目的 探讨老年高血压合并射血分数保留的心力衰竭(HFpEF)的临床特点及其相关危险因素.方法 纳入569例老年高血压住院病人,根据是否合并HFpEF分为HFpEF组和对照组,比较2组间临床特点的差异;采用多元Logistic回归分析老年高血压病人发生HFpEF的影响因素.结果 HFpEF组年龄、女性比例、超重、2型糖尿病患病率、血清B型尿钠肽、尿素氮、肌酐水平显著高于对照组(P<0.05).HFpEF组舒张期室间隔厚度、舒张期左心室内径、舒张期左心室后壁厚度、左心房内径、左心室质量指数均显著高于对照组(P<0.01).Logistic回归分析显示,老年高血压合并HFpEF的相关危险因素包括女性、超重、2型糖尿病及左心室质量指数.结论 女性、超重、2型糖尿病、左心室质量指数是老年高血压病人合并HFpEF的相关危险因素.

Objective:To assess the correlation between hyperuricaemia and normoalbuminuric diabetic kidney disease(NADKD) in elderly type 2 diabetic patients.Methods:This retrospective case-control study enrolled 910 patients with type 2 diabetes mellitus who were hospitalized in the Geriatric Department of Nanjing Drum Tower Hospital from 2015 to 2020. The patients were divided into NADKD group [urinary albumin/creatinine(UACR)<30 mg/g and estimated glomerular filtration rate(eGFR) <60 mL·min -1·(1.73 m 2) -1, n=169)], albuminuria DKD group [UACR ≥30 mg/g and eGFR <60 mL·min -1·(1.73 m 2) -1, n=234], and control group [UACR <30 mg/g and eGFR≥60 mL·min -1·(1.73 m 2) -1, n=507]. Medical history, physical examination, and laboratory tests were collected. Results:The proportion of women in the NADKD group was significantly higher than that in the albuminuric DKD group(50.89% vs 40.60%, P<0.05). Duration of diabetes, HbA 1C, fasting plasma glucose(FPG), the prevalences of hypertension and hyperuricaemia, blood urea nitrogen, blood creatinine, and blood uric acid were significantly lower in the NADKD group than those in the albuminuric DKD group(all P<0.05). Blood urea nitrogen, serum creatinine, triglycerides, serum uric acid and the prevalence of hyperuricemia were significantly higher in the NADKD group compared the control group(all P<0.001) while the proportion of hypertension, systolic blood pressure, LDL-C, HbA 1C, and FPG were lower(all P<0.05). Multivariate linear regression analysis showed that eGFR was negatively associated with urea nitrogen and serum uric acid while positively associated with HbA 1C in normoalbuminuric elderly type 2 diabetic patients(all P<0.001). Logistic regression analysis revealed that hyperuricaemia was a risk factor for NADKD in elderly type 2 diabetic patients after adjusting for BMI, blood pressure, lipids, and glucose( OR=1.963, 95% CI 1.157-3.332, P=0.012). Conclusion:Hyperuricaemia is significantly associated with NADKD in elderly patients with type 2 diabetes.

PURPOSE:To develop a simple and clinically useful assessment tool for osteoporosis in older women with type 2 diabetes mellitus (T2DM).METHODS:A total of 601 women over 60 years of age with T2DM were enrolled in this study. The levels of serum sex hormones and bone metabolism markers were compared between the osteoporosis and non-osteoporosis groups. The least absolute shrinkage and selection operator regularization (LASSO) model was applied to generate a risk assessment tool. The risk score formula was evaluated using receiver operating characteristic analysis and the relationship between the risk score and the bone mineral density (BMD) and T-value were investigated.RESULTS:Serum sex hormone-binding globulin (SHBG), cross-linked C-telopeptide of type 1 collagen (CTX), and osteocalcin (OC) were significantly higher in the osteoporosis group. After adjustment for age and body mass index (BMI), SHBG was found to be correlated with the T-value or BMD. Then, a risk score was specifically generated with age, BMI, SHBG, and CTX using the LASSO model. The risk score was significantly negatively correlated with the T-value and BMD of the lumbar spine, femoral neck, and total hip (all P<0.05).CONCLUSION:A risk score using age, BMI, SHBG, and CTX performs well for identifying osteoporosis in older women with T2DM.

目的 了解老年T2DM住院病人的共病情况.方法 采用回顾性研究方法,收集我科住院的427例老年T2DM病人的临床资料,计算Charlson共病指数(CCI),并根据CCI得分分为低共病组(≤2分)和高共病组(>2分).分析2组病人的一般情况、伴发疾病、血糖控制和多重用药情况.结果 427例老年T2DM病人中,高共病患病率(CCI>2分)为65.34％(279/427).高共病组的年龄和糖尿病病程显著大于低共病组,差异有统计学意义(P<0.05).高共病组中有88.53％伴发高血压、81.00％伴发高血脂、63.44％伴发外周动脉血管疾病、60.93％伴发脑血管病、40.50％伴发缺血性心脏病,低共病组中有77.70％伴发高血脂、62.84％伴发外周动脉血管疾病、53.38％伴发高血压.高共病组伴多重用药的比例(62.37％)显著高于低共病组(47.30％),差异有统计学意义(P<0.01).低共病组和高共病组血糖控制及胰岛功能比较,差异没有统计学意义(P>0.05).结论 老年T2DM高共病病人较低共病病人年龄大、病程长、多重用药比例高,更容易伴发高血压和心脑血管疾病.