摘要
目的分析不同血压类型对老年2型糖尿病(T2DM)患者随访3年发生心肾血管事件的影响,并分析影响心肾血管事件的因素。方法前瞻性队列研究。连续纳入2016年1月至2019年1月商丘市第一人民医院收治的829例老年T2DM患者,根据24 h动态血压监测情况分为三组:杓型血压组(417例)、非杓型血压组(304例)和反杓型血压组(108例)。随访3年,主要研究终点是心肾血管事件,包括心血管死亡、非致死性心肌梗死、非致死性卒中、大量蛋白尿、肾功能持续下降和需要持续肾脏替代治疗的复合终点。结果829例老年T2DM患者,女性448例(54.0%),平均年龄为(67.9±6.8)岁。三组中反杓型血压组患者的年龄更大、女性更多、吸烟比例更高,更多合并高血压、高血脂、心肌梗死、卒中和心房颤动,空腹血糖、糖化血红蛋白和尿白蛋白/肌酐比的水平更高,相对室壁厚度和左室质量指数更高,应用钙通道阻滞剂的患者更多(均为P<0.05)。中位随访32个月,共有82例心肾血管事件,Kaplan-meier生存分析结果显示,与杓型血压组比较,反杓型血压组和非杓型血压组患者的非致死性心肌梗死(7.40%、3.29%比2.16%,分别为HR=2.837,95%CI:1.409~5.712,P=0.004;HR=1.442,95%CI:1.055~1.971,P=0.022)和心肾血管事件(21.30%、10.20%比6.71%,分别为HR=2.342,95%CI:1.163~4.716,P=0.017;HR=1.284,95%CI:1.012~1.629,P=0.040)的发生风险均显著增高。校正后,多因素Cox回归分析结果显示,年龄(HR=1.152)、女性(HR=1.146)、吸烟(HR=1.437)、高血压(HR=1.519)、陈旧心肌梗死(HR=1.413)、既往卒中(HR=1.462)、心房颤动(HR=1.129)、糖化血红蛋白(HR=1.263)、尿白蛋白/肌酐比(HR=1.269)、左室质量指数(HR=1.147)、夜间收缩压(HR=1.219)、夜间舒张压(HR=1.106)、非杓型血压(HR=1.519)、反杓型血压(HR=2.337)和使用血管紧张素转换酶抑制剂(HR=0.862)均为心肾血管事件的相关因素。结论反杓型血压和非杓型血压增加老年T2DM患
Objective To analyze the influence of different blood pressure(BP)types on 3-year cardiorenovascular events in elderly patients with type 2 diabetes mellitus(T2DM),and analyze its related factors.Methods This was a prospective cohort study.A total of 829 elderly T2DM patients admitted to First People’s Hospital of Shangqiu City from January 2016 to January 2019 were consecutively included.According to 24 h ambulatory blood pressure monitoring,they were divided into three groups:dipper BP group(417 cases),non-dipper BP group(304 cases),and antidipper BP group(108 cases).The primary outcome was cardiorenovascular events,including cardiovascular death,nonfatal myocardial infarction,nonfatal stroke,massive proteinuria,a composite end point of continuous decline in renal function and the need for continuous renal replacement therapy.Results Among 829 elderly T2DM patients,448 were female(54.0%),with an average age of(67.9±6.8)years.The patients in the reverse dipper BP group were older,more women,higher ratio of smokers,hypertension,hyperlipidemia,old myocardial infarction,previous stroke and atrial fibrillation,higher levels of fasting blood glucose,glycosylated hemoglobin and albumin creatinine ratio,higher relative ventricular wall thickness and left ventricular mass index,and more patients treated with calcium channel antagonists(all P<0.05).In addition,the daytime systolic BP decreased and the nighttime systolic BP and diastolic BP increased significantly in the patients with reverse dipper BP group(all P<0.05).After a median follow-up of 32 months,there were 82 cases of cardiorenovascular events,The risk of nonfatal myocardial infarction(7.40%,3.29%vs.2.16%,HR=2.837,95%CI:1.409-5.712,P=0.004;HR=1.442,95%CI:1.055-1.971,P=0.022)and cardiorenovascular events(21.30%,10.20%vs.6.71%,HR=2.342,95%CI:1.163-4.716,P=0.017;HR=1.284,95%CI:1.012-1.629,P=0.040)in patients with antidipper BP and non-dipper BP were significantly higher than those in dipper BP groups.Multivariate Cox regression analysis showed that age(HR=1.15
作者
马素霞
马海燕
王艳
王勇
Ma Suxia;Ma Haiyan;Wang Yan;Wang Yong(Department of Cardiology,The First People’s Hospital of Shangqiu City,Shangqiu 476100,China)
出处
《中国心血管杂志》
2023年第4期342-348,共7页
Chinese Journal of Cardiovascular Medicine
基金
河南省医学科技攻关计划联合共建项目(LHGJ20210987)。
关键词
反杓型血压
非杓型血压
老年人
糖尿病
心肾血管事件
相关因素
Antidipper blood pressure
Non-dipper blood pressure
Elderly
Diabetes
Cardiorenovascular event
Related factor
