张子月,王璋,钟大鹏
ZHANG Ziyue,WANG Zhang,ZHONG Dapeng

• 1:中国人民解放军西部战区总医院干部病房
• 2:中国人民解放军西部战区总医院内分泌科

摘要(Abstract)：

目的 分析老年2型糖尿病(T2DM)患者慢性血管并发症的危险因素。方法 选择60岁以上老年T2DM患者125例，按照是否合并慢性血管并发症分为合并组(n=57)和未合并组(n=68),比较两组患者一般资料[性别、年龄、糖尿病病程、体质量指数(BMI)、血压]、血糖相关指标[空腹血糖(FBG)、糖化血红蛋白(HbAlc)、平均血糖值(MAGE)、血糖标准差(SD-BG)]和生化指标[总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、血尿酸(SUA)、甘油三酯(TG)、血肌酐(Scr)、血尿素氮(BUN)];采用多因素logistic回归分析老年T2DM患者慢性血管并发症的危险因素，分析血糖波动对预测老年T2DM慢性血管并发症的价值。结果 两组患者在性别、烟酒史和血压情况、FBG、TC、HDL-C、LDL-C等方面比较，差异无统计学意义(P>0.05);合并慢性血管并发症组患者年龄大于未合并组，T2DM病程长于未合并组，差异有统计学意义(P<0.05);合并组MAGE、SD-BG和HbAlc、SUA、TG、Scr、BUN均高于未合并组，差异有统计学意义(P<0.05);多因素logistic回归分析显示，病程长、MAGE、SD-BG、TG、Scr和BUN水平升高是老年T2DM患者发生慢性血管并发症的危险因素(P<0.05);受试者工作特征曲线(ROC)结果示，MAGE和SD-BG联合预测老年T2DM是否合并慢性血管并发症的效能较高，其曲线下面积(AUC)为0.853,约登指数为0.634,敏感度、特异性分别为73.68%、89.71%。结论 血糖波动幅度大、血糖控制不佳且病程长是导致老年T2DM患者发生慢性血管并发症的危险因素。
Objective To analyze the risk factors of chronic vascular complications in elderly patients with type 2 diabetes mellitus(T2DM). Methods A total of 125 elderly T2DM patients over 60 years of age were selected and divided into combined group(n=57) and uncombined group(n=68) according to whether they had chronic vascular complications. The general data [gender, age, diabetes duration, body mass index(BMI), blood pressure)], blood glucose related indicators [fasting blood glucose(FBG), glycated hemoglobin(HbAlc), mean blood glucose value(MAGE), blood glucose standard deviation(SD-BG)], and biochemical indexes [total cholesterol(TC), high-density lipoprotein(HDL-C), low density lipoprotein(LDL-C), blood uric acid(SUA), triglycerides(TG), blood creatinine(Skr), blood urea nitrogen(BUN)] were compared between two groups. Multivariate logistic regression was used to analyze the risk factors of chronic vascular complications in elderly T2DM patients and to analyze the value of blood glucose fluctuations for predicting chronic vascular complications in elderly T2DM. Results There were no significant differences between the two groups regarding gender, tobacco, and alcohol history, and blood pressure, FBG, TC, HDL-C, and LDL-C(P>0.05). Patients in the group with chronic vascular complications were older than the uncombined group, and the duration of T2DM was longer than the uncombined group. The difference was statistically significant(P<0.05). The combined groups with MAGE, SD-BG, and HbAlc, SUA, TG, Scr, and BUN were all higher than those in the uncombined group, and the difference was statistically significant(P<0.05). Multivariate logistic regression analysis showed that long disease duration, MAGE, SD-BG, TG, Scr, and elevated levels of BUN were risk factors for chronic vascular complications in elderly patients with T2DM(P<0.05). The receiver operating characteristic curve(ROC) results showed that MAGE and SD-BG were more effective in predicting whether T2DM occurs with chronic vascular complications in the elderly. The area under the curve(AUC) was 0.853, the Youden index was 0.634, and the sensitivity and specificity were 73.68% and 89.71%, respectively. Conclusion Large glucose fluctuation, poor glycemic control, and long duration are risk factors for chronic vascular complications in older patients with T2DM.

