2型糖尿病合并高血压患者发生脑血管事件风险的巢式病例对照研究  

Risk factors of cerebrovascular events in patients with type 2 diabetes mellitus and hypertension:a nested case-control study

作　　者：曾文宝 康静 贺文超 姚思琪 潘建武 张正义[2] ZENG Wenbao;KANG Jing;HE Wenchao;YAO Siqi;PAN Jianwu;ZHANG Zhengyi(The Second Clinical Medical School,Lanzhou University,Lanzhou 730030,China;Department of General Practice,The Second Hospital of Lanzhou University,Lanzhou 730030,China;Linxia Road Community Health Service Center,Chengguan District,Lanzhou City,Lanzhou 730000,China)

机构地区：[1]兰州大学第二临床医学院,甘肃兰州730030 [2]兰州大学第二医院全科医学科,甘肃兰州730030 [3]兰州市城关区临夏路社区卫生服务中心,甘肃兰州730000

出　　处：《兰州大学学报(医学版)》2025年第2期10-16,31,共8页Journal of Lanzhou University(Medical Sciences)

基　　金：甘肃省科技计划资助项目(23YFA0039);兰州大学教育研究资助项目(071100135)。

摘　　要：目的探讨2型糖尿病(T2DM)患者合并高血压时是否增加脑血管事件(CVE)的风险。方法采用巢式病例对照设计,收集2018年1—12月在兰州大学第二医院诊断为T2DM的住院患者,随访5年,以队列中54例新发CVE的患者作为病例组,按照年龄±3岁、性别和入院时间进行1∶3匹配,从队列中抽取162例未发生CVE的患者作为对照组,利用LASSO回归筛选变量,并使用二元Logistic回归进行多因素分析。结果T2DM合并高血压发生CVE的风险是无高血压的3.03倍(95%CI:[1.26,7.32]);合并冠心病(OR=5.66,95%CI:[1.91,16.83])、T2DM病程>5年(OR=6.41,95%CI:[1.57,35.07])、舒张压管理不达标(OR=2.70,95%CI:[1.32,5.52])、高密度脂蛋白管理不达标(OR=2.33,95%CI:[1.11,4.90])是T2DM患者发生CVE的独立危险因素(P<0.05)。结论合并高血压显著增加T2DM患者发生CVE的风险;合并冠心病、T2DM病程>5年、舒张压管理不达标、高密度脂蛋白管理不达标是T2DM发生CVE的独立危险因素。因此,对T2DM患者应做好定期血压监测,对合并高血压的共病人群应采取综合管理策略,应着重于舒张压及高密度脂蛋白的监测,同时应对冠心病进行早期筛查与干预,以降低CVE的风险。Objective To evaluate the association between hypertension and risk of cerebrovascular events(CVE)among patients with type 2 diabetes mellitus(T2DM).Methods A nested case-control study was conducted based on a cohort of inpatients with T2DM from The Second Hospital of Lanzhou University from January to December 2018.As of Dec.31,2023,a total of 54 incident cases of CVE were identified,and 162 matched controls were randomly selected among the cohort subjects who were free of CVE.The matching criteria were age(within 3 years),gender,and date of admission.The variables with non-zero coefficients,which were screened out by LASSO regression,were included in a binary Logistic regression to estimate the odd ratio(OR)and 95%confidence interval(CI).Results Patients with T2DM and hypertension or never were associated with risk of CVE(OR=3.03,95%CI:[1.26,7.32]).Additionally,coronary heart disease(OR=5.66,95%CI:[1.91,16.83]),duration more than 5 years of T2DM(OR=6.41,95%CI:[1.57,35.07]),inadequate diastolic blood pressure(OR=2.70,95%CI:[1.32,5.52])and inadequate high-density lipoprotein(OR=2.33,95%CI:[1.11,4.90])were identified as independent risk factors for CVE in patients with T2DM(P<0.05).Conclusion Patients with T2DM and hypertension are more likely to have CVE.Additionally,coronary heart disease,increasing duration more than 5 years of T2DM,inadequate diastolic blood pressure and inadequate high-density lipoprotein are independent risk factors for CVE in T2DM.This study can offer a more comprehensive reference for the holistic management of stroke risk in T2DM patients.

关 键 词：2型糖尿病 高血压 脑血管事件 巢式病例对照研究 共病管理 冠心病 高密度脂蛋白 

分 类 号：R587.2[医药卫生—内分泌]