Relationship between left ventricular remodeling and glycosylated hemoglobin in normoglycemic elderly hypertensive patients
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摘要: 目的 探讨老年高血压患者糖化血红蛋白(HbA1c)水平与左心室重构的关系。方法 回顾性选取2018年6月—2021年2月我院收治的血糖水平正常的高血压老年患者229例，按照是否存在左心室重构分为重构组(72例)和非重构组(157例)。检测患者HbA1c水平，并按照四分位数分为Q1组(HbA1c≤5.31%)，Q2组(5.32%~5.69%)，Q3组(5.70%~6.10%)和Q4组(6.11%~6.49%)4组，观察不同HbA1c水平与左心室重构的关系。结果 与非重构组比较，重构组患者年龄更高，收缩压(SBP)、左室舒张末期内径(LVEDd)、室间隔厚度(IVS)、左室后壁厚度(LVPW)、左室质量指数(LVMI)、甘油三酯(TG)、血清尿酸、血清肌酐、空腹血糖(PFG)、HbA1c水平均更高，上述差异均具有统计学意义(P＜0.05)。按照HbA1c分组，组间比较发现，LVEDd、IVST、LVPWT、LVMI等指标均有显著统计学差异(P＜0.05)，Q4组和Q3组LVEDd、IVS均高于Q1组和Q2组(P＜0.05)，Q4组LVPW显著高于Q1组和Q2组(P＜0.05)，Q4组LVMI显著高于其他3组(P＜0.05)，Q3组LVMI高于Q1组及Q2组(P＜0.05)。多因素logistic回归分析显示HbA1c是血糖正常的老年高血压患者发生左心室肥厚的独立危险因素(OR=1.940，95%CI：1.378~4.598，P=0.006)。结论 对于血糖水平正常的老年高血压患者，HbA1c水平变化可能是影响左心室重构发生的独立危险因素之一。Abstract: Objective To investigate the relationship between glycosylated hemoglobin(HbA1C) level and left ventricular remodeling in elderly hypertensive patients.Methods From June 2018 to February 2021, 229 elderly hypertensive patients with normal blood glucose levels who were admitted to our hospital were retrospectively selected. All patients were divided into remodeling group(n=72) and non remodeling group(n=157). The HbA1C level of the patients was detected and divided into Q1 group(HbA1C≤5.31%), Q2 group(5.32%-5.69%), Q3 group(5.70%-6.10%) and Q4 group(6.11%-6.49%). We observed the relationship between different HbA1c levels and left ventricular remodeling.Results Compared with the non-remodeling group, systolic blood pressure(SBP), left ventricular end-diastolic diameter(LVEDd), interventricular septum thickness(IVS), left ventricular posterior wall thickness(LVPW), left ventricular Quality index(LVMI), triglyceride(TG), serum uric acid, serum creatinine, fasting blood glucose(PFG), and HbA1C levels were higher significantly in the remodeling group(P< 0.05). The LVEDd, IVST, LVPWT, LVMI and other indicators were significantly different in different HbA1c groups(P< 0.05). The LVPW of Q4 group was significantly higher than that of Q1 and Q2 groups(P< 0.05). The LVMI of Q4 group was significantly higher than those of the other three groups(P< 0.05), and the LVMI of Q3 group was higher than those of Q1 and Q2 groups(P< 0.05). Multivariate Logistic regression analysis showed that HbA1C was an independent risk factor for left ventricular hypertrophy in normoglycemic elderly hypertensive patients(OR=1.940, 95%CI: 1.378-4.598,P=0.006).Conclusion For elderly hypertensive patients with normal blood glucose level, the change of HbA1c level may be one of the independent risk factors for left ventricular remodeling.
