金婕　金岩　韩锐

[摘要] 目的 探讨糖尿病人群糖化血红蛋白（HbA1c）与高血压及冠心病的关系，为相关慢性病的早期发现及预防提供参考。 方法 选择2010年7月～2014年6月于抚顺市中心医院内分泌科住院患者382例，根据有无2型糖尿病病史分为糖尿病组197例，非糖尿病组185例。比较两组血脂[总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）]、血糖[空腹血糖（FPG）、空腹胰岛素（FINS）]、血压[收缩压（SBP）、舒张压（DBP）]、超敏C反应蛋白（hs-CRP）及HbA1c水平。根据是否患高血压及冠心病将糖尿病患者分为对应亚组，比较各亚组HbA1c水平。采用Pearson检验分析HbA1c水平与血压及hs-CRP的相关性。 结果 两组血脂指标：两组TC、TG、LDL-C水平比较差异无统计学意义（P > 0.05），但糖尿病组HDL-C水平低于非糖尿病组，差异有统计学意义（P < 0.05）。糖尿病组SBP及DBP均高于非糖尿病组，差异有统计学意义（P < 0.05）。两组血糖相关指标（FPG、FINS）比较差异有统计学意义（P < 0.05），糖尿病组均较高。糖尿病组hs-CRP及HbA1c水平高于非糖尿病组，且差异有统计学意义（P < 0.05）。糖尿病合并高血压组HbA1c水平高于非高血压组，差异有统计学意义（P < 0.05）。糖尿病合并冠心病组HbA1c水平高于非冠心病组，差异有统计学意义（P < 0.05）。Pearson相关分析结果显示，糖尿病患者HbA1c水平与SBP、DBP及hs-CRP均呈正相关（P < 0.05）。 结论 2型糖尿病患者HbA1c水平与血压及hs-CRP呈正相关，对高血压及冠心病有一定的预测作用，临床应特别注意对HbA1c较高的糖尿病患者的高血压及冠心病筛查及预防。

[关键词] 糖尿病；高血压；冠心病；糖化血红蛋白

[中图分类号] R587；R544.1 [文献标识码] A [文章编号] 1673-7210（2015）02（b）-0032-04

[Abstract] Objective To discuss the relationship between glycosylated hemoglobin level of diabetes mellitus patients and hypertension， cardiovascular disease， in order to provide references for chronic disease early detection and prevention. Methods 382 case of patients in Department of Endocrinology of Fushun Central Hospital from July 2010 to June 2014 were selected. According to the history of type 2 diabetes mellitus （T2DM）， patients were divided into T2DM group （n = 197） and non-T2DM group （n = 185）. The levels of blood lipid （TC， TG， LDL-C and HDL-C）， blood glucose （FPG， FINS）， blood pressure （SBP， DBP）， hs-CRP and HbA1c between the two groups were compared. Then according to suffered with hypertension and coronary heart disease or not， patients with T2DM were divided into subgroups. Pearson analysis was used to analyze the relationship between HbA1c and SBP， DBP， hs-CRP. Results Serum lipid： the differences in levels of TC， TG， LDL-C between the two groups were not statistically significant （P > 0.05）， while the level of HDL-C in the T2DM group was lower than that in the non-T2DM group， with a statistically significant difference （P < 0.05）. The levels of blood glucose （FPG， FINS） and blood pressure （SBP， DBP） in the T2DM group were all higher than those in the non-T2DM group， with statistically significant differences （all P < 0.05）. The differences in levels of hs-CRP and HbA1c between the two groups were statistically significant （P < 0.05）， which in the T2DM group were all higher. The HbA1c level in T2DM combined with hypertension group was higher than that of non- hypertension group （P < 0.05）. The HbA1c level in T2DM combined with cardiovascular disease group was higher than that of non-cardiovascular disease group （P < 0.05）. Pearson correlation analysis showed that HbA1c levels of diabetes mellitus patients were correlated with SBP， DBP and hs-CRP positively （P < 0.05）. Conclusion HbA1c levels of diabetes mellitus patients are correlated with blood pressure and hs-CRP positively， which has certain prediction effect for hypertension， cardiovascular disease. T2DM patients with higher HbA1c levels should pay special attention to screening and prevention of hypertension and coronary heart disease in clinic.

[Key words] Diabetes mellitus； Hypertension； Cardiovascular disease； Glycosylated hemoglobin

随着现代人们生活水平的不断提高，慢性疾病发病率日渐升高，逐渐成为社会关注的热点。糖尿病作为最主要的慢性疾病之一，其并发症众多，且糖尿病患者患高血压及心脑血管疾病的比例也日益增大，严重威胁人类健康，造成了严重的社会负担及经济负担，近年来受到了越来越多的关注。糖化血红蛋白（HbA1c）是葡萄糖与血红蛋白的氨基发生非酶催化的糖化反应的产物，可作为反映糖代谢能力的重要指标，大部分糖尿病患者有HbA1c异常[1-2]，HbA1c是监测血糖稳定性及药物疗效的一个有效指标。有研究报道，HbA1c与心脑血管疾病密切相关，是心脑血管疾病独立、进展性危险因素，可以明确预测心脑血管相关疾病[3]。本文……