摘要/Abstract
摘要： 目的·探讨同时患有2型糖尿病（type 2 diabetes mellitus，T2DM）、高血压和心房颤动患者中，不同血糖、血压控制水平及心房颤动控制策略对于新发射血分数保留心力衰竭（heart failure with preserved ejection fraction，HFpEF）风险的影响。方法·收集2008年1月—2012年12月在上海交通大学医学院附属第九人民医院心血管内科就诊的418例同时患有T2DM、高血压和心房颤动，但无心力衰竭症状及体征的患者。观察7年随访期内，不同血糖控制水平（糖化血红蛋白：<7.0%、7.0%～8.0%、>8.0%）、不同血压控制水平[24 h收缩压：<120 mmHg（1 mmHg=0.133 kPa）、120～140 mmHg、>140 mmHg]以及心房颤动节律控制或心率控制对该人群新发HFpEF风险的影响。采用单因素和多因素Cox回归模型探索新发HFpEF的相关危险因素。结果·7年随访期内，418例患者中有67例发生HFpEF；对比糖尿病、高血压和心房颤动的不同控制水平或治疗策略，强化降糖（糖化血红蛋白<7.0%）、血压控制不佳（24 h收缩压>140 mmHg）和心房颤动心率控制的患者新发HFpEF风险最高（37.9%），而标准降糖（糖化血红蛋白7.0%～8.0%）、强化降压（24 h收缩压<120 mmHg）和心房颤动节律控制的患者新发HFpEF风险最低（4.8%）。多因素Cox回归分析显示，心房颤动心率控制策略（HR=1.727，95%CI 1.079～2.997，P=0.036）是新发HFpEF的独立危险因素。结论·对于同时患有T2DM、高血压和心房颤动的患者，采取标准降糖、强化降压和心房颤动节律控制可能是延缓HFpEF进展的重要因素。
关键词: 射血分数保留心力衰竭, 糖尿病, 高血压, 心房颤动, 优化管理
Abstract:
Objective · To investigate the effects of different blood glucose (BG), blood pressure (BP) control levels and atrial fibrillation (AF) control strategies on the risk of the new-onset heart failure with preserved ejection fraction (HFpEF) in patients with type 2 diabetes mellitus (T2DM), hypertension and AF. Methods · A total of 418 patients with T2DM, hypertension and AF, but without clinical signs or symptoms of heart failure, admitted to the Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2008 to December 2012 were enrolled. The participants were followed up for 7 years to examine the effects of BG control [glycosylated hemoglobin (HbA1c): <7.0%, 7.0%–8.0% and >8.0%), BP control [24 h systolic BP (SBP): <120 mmHg (1 mmHg=0.133 kPa), 120–140 mmHg and >140 mmHg] and rhythm or rate control for AF on new-onset HFpEF. Univariate and multivariate Cox regression models were used to estimate the related risk factors of new-onset HFpEF. Results · With a 7-year follow-up, the new-onset HFpEF occurred in 67 of 418 enrolled patients. In different control levels for diabetes mellitus, hypertension and AF, the intensive control of BG (HbA1c<7.0%), poor control of BP (24 h SBP>140 mmHg) and rate control of AF had the highest risk (37.9%), and the conservative control of BG (HbA1c 7.0%–8.0%), intensive control of BP (24 h SBP<120 mmHg) and rhythm control of AF had the lowest risk of new-onset HFpEF (4.8%). Multivariable Cox regression analysis showed that rate control for AF (HR=1.727, 95%CI 1.079–2.997, P=0.036) was independently associated with the presence of new-onset HFpEF. Conclusion · Conservative control of BG, besides intensive control of BP and rhythm control of AF, is found to be a crucial factor to delay the progression of HFpEF among patients with T2DM, hypertension and AF.
Key words: heart failure with preserved ejection fraction (HFpEF), diabetes mellitus, hypertension, atrial fibrillation (AF), optimal management
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