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Key words:
- hypertension /
- blood glucose /
- glycosylated hemoglobin /
- left ventricular remodeling
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表 1 重构组和非重构组一般临床资料比较
Table 1. Comparison of clinical baseline data of patients in two groups
X±S 项目 重构组(72例) 非重构组(157例) t/χ2值 P值 年龄/岁 69.35±6.20 66.21±4.05 4.211 ＜0.001 男/女/例 46/26 83/74 0.423 0.520 BMI/(kg·m-2) 25.41±8.16 25.73±5.07 0.637 0.601 吸烟史/例(%) 32(44.44) 44(28.02) 0.269 0.590 饮酒史/例(%) 18(25.00) 40(25.48) 0.053 0.707 心率/(次·min-1) 79.04±11.18 78.42±11.67 1.630 0.114 SBP/mmHg 148.00±17.18 140.57±15.60 2.959 0.003 DBP/mmHg 82.39±9.10 80.29±9.37 1.606 0.110 服用降压药/例(%) β受体阻滞剂 26(36.11) 52(33.12) 0.189 0.666 ACEI 21(29.17) 49(31.21) 0.117 0.654 ARB 11(15.28) 26(16.56) 0.046 0.825 利尿剂 11(15.28) 25(15.92) 0.056 0.836 钙离子拮抗剂 39(54.16) 72(45.86) 0.976 0.344 超声心动图指标 LVEF/% 57.41±7.46 57.59±7.11 0.985 0.396 LVEDd/mm 50.39±5.88 48.16±6.44 2.432 0.017 IVS/mm 11.17±1.42 10.97±1.48 2.493 0.018 LVPW/mm 10.87±1.04 10.29±1.29 2.099 0.039 LVMI/(g·m-2) 132.66±11.76 112.90±9.47 14.479 ＜0.001 生化指标 TG/(mmol·L-1) 2.13±0.66 1.90±0.67 2.139 0.037 TC/(mmol·L-1) 4.95±1.35 4.87±1.19 0.895 0.377 LDL-C/(mmol·L-1) 2.88±0.76 2.66±0.91 1.675 0.095 HDL-C/(mmol·L-1) 1.13±0.25 1.07±0.59 0.967 0.349 尿酸/(μmol·L-1) 376.65±86.30 346.49±78.01 2.353 0.020 肌酐/(μmol·L-1) 82.78±16.45 77.24±15.95 2.204 0.025 尿素氮/(mmol·L-1) 5.89±1.59 5.83±1.69 0.997 0.359 FPG/(mmol·L-1) 5.56±0.62 5.06±0.78 3.242 0.002 2 hPG/(mmol·L-1) 8.03±1.54 7.94±1.83 1.647 0.054 HbA1c/% 5.84±0.36 5.41±0.32 11.931 ＜0.001 
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表 2 不同HbA1c水平患者心功能指标比较
Table 2. Comparison of cardiac function indexes in patients with different HbA1c levels
X±S 组别 例数 LVEF/% LVEDd/mm IVS/mm LVPW/mm LVMI/(g·m-2) Q1组 52 59.15±8.19 48.14±5.21 11.36±1.38 10.37±1.28 111.74±9.02 Q2组 60 58.72±7.24 48.29±4.65 10.59±1.21 10.49±1.36 114.25±10.15 Q3组 65 58.48±6.35 50.17±5.541) 11.16±1.321)2) 10.95±1.37 129.25±9.141)2) Q4组 52 56.92±7.27 51.47±6.561)2) 11.31±1.291)2) 11.13±1.311)2) 133.65±11.201)2)3) t/χ2值 1.161 6.623 5.766 3.934 24.108 P值 0.339 ＜0.001 0.001 0.010 ＜0.001 与Q1组比较，1)P＜0.05；与Q2组比较，2)P＜0.05；与Q3组比较，3)P＜0.05。
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表 3 血糖水平正常的老年高血压患者发生LVH的多因素回归分析
Table 3. Multivariate regression analysis of LVH in elderly hypertensive patients with normal blood glucose level
变量 β值 SE值 Wald χ2值 OR值 95%CI P值 年龄 0.897 0.320 12.145 2.452 1.781~6.176 ＜0.001 SBP 0.982 0.373 8.189 2.671 1.650~7.112 0.004 TG 0.276 0.371 1.949 1.320 0.897~3.796 0.162 血尿酸 0.369 0.158 5.557 1.447 1.297~2.511 0.018 血肌酐 0.623 0.450 2.995 1.865 0.642~3.219 0.084 FPG 0.282 0.327 2.271 1.326 0.905~2.971 0.132 HbA1c 0.663 0.307 7.596 1.940 1.378~4.598 0.006
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