CAJ | 학술논문

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.
목적 료해2형당뇨병(T2DM)합병대사종합정(MS)환자발생심뇌혈관질병적풍험.방법 2008년재북경시신가구사구중심취진적T2DM환자376례,기중단순T2DM환자118례(단순T2DM조),당뇨병합병MS환자258례(68.6％,T2DM합병MS조),T2DM합병MS환자적BMI、요위、둔위、수축압、서장압、공복혈당、당화혈홍단백(HbA1c)、TG、TC、HDL-C、혈뇨산수평,고우단순T2DM환자,차이유통계학의의(균P＜0.05).소유환자균계속입조전삼갑의원학정적약물간예방안진행치료,재사구진행건강교육여수방적당뇨병관리방안,즉매6개월수방1차,검측BMI、혈압、혈지、공복혈당、찬후2h혈당、HbA1c수평급간신공능、심뇌혈관질병발생정황,공수방6년.결과 ①수방결속시,T2DM합병MS조적BMI、요위、둔위、경위、수축압、찬후혈당、HDL-C비단순T2DM조수평고,차이균유통계학의의(t치분별위-7.42、-6.63、-5.09、-3.02、-2.88、-3.60화2.33,균P＜0.05),기중T2DM합병MS조적수축압하강2.99 mmHg(1 mmHg =0.133 kPa)、HbA1c하강0.43％、LHL-C수평하강0.50 mmol/L,단순T2DM조수축압하강1.58 mmHg、HbA1c하강0.01％、LHL-C수평하강0.68 mmol/L,량조간예전후적수축압、HbA1c、LHL-C차치비교차이균유통계학의의(t치분별위2.34、2.28、1.98,균P＜0.05);②단순T2DM조발생심뇌혈관질병6례(5.1％,6/118),T2DM합병MS조발생34례(13.2％,34/258);Kaplan-Merier분석,량조환자심뇌혈관질병루적풍험적차이유통계학의의(x2=3.877,P=0.049);③Cox회귀분석현시,T2DM합병MS조발생심뇌혈관질병풍험비(HR)시단순T2DM조적2.21배(95％ CI:1.02 ～4.73);조정성별、년령、교육정도적영향후,T2DM합병MS조발생심뇌혈관질병풍험비시단순T2DM조적2.31배(95％CI:1.01～5.28).결론 T2DM환자합병MS증가심뇌혈관질병발생적풍험,사구T2DM환자적관리요가강대MS적간예.
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.