目的 探讨糖化血红蛋白(HbA1c)、24 h动态血压监测(ABPM)及心率变异性(HRV)与老年2型糖尿病(T2DM)合并原发性高血压(EH)患者靶器官损害的关系。方法 选择2020年5月至2023年5月收治的307例老年T2DM合并EH患者，根据是否合并靶器官损害分为T2DM合并EH组(n=129)和伴靶器官损害组(n=178)。比较两组的临床资料、24 h ABPM及HRV指标;采用Spearman相关性分析伴靶器官损害组的HbA1c、24 h ABPM、HRV参数与24 h微量白蛋白(mAlb)、左室心肌质量指数(LVMI)及颈动脉内膜中层厚度(IMT)的相关性。结果 伴靶器官损害组的饮酒史、吸烟史占比、体质指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)水平、HbA1c、24 h mAlb、LVMI、IMT高于T2DM合并EH组，高密度脂蛋白胆固醇(HDL-C)水平低于T2DM合并EH组(P＜0。05)。伴靶器官损害组的24 h平均收缩压(24 h SBP)、白天平均收缩压(dSBP)及夜间平均收缩压(nSBP)高于T2DM合并EH组，24 h平均舒张压(24 h DBP)、白天平均舒张压(dDBP)及夜间平均舒张压(nDBP)低于T2DM合并EH组(P＜0。05)。伴靶器官损害组的HRV各项指标低于T2DM合并EH组(P＜0。05)。HbA1c、24 h SBP、dSBP、nSBP与靶器官损害指标呈正相关，24 h DBP、dDBP、nDBP及HRV各项参数与靶器官损害指标呈负相关(P＜0。05)。结论 HbA1c、24 h ABPM及HRV与老年T2DM合并EH患者的肾脏、心脏、血管等靶器官损害有关，通过动态监测有利于早期发现高危人群，对保护靶器官有重要意义。
Relationship between glycosylated hemoglobin,24 h ambulatory blood pressure monitoring and heart rate variability and target organ damage in elderly patients with type 2 diabetes mellitus complicated with essential hypertension
Objective To investigate the relationship between glycosylated hemoglobin(HbA1c),24 h ambulatory blood pressure monitoring(ABPM),heart rate variability(HRV)and target organ damage in elderly patients with type 2 diabetes mellitus(T2DM)complicated with essential hypertension(EH).Methods A total of 307 elderly patients with T2DM complicated with EH admitted from May 2020 to May 2023 were selected and divided into T2DM complicated with EH group(n=129)and target organ damage group(n=178)according to whether they had target organ damage.The clinical data,24 h ABPM and HRV indexes were compared between the two groups.Spearman correlation analysis was used to analyze the correlation between HbA1c,24 h ABPM,HRV parameters and 24 h microalbumin(mAlb),left ventricular mass index(LVMI)and intima-media thickness(IMT)in the target organ damage group.Results The proportion of alcohol consumption history,smoking history,body mass index(BMI),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),fasting plasma glucose(FPG)levels,HbA1c,24 h mAlb,LVMI and IMT in the target organ damage group were higher than those in the T2DM complicated with EH group,while high-density lipoprotein cholesterol(HDL-C)level was lower than that in the T2DM complicated with EH group(P＜0.05).The 24 h mean systolic blood pressure(24 h SBP),daytime average systolic blood pressure(dSBP)and nighttime average systolic blood pressure(nSBP)in the target organ damage group were higher than those in the T2DM complicated with EH group,the 24 h mean diastolic blood pressure(24 h DBP),daytime average diastolic blood pressure(dDBP)and nighttime average diastolic blood pressure(nDBP)were lower than those in the T2DM complicated with EH group(P＜0.05).The indexes of HRV in the target organ damage group were lower than those in the T2DM complicated with EH group(P＜0.05).HbA1c,24 h SBP,dSBP and nSBP were positively correlated with target organ damage indexes,and 24 h DBP,dDBP,nDBP and HRV parameters were negatively correlated with target organ damage indexes(P＜0.05).Conclusion HbA1c,24 h ABPM and HRV are related to the damage of target organs such as kidney,heart and blood vessels in elderly patients with T2DM and EH.Dynamic monitoring is conducive to early detection of high-risk groups and is of great significance for protecting target organs.
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