老年糖尿病合并高血压患者颈动脉粥样硬化的相关因素研究  

Research on risk factors of carotid atherosclerosis in older patients with diabetes and hypertension

作　　者：杜宏伟[1] 杨洋[2] 王建华[3] 成珍珍[3] 吴海云[4] 何耀[4] 秦银河[4] 

机构地区：[1]北京军区总医院医务部,北京100700 [2]空军总医院血液科,北京100042 [3]北京军区总医院超声科,北京100700 [4]解放军总医院老年心血管病研究所,北京100853

出　　处：《中华疾病控制杂志》2012年第11期919-922,共4页Chinese Journal of Disease Control & Prevention

基　　金：国家自然科学基金(81072355);国家科技支撑计划项目(2009BAI86B01);国家卫生行业科研专项(201002011)

摘　　要：目的探讨老年糖尿病合并高血压患者颈动脉粥样硬化的相关因素,以及血压、血糖控制对颈动脉粥样硬化的影响。方法以2009年1月～2011年12月在北京军区总医院内分泌科住院的60岁以上的糖尿病合并高血压患者共475例为研究对象,收集其相关临床资料和颈动脉超声检查数据进行分析。结果该住院老年糖尿病人群中颈动脉粥样斑块的检出率为77.05%,颈动脉内中膜增厚(carotid intima-media thickness,CIMT)检出率为44.21%。多因素Logistic回归分析显示,高龄(OR=1.095,95%CI:1.064～1.126)、收缩压升高(OR=1.027,95%CI:1.010～1.043)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)升高(OR=1.430,95%CI:1.121～1.823)和吸烟(OR=1.452,95%CI:1.014～2.079)是颈动脉粥样硬化的危险因素;与血压严格控制组相比较,血压未控制组发生颈动脉粥样斑块和CIMT的风险比血压严格控制组分别增加了46.5%和38.7%;但血糖控制对其风险的影响未见差异。结论高龄、收缩压升高、LDL-C增高与吸烟可能是住院老年糖尿病合并高血压患者颈动脉粥样斑块形成的危险因素。对于糖尿病合并高血压的老年患者,血压控制可能比血糖控制对防治颈动脉粥样硬化的进展更有意义。Objective To study the effects of the risk factors, blood pressure and glycemic control on carotid atheroselerosis in older patients with diabetes and hypertension. Methods 475 patients aged 60 or above With diabetes and hypertension were enrolled. Relevant clinical data and the data of carotid ultrasonography were collected. Results The detection rate of carotid artery plaque was 77.05% in hospitalized older patients with diabetes and hypertension. The detection rate of elevated carotid intima-media thickness （CIMT） was 44.21%. The Logistic regression analysis showed that age （0R=1.095,95% CI：1.064-1.126）, SBP （OR=1.027, 95% C1：1.010-1.043）, LDL-C （OR=1.430, 95% CI： 1. 121-1. 823）, and smoking （OR= 1. 452, 95% CI： 1. 014-2. 079） were significant risk factors of carotid artery atherosclerotic plaques. Campared with tight control group, the status of blood pressure of uncontrolled group was associated with a 46.5% higher risk of having carotid plaque （ OR= 1. 465, 95% CI： 1. 105-1. 942） , a 38.7% higher risk of having elevated CIMT （ OR= 1. 387, 95% CI： 1. 040-1. 849） ; but did not show that glyeemie control status was an independent predictor of either having carotid plaque or elevated CIMT. Conclusions Age, SBP, LDL-C and smoking were significant risk factors of carotid artery atherosclerotic plaques in hospitalized patients with diabetes and hypertension. In older patients with diabetes and hypertension, blood pressure control, but not glyeemic control, was a more meaningful factor for prevention from progression of clinical carotid atheroselerosis.

关 键 词：高血压 糖尿病 动脉粥样硬化 危险因素 

分 类 号：R543.4[医药卫生—心血管疾病] R181.1[医药卫生—内科学]