2型糖尿病合并体位性低血压的危险因素分析

目的了解2型糖尿病人群体位性低血压的患病率，并探讨其相关的危险因素。方法以2010年8月-2011年4月256例30—80岁住院2型糖尿病患者作为调查对象，采用直立倾斜床连接心电监护仪测量静息状态下患者坐位、卧位以及立位即刻、1、2、3及5min末的血压、心率；并记录详细病史、检测生化指标及进行自主神经功能检查等。结果住院2型糖尿病人群体位性低血压患病率为31．1％，多因素Logistic逐步回归分析提示，2型糖尿病患者合并体位性低血压风险与糖尿病肾病（OR=3．979，95％CI：1．606～9．859）、HbA1C水平（OR=1．222，95％CI：1．005～1．486）、卧位收缩压（OR=1．073，95％Ch1．021～1．128）呈正相关，与坐位收缩压（OR=0．929，95％CI：0．888．0．971）呈负相关。结论体位性低血压在住院2型糖尿病人群中有较高的患病率，其危险因素包括合并糖尿病肾病、HbA1C水平升高、卧位收缩压升高等，故应尽早控制好血糖、保护肾功能，阻止和延缓体位性低血压的发生及改善糖尿病患者的预后。

The Clinical Study of Risk Factors for Orthostatic Hypotension in Patients with Type 2 Diabetes Mellitus

Objective To determine the prevalence and risk factors of orthostatic hypotension （OH） in hospitalized patients with type 2 diabetes mellitus （T2DM） by head-up tilt testing （HUT）. Methods This cross-sectional study was conducted in 256 inpatients with T2DM aged 30 to 80 years from August 2010 to April 2011. Blood pressure and heart rate were measured in sitting, supine position and at the end of immediately, 1 min, 2 min, 3 min and 5 min after the upright tilt inclination ≥60°with remote ECG monitoring instrument. Other information including the detailed history, laboratory indexes and the autonomic nervous function was also collected. Results The prevalence of orthostatic hypotension was 31.1% in hospitalized patients with T2DM. After adjustment for age, gender, BMI, hypotension, Logistic regression analysis showed that diabetic nephropathy （OR =3.979, 95%CI： 1.606-9.859）, HbA1c （OR=1.222; 95%CI： 1.005-1.486）, supine SBP （OR=1.073; 95%CI： 1.021-1.128）, sitting SBP （OR= 0.929; 95% CI： 0.888-0.971） were predisposing determinants for orthostatic hypotension in hospitalized T2DM patients. Conclusion Hospitalized T2DM patients has a relatively high prevalence of orthostatic hypotension, which increased with diabetic nephropathy, HbA1c, supine SBP and negatively correlated with sitting SBP. The blood pressure and glycemic control in hospitalized patients with T2DM should be managed reasonably so as to reduce the incidence of orthostatic hypotension.