血脂异常和高血压对2型糖尿病患者血糖控制的交互作用  

Interaction of dyslipidemia and hypertension on glycemic control in patients with type 2 diabetes mellitus

作　　者：别霖臻 娄培安 张盼[2] 董宗美 江宜雪 刘德 陈培培[2] 李婷[2] 朱璇 乔程[2] Bie Linzhen;Lou Peian;Zhang Pan;Dong Zongmei;Jiang Yixue;Liu De;Chen Peipei;Li Ting;Zhu Xuan;Qiao Cheng(School of Public Health,Xuzhou Medical University,Xuzhou 221000,China;Department of Chronic Disease Control and Prevention,Xuzhou Province Center for Disease Control and Prevention,Xuzhou 221000,China)

机构地区：[1]徐州医科大学公共卫生学院,徐州221000 [2]徐州市疾病预防控制中心慢性非传染病防制科,徐州221000

出　　处：《中华糖尿病杂志》2022年第9期961-967,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：2016年江苏省卫生厅科教兴卫工程青年医学人才项目(QNRC2016375);徐州市卫生健康委2020年度青年医学科技创新项目(XWKYHT20200004);2015和2018年度江苏省预防医学科研课题(Y2015010, Y2018016)。

摘　　要：目的探讨血脂异常和高血压对2型糖尿病(T2DM)患者血糖控制的交互作用。方法本研究为横断面研究。选取2021年3至12月江苏省徐州市"三高共管"项目调查中的T2DM患者为研究对象。收集研究对象血压、血脂四项[包括总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、糖化血红蛋白(HbA1c)等指标。HbA1c<7.0%定义为血糖控制良好,否则为血糖控制不良。血脂异常定义为TC≥6.2 mmol/L,或TG≥2.3 mmol/L,或HDL-C<1.0 mmol/L,或LDL-C≥4.1 mmol/L,或自报有血脂异常史或近2周内服用降脂药。高血压定义为本次调查收缩压≥140 mmHg(1 mmHg=0.133 kPa)和(或)舒张压≥90 mmHg,或自报有高血压病史且近2周内服用降压药。血糖控制的多因素分析采用非条件logistic回归,通过Andersson等编制的Excel表计算交互作用指标,包括相对超额危险度(RERI)、交互作用归因比(AP)、交互作用指数(SI)。结果共纳入T2DM患者2 485例,血糖控制不良的患者占55.5%(1 379/2 485),血脂异常患者占62.1%(1 544/2 485),高血压患者占55.0%(1 367/2 485)。以无高血压且血脂正常者为参照组,无高血压但伴有血脂异常这一因素能够影响患者的血糖控制(OR=1.275,95%CI为0.987~1.648,P=0.010);有高血压但血脂正常也能影响患者血糖控制(OR=1.383,95%CI为1.054~1.814,P=0.019);当高血压和血脂异常同时存在时,患者的血糖更难控制(OR=2.735,95%CI为2.117~3.532,P<0.001)。血脂异常和高血压同时存在时对T2DM患者血糖控制的危害大于两因素单独作用时,RERI、AP和SI的OR(95%CI)分别为1.077(0.558~1.595)、0.394(0.230~0.558)和2.637(1.268~5.486)。结论血脂异常与高血压对于糖尿病患者血糖控制不良存在相加交互作用,两者同时存在时,对血糖控制的危害大于单因素作用。Objective To investigate the interaction of dyslipidemia and hypertension on glycemic control in patients with type 2 diabetes mellitus(T2DM).Methods This study was a cross-sectional study.T2DM patients in the"Three-High Co-Management"project survey in Xuzhou City,Jiangsu Province from March to December 2021 were selected as the research participants.Blood pressure,blood lipids[including total cholesterol(TC),triglyceride(TG),high-density lipoprotein-cholesterol(HDL-C),low-density lipoprotein-cholesterol(LDL-C)],glycated hemoglobin A1c(HbA1c)and other indicators were collected.HbA1c<7.0%was defined as good blood sugar control,otherwise poor blood sugar control.Dyslipidemia was defined as TC≥6.2 mmol/L,or TG≥2.3 mmol/L,or HDL-C<1.0 mmol/L,or LDL-C≥4.1 mmol/L,or self-reported history of dyslipidemia or within the past 2 weeks internal use of lipid-lowering drugs.Hypertension was defined as systolic blood pressure≥140 mmHg(1 mmHg=0.133 kPa)and/or diastolic blood pressure≥90 mmHg,or self-reported history of hypertension and taking antihypertensive drugs within the past 2 weeks.The multivariate analysis of blood sugar control used unconditional logistic regression,and the interaction indicators were calculated by the Excel table prepared by Andersson et al including relative excess risk of interaction(RERI),attributable proportion of interactin(AP),the synergy index(SI).Results A total of 2485 T2DM patients were included,of which 55.5%(1379/2485)had poor blood sugar control,62.1%(1544/2485)had dyslipidemia,and 55.0%(1367/2485)had hypertension.Taking patients without hypertension and normal blood lipids as the reference group,the factors without hypertension but with dyslipidemia might affect the blood sugar control of patients(OR=1.275,95%CI 0.987-1.648,P=0.010).However,patients who had normal blood lipids with hypertension and were able to be affected by the level of glycemic control(OR=1.383,95%CI 1.054-1.814,P=0.019.When hypertension and dyslipidemia coexisted,the glycemic control of patients was more dif

关 键 词：糖尿病 2型 血脂异常 高血压 血糖控制 交互作用 

分 类 号：R587.1[医药卫生—内分泌]