社区糖尿病合并代谢综合征患者发生心脑血管疾病的六年随访观察  

Risk factors of cardiocerebrovascular events in diabetic patients with metabolic syndrome

作　　者：李玉玲 朱良湘[2] 原琪 孙微 陈硕 亢蓉 高文辉 袁申元[2] 

机构地区：[1]北京市西城区新街口社区卫生服务中心,100034 [2]首都医科大学附属北京同仁医院内分泌科

出　　处：《中华全科医师杂志》2015年第8期594-598,共5页Chinese Journal of General Practitioners

基　　金：首都医学发展科研基金（2007-1035）;首都卫生发展科研专项（2011-2005-01）;国际糖尿病联盟IDF-BRIDGES4th Round of Funding（ST12-024）

摘　　要：目的 了解2型糖尿病（T2DM）合并代谢综合征（MS）患者发生心脑血管疾病的风险.方法 2008年在北京市新街口社区中心就诊的T2DM患者376例,其中单纯T2DM患者118例（单纯T2DM组）,糖尿病合并MS患者258例（68.6％,T2DM合并MS组）,T2DM合并MS患者的BMI、腰围、臀围、收缩压、舒张压、空腹血糖、糖化血红蛋白（HbA1c）、TG、TC、HDL-C、血尿酸水平,高于单纯T2DM患者,差异有统计学意义（均P＜0.05）.所有患者均继续入组前三甲医院确定的药物干预方案进行治疗,在社区进行健康教育与随访的糖尿病管理方案,即每6个月随访1次,检测BMI、血压、血脂、空腹血糖、餐后2h血糖、HbA1c水平及肝肾功能、心脑血管疾病发生情况,共随访6年.结果 ①随访结束时,T2DM合并MS组的BMI、腰围、臀围、颈围、收缩压、餐后血糖、HDL-C比单纯T2DM组水平高,差异均有统计学意义（t值分别为-7.42、-6.63、-5.09、-3.02、-2.88、-3.60和2.33,均P＜0.05）,其中T2DM合并MS组的收缩压下降2.99 mmHg（1 mmHg =0.133 kPa）、HbA1c下降0.43％、LHL-C水平下降0.50 mmol/L,单纯T2DM组收缩压下降1.58 mmHg、HbA1c下降0.01％、LHL-C水平下降0.68 mmol/L,两组干预前后的收缩压、HbA1c、LHL-C差值比较差异均有统计学意义（t值分别为2.34、2.28、1.98,均P＜0.05）;②单纯T2DM组发生心脑血管疾病6例（5.1％,6/118）,T2DM合并MS组发生34例（13.2％,34/258）;Kaplan-Merier分析,两组患者心脑血管疾病累积风险的差异有统计学意义（x2=3.877,P=0.049）;③Cox回归分析显示,T2DM合并MS组发生心脑血管疾病风险比（HR）是单纯T2DM组的2.21倍（95％ CI：1.02 -4.73）;调整性别、年龄、教育程度的影响后,T2DM合并MS组发生心脑血管疾病风险比是单纯T2DM组的2.31倍（95％CI：1.01-5.28）.结论 T2DM患者合并MS增加心脑血管疾病发生的风险,社区T2DM患者的管理要加强对MS的干预.Objective To investigate the risk factors of cardiocerebrovascular events in type 2 diabetic （T2DM） patients with metabolic syndrome （MS）.Methods Total 376 patients with type 2 diabetes,including 258 cases with metabolic syndrome and 118 cases without metabolic syndrome,entered in community diabetes management program in 2008 and followed up for 6 years.The body mass index （BMI）,blood pressure,blood lipids,fasting blood glucose,postprandial 2 h blood glucose,glycated hemoglobin （HbA1 c）,the incidence of liver and kidney function and other indicators were measured in a 6-month interval,the cardiovascular events were documented.Results At the end of follow-up：BMI,waist circumference,hip circumference,systolic blood pressure,postprandial blood glucose,high density lipoprotein levels of T2DM patients with MS were higher than those of T2DM patients （P ＜ 0.05）.The systolic pressure,HbA1c and low density lipoprotein levels of T2DM with MS patients were decreased by 2.99 mmHg（1 mmHg=0.133 kPa）,0.43％,and 0.50 mmol/L,respectively （P ＜0.05）;those of T2DM patients were decreased by 1.58 mmHg,0.01％ and 0.68 mmol/L,respectively （P ＜ 0.05）.The incidence rate of cardiocerebrovascular events in T2DM group was 5.1％ （6/118）,that in T2DM with MS was 13.2％ （34/258）,Kaplan-Merier analysis showed that Cum Hazard rate of cardiovascular diseases between two groups was significantly different （x2 =3.877,P =0.049）.The Cox surv ival analysis showed that the risk rate of cardiocerebrovascular events in T2DM with MS patients was 2.21 times higher （95％ CI：1.02-4.73） than diabetic group.After adjustment of gender,age,education level,metabolic syndrome,the risk was 2.31 times （95％ CI：1.01-5.28） higher than diabetic group.Conclusion The diabetic patients with metabolic syndrome increase the risk of cardiocerebrovascular events,and the management of T2DM with MS patients need to be strengthened.

关 键 词：心血管疾病 糖尿病 2型 代谢综合征 社区卫生服务 

分 类 号：R587.1[医药卫生—内分泌] R589[医药卫生—内科学]