血尿酸及颈动脉病变情况与H型高血压合并2型糖尿病的关系

摘要

Objective To analyze changes of serum uric acid (SUA) and carotid lesions in H type hypertension patients with type 2 diabetes mellitus (T2DM) and explore the risk factors of H type hypertension with T2DM. Methods A total of 119 patients diagnosed as H-type hypertension and admitted to our hospital from November 2016 to December 2017 were included in this study. Patients were divided into two groups according to whether they were combined with T2DM: 64 cases in simple H type hypertension group (simple group) and 55 cases in H type hypertension combined with T2DM group (combined group). Fifty healthy people in healthy physical examination at the same period were enrolled in this study as the control group. Questionnaires (age, gender, hypertensive history, cerebrovascular history, smoking history and drinking history) were collected in patients. The blood biochemical indicators including homocysteine (Hcy), SUA, fasting plasma glucose (FPG), triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were detected. The color Doppler ultrasonography was used to measure carotid intima-media thickness (cIMT). The carotid plaque scores were also measured. The risk factors of H type hypertension with T2DM were analyzed by multivariate Logistic regression. Results Values of SUA, cIMT incrassation ratio, carotid plaque score, carotid plaque detection rate, cerebrovascular history, smoking history and drinking history in simple group was higher than control group and lower than combined group (P＜0.05). Data of hypertension and Hcy were increased in simple group and combined group (P＜0.05). The serum level of FPG was significantly higher in combined group than that of control group and simple group (P＜0.05). There were no significant differences in hypertensive history, blood pressure and Hcy between simple group and combined group. There were no significant differences in TC, TG, HDL-C and LDL-C between three groups. Multivariate Logistic regression analysis showed that the elevated SUA ( OR=1.015, 95% CI : 1.008-1.023), cIMT incrassation ( OR=13.754, 95% CI : 2.556-74.016) and smoking history ( OR=5.229, 95% CI : 2.872-9.775) were risk factors for H type hypertension with T2DM. Conclusion For patients with hypertension and T2DM, Hcy, SUA and cIMT should be routinely tested, which can take corresponding intervention at early stage to prevent atherosclerosis and control the occurrence of cardiovascular and cerebrovascular diseases effectively.%目的 分析同时合并H型高血压及2型糖尿病(T2DM)的患者血尿酸(SUA)水平及颈动脉病变情况,探讨H型高血压合并T2DM的危险因素.方法 选取我院2016年11月—2017年12月收治并确诊为H型高血压的患者119例,根据是否合并T2DM分为单纯H型高血压组(单纯组)64例和合并T2DM的H型高血压组(合并组)55例,另择50例同期行健康体检者为对照组,收集患者高血压病程、脑血管病史、吸烟史、饮酒史等一般资料;检测同型半胱氨酸(Hcy)、SUA、空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等生化指标;应用彩色多普勒超声测量颈动脉内中膜厚度(cIMT),并测定斑块及斑块积分.多因素Logistic回归分析H型高血压合并2型糖尿病的影响因素.结果 对照组、单纯组和合并组脑血管病史、吸烟史、饮酒史、SUA、cIMT增厚比例、颈动脉斑块积分及斑块检出率均依次升高(P＜0.05),单纯组和合并组血压、Hcy均高于对照组(P＜0.05);合并组FPG高于对照组及单纯组(P＜0.05),单纯组与合并组高血压病程、血压及Hcy差异无统计学意义;3组间TC、TG、HDL-C、LDL-C差异均无统计学意义.多因素Logistic回归分析示SUA升高(OR=1.015, 95% CI :1.008～1.023)、cIMT增厚(OR=13.754,95% CI :2.556～74.016)及吸烟史(OR=5.229,95% CI :2.872～9.775)是H型高血压合并T2DM的危险因素.结论 对患有高血压、糖尿病的患者常规检测Hcy、SUA及cIMT可早期采取相应的干预措施预防动脉硬化,有效地控制心脑血管疾病的发生.