北京社区自然抽样人群冠状动脉钙化的多排螺旋CT初步研究

目的 探讨住院2型糖尿病(T2DM)患者血压控制的影响因素。方法 169例合并高血压的T2DM患者给予降压等综合治疗，以出院时血压130/80mmHg为界限分为达标组(n=97)及未达标组(n=72)，比较两组入院时临床及实验室指标，并通过回归分析观察各种因素对出院时平均动脉压(MAP)水平的影响。结果 全组T2DM入院时收缩压(SBP)为143±15 mmHg，舒张压(DBP)为 78±8 mmHg，控制达标率仅17.8%；出院时血压达标率57.4%，降压药物种类平均增加0.8种。未达标组患者入院时SBP(151±15 vs. 137±12 mmHg, P=0.000)、DBP(80±9 vs. 77±7 mmHg, P=0.000)均高于达标组，且总胆固醇(TC)及24h尿白蛋白排泄率(UAE)显著升高。回归分析显示MAP与入院时SBP、DBP、TC及高血压病程显著正相关，与年龄负相关；MAP与UAE显著正相关(r=0.303, P=0.000)。合并糖尿病肾病(DN)患者随UAE增多而SBP显著升高，大量蛋白尿者需要多种降压药物联合且血压难以控制。结论 T2DM患者门诊血压控制达标率低；住院T2DM患者血压控制受入院时血压水平、高血压病程、高胆固醇血症、高UAE等因素影响；UAE增加可能是合并DN患者血压难以控制的直接原因。

The initial research on coronary artery calcium of the community population in Beijing with MDCT

Objective To explore factors which affecting blood pressure (BP) control in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods 169 T2DM patients with hypertension were hospitalized and synthetically treated according to localguidelines.They were allocated to targeted (n=97) and untargeted (n=72) group as the comparison between their out-hospital BP levels and the borderline BP level at 130/80 mmHg, the in-hospital clinical and laboratory data were then compared between 2 groups. Correlations between out-hospital mean arterial pressure (MAP) and various factors were elucidated by a multivariate regression. Results Systolic BP (SBP) and diastolic BP (DBP) were 143±15 mmHg and 78±8 mmHg respectively for 169 admitted patients. Only 17.8% of the patients got well-controlled BP by out-patient treatments, and hospitalized interventions increased this ratio to 57.4% accompanied with averagely 0.8 increase of hypotensive agent amount. The untargeted group showed significantly higher in-hospital SBP (151±15 vs. 137±12 mmHg, P=0.000) and DBP (80±9 vs. 77±7 mmHg, P=0.000) than the targeted group, while plasma total cholesterol (TC) and daily urinary albumin excretion (UAE) were also significantly increased. Out-hospital MAP positively correlated with in-hospital SBP, DBP, TC, hypertension courses and negatively correlated with age, especially, UAE showed a strongly positive correlation with MAP (r=0.303, P=0.000). In patients with diabetic nephropathy (DN), SBP remarkably elevated as UAE increased, more hypotensive agents were required and poor BP control was resulted in macroalbuminuric patients. Conclusions Out-patient treatments led to poor BP control in T2DM patients. For hospitalized T2DM, BP control was affected by several factors including in-hospital BP level, hypertension courses, plasma cholesterol level and increased UAE, DN itself may directly aggravate BP control in T2DM patients.