本文選題：高血壓 + 糖尿病　； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的:討論老年H型高血壓合并糖尿病患者與單純老年H型高血壓患者動脈硬化嚴(yán)重程度比較。方法:選取2014年01月至2016年07月,于蘭州大學(xué)第一醫(yī)院老年病一科入院的324名患者。該324名患者均為老年H型高血壓,根據(jù)其是否存在糖尿病分為2組:老年H型高血壓合并糖尿病組(合并組)158例、老年H型高血壓組(高血壓組)166例,分別對其進行無創(chuàng)動脈硬化檢查,檢測其動脈硬化指標(biāo)(C-RPWV、C-FPWV、C-DPWV),比較兩組間動脈硬化程度,及其影響因素并對其臨床檢查結(jié)果做一比較與分析。結(jié)果:1.高血壓組、合并組:年齡、TC、TG、LDL、UA、BMI均差距不大。而兩組間的Hcy水平、C-RPWV、C-FPWV檢測指標(biāo)均有所差距且具有統(tǒng)計學(xué)意義(P0.05)。2.血漿同型半胱氨酸:合并組的Hcy水平(20.53±7.54)較高血壓組的Hcy水平(15.91±4.87)升高且P0.05,差異具有統(tǒng)計學(xué)意義。3.動脈硬化指標(biāo):(1)C-RPWV:合并組(11.13±2.80)較高血壓組(10.06±1.16)C-RPWV水平升高(P0.05)差異具有統(tǒng)計學(xué)意義。(2)C-FPWV:合并組(13.68±2.68)較高血壓組(11.62±2.52)的C-FPWV水平升高(P0.05)差異具有統(tǒng)計學(xué)意義。(3)C-DPWV:合并組(10.42±7.01)水平較高血壓組的C-DPWV(10.41±1.56)水平無明顯差異。4.使用Pearson線性相關(guān)分析:分析Hcy水平與動脈硬化指標(biāo)相關(guān)性結(jié)果示:Hcy水平與動脈硬化指標(biāo)(C-RPWV、C-FPWV)成線性正相關(guān),相關(guān)系數(shù)分別為0.441、0.906,提示Hcy水平越高,動脈指數(shù)(C-RPWV、C-FPWV)值越高,動脈硬化程度亦越嚴(yán)重。5.使用多元回歸分析法分析多因素:年齡、血糖、TC、TG、LDL、BMI、UA、Hcy對動脈動脈硬化指標(biāo)危險因素。結(jié)果顯示:年齡、血糖、TC、TG、BMI、Hcy均是動脈硬化發(fā)生發(fā)展的危險因素。結(jié)論:在我院2014年至2016年上半年期間住院的老年患者中,老年H型高血壓合并糖尿病患者較老年H型高血壓患者的動脈硬化程度明顯升高。表現(xiàn)為動脈硬化指標(biāo)(C-RPWV、C-FPWV)的升高,且Hcy水平與動脈硬化指標(biāo)水平呈正相關(guān)。提示:Hcy水平與動脈硬化發(fā)生呈正相關(guān)。年齡、血糖、TC、TG、BMI、Hcy均是影響動脈硬化發(fā)生發(fā)展的危險因素。對老年高血壓患者的診治過程中,除監(jiān)測治療血壓外,還應(yīng)注意對血脂、血漿同型半胱氨酸、體重指數(shù)的監(jiān)測,老年糖尿病合并高血壓患者較單純老年高血壓患者動脈硬化程度嚴(yán)重,提示對老年高血壓合并糖尿病的患者在降壓的同時注意對血糖的調(diào)節(jié),延緩高血壓患者并發(fā)癥及靶器官的損害,對于心血管、腦血管、腎功能損害患者還應(yīng)注意監(jiān)測動脈硬化指標(biāo),降低疾病的發(fā)生及死亡率。
[Abstract]:Objective: to compare the severity of arteriosclerosis between elderly patients with type H hypertension and diabetes mellitus. Methods: from January 2014 to July 2016, 324 patients were admitted to Department of Geriatrics in the first Hospital of Lanzhou University. The 324 patients were all elderly patients with type H hypertension and were divided into two groups according to whether they had diabetes mellitus: elderly patients with type H hypertension combined with diabetes mellitus (158 cases) and elderly patients with type H hypertension (166 cases of hypertension group). Non-invasive arteriosclerosis examination was performed to detect the arteriosclerosis index (C-RPWV), C-FPWVV C-DPWVV, to compare the degree of arteriosclerosis between the two groups and its influencing factors, and to make a comparison and analysis on the results of clinical examination. The result is 1: 1. In hypertension group and complicated group, there was no significant difference in BMI of age group. The Hcy level of C-RPWV and C-FPWV between the two groups were different and had statistical significance. Plasma homocysteine: the level of Hcy in the combined group (20.53 鹵7.54) was higher than that in the hypertensive group (15.91 鹵4.87) and the difference was statistically significant (P 0.05). Arteriosclerosis index: the level of C-RPWV in the combined group (11.13 鹵2.80) was significantly higher than that in the hypertension group (10.06 鹵2.80) (P < 0.05). The level of C-FPWV in the combined group was 13.68 鹵2.68) higher than that in the hypertension group (11.62 鹵2.52). There were significant differences in the level of C-FPWV between the combined group (10.42 鹵7.01) and the hypertension group (10.42 鹵7.01). There was no significant difference in C-DPWV(10.41 鹵1. 56) level. 4. Using Pearson linear correlation analysis, the correlation between Hcy level and arteriosclerosis index was analyzed. The results showed that there was a positive linear correlation between Hcy level and atherosclerosis index C-RPWV C-FPWV, and the correlation coefficient was 0.441 ~ 0.906, respectively, indicating that the higher the Hcy level, the higher the C-RPWVV C-FPWV value. The more severe the arteriosclerosis. Multivariate regression analysis was used to analyze the risk factors for atherosclerosis: age, TCG-TGG, LDL- BMI-UAHcy. The results showed that age and blood glucose levels were all risk factors for the development of atherosclerosis. Conclusion: the degree of arteriosclerosis in elderly patients with type H hypertension complicated with diabetes is significantly higher than that in elderly patients with type H hypertension. There was a positive correlation between the level of Hcy and the index of arteriosclerosis. The results suggest that the level of Hcy is positively correlated with the occurrence of arteriosclerosis. Age, blood glucose, TGG and BMI Hcy were all risk factors for the development of atherosclerosis. In the diagnosis and treatment of elderly patients with hypertension, in addition to monitoring the blood pressure, we should also pay attention to the monitoring of blood lipids, plasma homocysteine, body mass index. The degree of arteriosclerosis in elderly patients with diabetes complicated with hypertension is more serious than that in patients with simple hypertension. It suggests that the elderly patients with hypertension and diabetes should pay attention to the regulation of blood glucose while lowering blood pressure. Patients with cardiovascular, cerebrovascular and renal dysfunction should pay attention to monitoring arteriosclerosis indexes and reducing the incidence and mortality of diseases.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1;R544.1

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