摘要
目的探讨糖尿病、高血压人群心脑血管事件的发生情况及影响因素。方法开滦研究队列中,符合单纯糖尿病诊断的3173例,单纯高血压诊断的35 161例,糖尿病合并高血压诊断的5261例,对照组（无高血压及糖尿病）50 320人。随访研究对象是否发生心脑血管事件或死亡。采用多因素Cox比例风险回归模型分析影响心脑血管事件及全因死亡的因素。结果高血压组的男性比例、血压、体质量指数（BMI）、肌酐、高密度脂蛋白胆固醇（HDL-C）、尿酸均高于糖尿病组（P〈0.05）;糖尿病组的总胆固醇、三酰甘油、空腹血糖、高敏C反应蛋白（hsCRP）高于高血压组（均P〈0.05）。平均随访48月,发生心脑血管事件1863例。对照组总心脑血管事件、心肌梗死、脑出血、脑梗死和全因死亡事件的发病率分别为0.87%、0.19%、0.20%、0.49%、1.09%;糖尿病组分别为3.18%、0.88%、0.38%、1.95%、2.90%;高血压组分别为2.99%、0.55%、0.74%、1.77%、2.20%;糖尿病合并高血压组分别为5.11%、1.27%、0.78%、3.19%、3.78%（均P〈0.05）。Cox比例风险回归模型分析显示：调整了其他心脑血管危险因素后,与对照组比较,糖尿病组、高血压组、糖尿病合并高血压组发生总事件的RR值（95%CI）分别为2.773（2.225-3.455）、2.571（2.290-2.887）、3.975（3.390-4.662）;发生心肌梗死的RR值（95%CI）分别为3.040（1.976-4.677）、1.965（1.528-2.528）、3.797（2.740-5.261）;发生脑梗死的RR值（95%CI）分别为3.026（2.281-4.015）、2.629（2.256-3.063）、4.383（3.569-5.383）;发生脑出血的RR值（95%CI）分别为1.927（1.058-3.508）、3.733（2.961-4.705）、3.977（2.763-5.723）;发生全因死亡的RR值（95%CI）分别为1.988（1.584-2.494）、1.462（1.305-1.639）、2.411（2.035-2.856）（均P〈0.05）。结论糖尿病、高血压是心脑血管事件的独立危险因素。糖尿病患者的心肌梗死和全因死亡发病率高于高血压患者,高血压患者的脑出血发病率高于糖尿病患者。
Objective To study the incidence of cardiovascular events and related risk factors in diabetes and hypertension patients. Methods A total of 3173 patients with diabetes,35 161 with hypertension,5261 with both hypertension and diabetes,and 50 320 without hypertension and diabetes（controls）from the KaiLuan study cohort were enrolled. The incidence of cardiocerebral vascular events including myocardial infarction,cerebral infarction and cerebral hemorrhage,and all-cause mortality events was obtained during follow-up. Multivariable Cox proportional hazards regression models was used to assess relative risk for cardiovascular and all-cause mortality events.Results Compared to diabetes group,in hypertension group the proportion of male,blood pressure,body mass index（BMI）,serum creatinine,high density lipoprotein cholesterol（HDL-C）and uric acid（UA）were higher,the average levels of total cholesterol,triglyceride（TG）,fasting plasma glucose（FPG）and high sensitivity C-reactive protein（hsCRP）were lower（P〈0.05）. During a 48 months mean follow-up time,a total of 1863 cardiovascular events recorded. In patients without hypertension and diabetes,the incidence rates of cardiovascular events,myocardial infarction,cerebral hemorrhage,cerebral infarction,and all-cause mortality were 0.87%,0.19%,0.20%,0.49%,1.09%;in patients with diabetes were 3.18%,0.88%,0.38%,1.95% and 2.9%;in hypertensives were 2.99%,0.55%,0.74%,1.77% and 2.20% and in patients with both hypertension and diabetes were 5.11%,1.27%,0.78%,3.19%,3.78%,respectively（all P0.05）. After adjusted for other traditional cardiovascular risk factors,compared with subjects without hypertension and diabetes,the HR（95% CI）in patients with diabetes,hypertension or diabetes combined hypertension were 2.773（2.225-3.455）,2.571（2.290-2.887）,3.975（3.390-4.662）respectively for cardiovascular events;3.040（1.976-4.677）,1.965（1.528-2.528）,3.797（2.740-5.261）for myocardial infarction;3.026（2.281-4.015）,2.629（2.256-3.063）,4.383（3.569-5.383）for cerebral infarction;1.927（1.058-3.508）,3.733（2.961-4.705）,3.977（2.763-5.723）for cerebral hemorrhage;and1.988（1.584- 2.494）, 1.462（1.305- 1.639）, 2.411（2.035- 2.856） for all-cause mortality.Conclusion In Kai Luan cohort,Diabetes and hypertension are independent risk factors for cardiovascular events.Compared with the patients with diabetes,in patients with hypertension the incidence of myocardial infarction and all-cause mortality events were higher,while the incidence of cerebral hemorrhage was lower.
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2014年第12期1132-1138,共7页
Chinese Journal of Hypertension
关键词
高血压
糖尿病
心血管事件
危险因素
Hypertension
Diabetes
Cardiovascular events
Risk factors
