长期强化降糖治疗对2型糖尿病患者生活质量及心血管事件的影响研究

摘要

目的：探讨长期强化降糖治疗对2型糖尿病患者生活质量及心血管事件的影响。方法选取延安大学附属医院2009年2月—2010年7月收治的2型糖尿病患者136例，根据随机数字表法分为强化降糖组和标准降糖组，各68例。标准降糖组患者糖化血红蛋白（HbA1c ）控制目标为6.5%～7.5%，强化降糖组 HbA1c控制目标为＜6.5%。比较两组患者干预前（T0）、干预3年（T1）、干预5年（T2）时 HbA1c水平及空腹血糖（FBG），T0和 T2时生活质量；患者均随访5年，记录随访期间心血管事件（大血管并发症、微血管并发症、血管事件复合终点）及低血糖发生率。结果 T0时两组患者 HbA1c水平及 FBG 比较，差异无统计学意义（P ﹥0.05）；T1、T2时强化降糖组患者 HbA1c水平及FBG 低于标准降糖组（P ＜0.05）；T1、T2时两组患者 HbA1c水平及 FBG 均低于 T0时（P ＜0.05）。T0时两组患者世界卫生组织生存质量测定简表（ WHOQOL-BREF）评分比较，差异无统计学意义（ P ﹥0.05）；T2时强化降组患者WHOQOL-BREF评分高于标准降糖组（P ＜0.05）。两组患者大血管并发症及微血管并发症发生率比较，差异无统计学意义（P ﹥0.05）；强化降糖组患者血管事件复合终点发生率低于标准降糖组，低血糖发生率高于标准降糖组（ P ＜0.05）。结论长期强化降糖治疗可提高2型糖尿病患者的生活质量，降低心血管事件发生率，但需要注意预防低血糖的发生。%Objective To investigate the impact of long - term intensive hypoglycemic therapy on quality of life and cardiovascular events of patients with type 2 diabetes mellitus. Methods A total of 136 patients with type 2 diabetes mellitus were selected in the Affiliated Hospital of Yan′an University from February 2009 to July 2010,and they were randomly divided into A group and B group according to random number table,each of 68 cases. The control target of HbA1c of A group was 6. 5%to 7. 5% ,while that of B group was less than 6. 5% . HbA1c and FBG before intervention,after 3 years of intervention,after 5 years of intervention were compared between the two groups;quality of life was evaluated before intervention,after 5 years of intervention, respectively; incidence of cardiovascular events ( including macrovascular complications, microvascular complications and composite endpoints of cardiovascular events)and hypoglycemia were recorded during the 5 - year follow up. Results No statistically significant differences of HbA1c or FBG was found between the two groups before intervention( P ﹥0. 05),while HbA1c and FBG of B group were statistically significantly lower than those of A group after 3 years of intervention, after 5 years of intervention(P < 0. 05);after 3 years of intervention,after 5 years of intervention,HbA1c and FBG of the two groups were statistically significantly lower than those before intervention(P < 0. 05). No statistically significant differences of WHOQOL-BREF score was found between the two groups before intervention(P ﹥ 0. 05),while WHOQOL-BREF score of B group was statistically significantly higher than that of A group after 5 years of intervention( P < 0. 05 ). No statistically significant differences of incidence of macrovascular complications or microvascular complications was found between the two groups(P ﹥ 0. 05);incidence of composite endpoints of cardiovascular events of B group was statistically significantly lower than that of A group,while incidence of hypoglycemia of B group was statistically significantly higher than that of A group( P <0. 05). Conclusion Long - term intensive hypoglycemic therapy can effectively improve the quality of life of patients with type 2 diabetes mellitus,reduce the incidence of cardiovascular events,but we should pay attention to the onset of hypoglycemia.