临床老年慢性非传染性疾病患者5年代谢指标变化趋势的关联研究

doi:10.16138/j.1673-6087.2023.02.005

摘要/Abstract

摘要：

目的: 探究老年慢性非传染性疾病患者5年代谢指标变化趋势以及代谢指标之间的相关性。方法: 2016年1月至12月基线纳入上海交通大学医学院附属瑞金医院老年病科收治的159例慢性非传染性疾病患者，年龄（66.2±7.4）岁。连续随访至2020年12月，每年采集临床资料与生化指标。运用Spearman相关性分析检测基线各代谢指标间的相关性及各代谢指标5年变化间的相关性。结果: Spearman相关分析显示，基线横断面分析中，受试者收缩压与2 h血糖（r=0.371）、空腹胰岛素（r=0.287）、C反应蛋白（r=0.379）、血尿酸（r=0.268）水平呈正相关（均P<0.05），与高密度脂蛋白（r=-0.308）和载脂蛋白A（r=-0.311）呈负相关（均P<0.05）；另外收缩压水平的变化与C反应蛋白水平的变化呈正相关（r=0.305，P<0.05），与高密度脂蛋白水平的变化呈负相关（r=-0.269，P<0.05）；糖代谢指标中的空腹胰岛素及2 h胰岛素与低密度脂蛋白（r分别为0.349、0.287）、空腹胰岛素及2 h胰岛素与载脂蛋白B（r分别为0.290、0.259）、2 h血糖及空腹胰岛素与血尿酸（r分别为0.287、0.327）水平的变化呈正相关（均P<0.05）；高密度脂蛋白和载脂蛋白A水平的变化与C反应蛋白（r分别为-0.295、-0.377）、血尿酸（r分别为-0.263、-0.262）水平的变化呈负相关（P<0.05），低密度脂蛋白和载脂蛋白B水平的变化与血尿酸（r分别为0.258、0.257）水平的变化呈正相关（P<0.05）。结论: 老年慢性非传染性疾病患者的血压、血糖、血脂和炎症指标变化间具有相关性，呈现协同变化趋势。

关键词: 老年慢性非传染性疾病, 代谢指标, 长期变化趋势

Abstract:

Objective To investigate the correlations and 5-year changes of metabolic traits in elderly patients with chronic non-communicable diseases. Methods Between January and December 2016, 159 patients with chronic non-infectious diseases were included and followed up until December 2020. Clinical data and biochemical indicators tested in first time (baseline metabolic traits) and every following year were collected. Spearman correlation coefficients were used to analyze correlations among baseline metabolic traits, as well as 5-year changes in metabolic traits. Results Spearman correlation analysis showed that systolic blood pressure in baseline cross-sectional analysis was significantly positively correlated with 2 h blood glucose (r=0.371), fasting insulin (r=0.287), C-reactive protein (r=0.379) and serum uric acid (r=0.268) levels (all P<0.05); while it was negatively correlated with high-density lipoprotein (r=-0.308) and apolipoprotein A (r=-0.311) (both P<0.05). Systolic blood pressure was positively correlated with C-reactive protein level (r=0.305, P<0.05), and negatively correlated with high-density lipoprotein level (r=-0.269, P<0.05). Fasting insulin and 2 h insulin was associated with low density lipoprotein(r=0.349, 0.287), fasting insulin and 2 h insulin were correlated with apolipoprotein B (r=0.290, 0.259), 2 h blood glucose and fasting insulin were positively correlated with serum uric acid (r=0.287 and 0.327, respectively) (all P<0.05). The changes of high-density lipoprotein and apolipoprotein A levels were significantly negatively correlated with the changes of C-reactive protein(r=-0.295, -0.377) and blood uric acid (r=-0.263, -0.262) levels (P<0.05). The changes of low-density lipoprotein and apolipoprotein B levels were significantly positively correlated with the changes of blood uric acid (r=0.258 and 0.257, respectively) (P<0.05). Conclusions The changes of blood pressure, glucose traits, lipids profile and inflammatory traits among the elderly patients with chronic non-infectious diseases showed significantly correlation and a synergistic trend.

Key words: The elderly with chronic non-communicable diseases, Metabolic trait, Long-term trend

中图分类号:

R592

李嫣然, 徐琛莹, 荣岚, 林青. 临床老年慢性非传染性疾病患者5年代谢指标变化趋势的关联研究[J]. 内科理论与实践, 2023, 18(02): 87-91.

LI Yanran, XU Chenying, RONG Lan, LIN Qing. Correlation of 5-year metabolic traits changes in elderly patients with chronic non-infectious diseases[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(02): 87-91.

