者血压难以控制的直接原因。Objective：To explore effects of short-time intensified blood pressure （BP） control and its influen- cing factors in hospitalized patients with type 2 diabetes mellitus （T2DM）. Methods： The total of 169 T2DM pa- tients with hypertension were hospitalized and synthetically treated according to local guidelines. They were alloca- ted to targeted （n=97） and untargeted （n=72） group as the comparison between their out-hospital BP levels and the borderline BP level at 130/80 mmHg, the in-hospital clinical and laboratory data were then compared between 2 groups. Correlations between out-hospital mean arterial pressure （MAP） and various factors were elucidated by a multivariate regression. Results：Systolic BP （SBP） and diastolic BP （DBP） were （143±15）mmHg and （78±8） mmHg respectively for 169 admitted patients. Only 17.80% of the patients got well-controlled BP by out-patient treatments, and hospitalized interventions increased this ratio to 57.4% accompanied with averagely 0.8 increase of hypotensive agent amount. The untargeted group showed significantly higher in-hospital SBP （[151 ± 15]vs [137±12]mmHg, P（0.01） and DBP （[80±9]vs [77±7]mmHg, P〈0.01） than the targeted group, while plasma total cholesterol （TC） and daily urinary albumin excretion （UAE） were also significantly increased. Out- hospital MAP positively correlated with in-hospital SBP, DBP, TC, hypertension courses and negatively correla- ted with age, especially, UAE showed a strongly positive correlation with MAP （r=0. 303, P（0.01）. In pa- tients with diabetic nephropathy （DN）, SBP remarkably elevated as UAE increased, more hypotensive agents were required and poor BP control was resulted in macroalbuminuric patients. Conclusions：Out-patient treatments lead to poor BP control and short-time in-hospital treatments ameliorates the condition in T2DM patients. For hos- pitalized T2DM, BP control is affected by several factors including in-hospital BP level, hypertension courses, plasm

关 键 词：高血压 2型糖尿病 治疗 影响因素 

分 类 号：R544.1[医药卫生—心血管疾病]