关键词(KeyWords)： 老年2型糖尿病;血糖波动幅度;慢性血管并发症;危险因素
elderly type 2 diabetes mellitus (T2DM);magnitude of blood glucose fluctuations;chronic vascular complications;risk factors

Abstract:

Keywords:

基金项目(Foundation): 四川省干部保健科研课题(18BJZ16)

作者(Author): 张子月,王璋,钟大鹏
ZHANG Ziyue,WANG Zhang,ZHONG Dapeng

DOI: 10.19367/j.cnki.2096-8388.2023.02.009

参考文献(References)：

• [1] 张洋，吴慧丽.不同方案对老年晚期结肠癌血清CEA,AFP,CA19-9,TK1水平及生存周期影响的对比[J].中国医院药学杂志，2019,11(3):269-273.
• [2] 中华人民共和国国家卫生健康委员会.中国结直肠癌诊疗规范(2020版)[J].中华消化外科杂志，2020(8):563-588.
• [3] 张成熙，李启刚.围术期CEA及CA19-9检测水平对结直肠癌术前分期及术后预后的影响[J].检验医学与临床，2018,15(24):3698-3701,3706.
• [4] 毛海波，朱国栋，方润娅，等.血管生成素-2、血管内皮生长因子、糖类抗原199及癌胚抗原对结肠癌诊断和复发转移的预测价值[J].实用医学杂志，2019,35(3):428-432.
• [5] 潘莉娟，杨静，董剑，等.术前血清CEA,CA19-9,CA50,AFP,TPS检测在结直肠癌肝转移中的预测价值[J].国际检验医学杂志，2020,41(8):923-926.
• [6] ZHAI H,HUANG J,YANG C,et al.Serum CEA and CA19-9 levels are associated with the presence and severity of colorectal neoplasia[J].Clinical Laboratory,2018,64(3):351-356.
• [7] 顾晋，汪建平，孙燕，等.中国结直肠癌诊疗规范(2017年版)[J].中华外科杂志，2018,12(1):3-23.
• [8] JI Q,CAI G,LIU X,et al.MALAT1 regulates the transcriptional and translational levels of proto-oncogene RUNX2 in colorectal cancer metastasis[J].Cell Death Disease,2019,10(6):378.
• [9] TAKAMARU H,SAITO Y,SEKIGUCHI M,et al.Endoscopic resection before surgery does not affect the recurrence rate in patients with high-risk t1 colorectal cancer[J].Clinical and Translational Gastroenterology,2021,12(4):e00336.
• [10]王奇龙，陈南征，吕铁升，等.血清CEA,CA19-9,CA242对结直肠癌转移及预后的评估价值[J].解放军医药杂志，2020,32(6):35-39.
• [11]付裕，鲁稳柱，李鸿鹏，等.结直肠癌术后血清CTCs,CA125,CEA及CA19-9水平与复发或转移的相关性研究[J].中国煤炭工业医学杂志，2020,23(2):143-148.
• [12]张刘平，许政文，张兴，等.血清miR-335-5p,CEA,CA19-9水平对结肠癌腹腔镜术后复发转移的预测价值[J].山东医药，2021,61(10):26-30.
• [13]罗炜，马贵亮，于璐，等.血清CEA,CA19-9联合ALP预测结直肠癌肝转移的价值[J].中国现代普通外科进展，2020,23(4):326-328,331.
• [14]孙国钢，宋新江.转化生长因子-β1,缺氧诱导因子-1α,血管内皮生长因子，癌胚抗原，糖类抗原199在结直肠癌根治术后复发转移中的预测价值[J].中国医师杂志，2020,22(12):1888-1892.
• [15]雷雨广，张伟丽，陈超，等.siRNA敲减缺氧诱导因子1α表达对口腔鳞癌细胞活力及癌胚抗原相关细胞黏附分子1表达的影响[J].中国病理生理杂志，2018,34(10):1736-1741.
• [16]姜雅聪，张旭初，王剑杰，等.血清肿瘤标志物测定联合应用对结直肠癌术后复发与转移探测的临床诊断价值[J].标记免疫分析与临床，2021,28(7):1106-1109.
• [17]赵晓朋，赵猛，任丽，等.术前血清CEA,CA19-9,CA72-4联合检测对Ⅰ～Ⅲ期结直肠癌手术患者预后的预测价值[J].山东医药，2019,59(34):66-69.
• [18]林雪丹，杨天兴，陶志华，等.癌胚抗原和糖类抗原19-9对Ⅱ～Ⅲ期结肠癌复发的预测价值[J].中国癌症杂志，2018,28(11):32-37.
• [19]XU W,HE Y,WANG Y,et al.Risk factors and risk prediction models for colorectal cancer metastasis and recurrence:an umbrella review of systematic reviews and meta-analyses of observational studies[J].BMC Med,2020,118(1):172.
• [20]SASAKI T,SHIGETA K,OKABAYASHI K,et al.Horizontal spread of pericolic lymph node metastasis as a prognostic factor for recurrence in Stage Ⅲ colorectal cancer[J].Colorectal Dis,2021,23(6):1370-1378.

文章评论(Comment)：