老年高血压合并糖尿病患者的心肾功能改变

Cardiac and renal functions in elderly hypertensive patients with diabetes mellitus

摘要:

目的 探讨老年高血压合并糖尿病患者的心脏结构和功能及肾功能的改变及其临床意义。方法 对206例老年患者依据病史分为单纯高血压组（A组）、高血压合并糖尿病组（B组），另选103例健康体检者为对照组（C组），观察上述患者的收缩压及舒张压，空腹血糖、糖化血红蛋白、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血尿酸、肌酐、血清胱抑素、24小时尿微量白蛋白水平以及超声心动测量指标包括左房内径（LAD）、左室舒张末期内径（LVEDD）、室间隔厚度（IVST）及左室后壁厚度（LVPWT）、相对室壁厚度（RWT）、左心室质量指数（LVMI）、左室射血分数（LVEF）、E/A值。结果 B组患者的血尿酸水平及尿微量白蛋白阳性率明显高于另外两组（P＜0.05），B组患者的FBG，PBG及HbA1c均显著高于其他两组（P＜0.05），A组及B组患者的LVEDD，IVST，LVMI，RWT及PWT水平明显高于C组，并且B组患者的LVEDD，IVST，LVMI，PWT及RWT水平明显高于A组患者，差异有统计学意义（P＜0.05）。A组及B组患者的E/A值明显低于C组（P＜0.05）。并且B组患者的E/A值低于A组，差异有统计学意义（P＜0.05）。结论 对于老年高血压合并糖尿病患者而言，血糖紊乱可能与左心室肥厚及舒张功能下降有关，临床中对高血压合并糖尿病患者应给予积极控制血糖，同时加强对多重危险因素的综合干预，才能减少心血管并发症的发生，并改善预后。

Abstract:

Objective To investigate the cardiac structure and function, and renal function in elderly hypertensive patients with diabetes mellitus. Methods A total of 206 over 60-year-old patients hospitalized in our department from April 2010 to May 2012 were enrolled in this study. They were divided into hypertension group [group A, n＝98, (72.1±7.3) years) and hypertension and diabetes group [group B, n＝108, (70.7±7.5) years]. And another 103 age- and sex-matched healthy individuals served as normal control. Hypertension and diabetes were confirmed by their international or national diagnostic criteria. All patients were observed for the systolic blood and diastolic blood pressure, fasting blood glucose (FBG), post blood glucose (PBG), glycated hemoglobin (HbA1c), triglycerides, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, serum uric acid, creatinine, serum cystatin, 24-hour urinary albumin. All patients received echocardiography for left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness (IVST) and left ventricular posterior wall thickness (LVPWT greater), relative wall thickness (RWT), left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and E/A ratio. Results The serum level of uric acid and urinary albumin-positive rate were significantly higher in group B than in the other two groups (P＜0.05). The patients of group B also had significantly higher levels of FBG, PBG and HbA1c than the other two groups (P＜0.05). The values of LVEDD, IVST, LVMI, RWT and PWT were significantly higher in group A and B than in group C (P＜0.05), and that of LVEDD, IVST, LVMI, PWT and RWT in group B even higher than in group A (P＜0.05). The E/A ratio were significantly lower in group A and B than in control (P＜0.05), with that of group B significantly lower than that of group A (P＜0.05). Conclusion For the elderly hypertensive patients with diabetes, glucose metabolic disorders may be associated with left ventricular hypertrophy and decreased diastolic function. In clinical practice for hypertensive patients with diabetes, better glucose control should be achieved, and intervention for multiple risk factors should be strengthened to reduce the incidence of cardiovascular complications and to improve prognosis.