图/表 3

表1

研究人群基线和5年随访的代谢指标水平[均n=159，M（Q1,Q3）]

代谢指标	基线	随访	差值Δ	P
收缩压（mmHg）	130.00（119.00, 144.00）	125.00（117.00, 138.00）	-4.00（-16.00, 6.00）	<.0001
舒张压（mmHg）	78.00（73.00, 83.00）	74.00（70.00, 79.00）	-3.00（-8.00, 2.00）	<.0001
脉压（mmHg）	70.00（68.00, 77.00）	72.00（70.00, 78.00）	2.00（-1.00, 6.00）	<.0001
空腹血糖（mmol/L）	5.51（5.07, 6.09）	5.38（5.06, 6.38）	-0.07（-0.44, 0.62）	<.0001
2 h血糖（mmol/L）	7.40（6.22, 9.10）	7.86（6.21, 9.85）	0.35（-075, 1.94）	<.0001
糖化血红蛋白（%）	5.80（5.50, 6.10）	5.80（5.50, 6.10）	0.00（-0.75, 1.94）	<.0001
空腹胰岛素（μU/L）	9.98（7.99, 14.28）	9.04（7.15, 12.85）	-0.22（-2.86, 1.45）	<.0001
2 h胰岛素（μU/L）	68.55（31.15, 109.20）	55.86（31.63, 123.90）	2.33（-31.15, 26.10）	<.0001
甘油三酯（mmol/L）	1.51（0.99, 1.96）	1.26（0.97, 1.68）	-0.20（-0.58, 0.10）	<.0001
总胆固醇（mmol/L）	4.72（3.98, 5.52）	4.73（3.93, 5.41）	-0.06（-0.79, 0.41）	<.0001
低密度脂蛋白（mmol/L）	2.76（2.06, 3.57）	2.67（2.16, 3.40）	-0.04（-0.69, 0.31）	<.0001
高密度脂蛋白（mmol/L）	1.29（1.14, 1.60）	1.35（1.17, 1.60）	0.07（-0.03, 0.17）	<.0001
载脂蛋白A（g/L）	1.40（1.27, 1.63）	1.39（1.28, 1.61）	-0.01（-0.08, 0.16）	<.0001
载脂蛋白B（g/L）	0.93（0.80, 1.06）	0.88（0.71, 1.03）	-0.04（-0.69, 0.31）	<.0001
C反应蛋白（mg/L）	2.1（1.6, 2.8）	7.0（5.0, 10.0）	4.9（2.4, 8.1）	<.0001
血肌酐（μmol/L）	77.00（68.00, 84.00）	77.00（70.00, 89.00）	1.00（-4.00, 6.00）	<.0001
血尿酸（μmol/L）	331.00（293.00, 380.00）	343.00（294.00, 390.00）	8.00（-31.00, 39.00）	<.0001
尿微量白蛋白（mg/L）	1.07（1.05, 1.10）	0.68（0.50, 1.08）	-0.50（-0.57, 0.05）	<.0001
尿白蛋白比肌酐（mg/mmol）	2.50（2.50, 2.50）	2.50（0.92, 2.50）	0.00（-1.54, 0.00）	<.0001

表1

表2

基线各代谢指标间的相关性

	A	B	C	D	E	F	G	H	I	J	K	L	M	N	O	P	Q	R	S
A	1.000	0.558^*	0.433^*	0.083	0.371^*	0.176	0.287^*	0.256	0.056	-0.179	-0.159	-0.308^*	-0.311^*	-0.080	0.379^*	0.142	0.268^*	-0.108	0.230
B	0.558^*	1.000	0.501	0.094	0.243	0.108	0.143	0.058	0.063	0.007	0.022	-0.102	-0.065	-0.010	-0.032	-0.198	0.072	-0.134	0.203
C	0.433^*	0.501^*	1.000	0.049	0.092	0.056	0.040	0.075	0.171	0.097	0.065	-0.089	-0.058	0.076	0.137	-0.150	0.043	-0.100	0.135
D	0.083	0.094	0.049	1.000	0.329^*	0.603^*	0.111	-0.166	0.139	-0.206	-0.129	-0.408^*	-0.318^*	-0.025	0.001	0.005	0.338^*	0.127	-0.035
E	0.371^*	0.243	0.092	0.329^*	1.000	0.516^*	0.197	0.457^*	0.095	-0.063	0.081	-0.304^*	-0.168	0.087	0.340^*	-0.042	0.258^*	-0.016	0.151
F	0.176	0.108	0.056	0.603^*	0.516^*	1.000	0.011	-0.029	0.117	-0.058	0.008	-0.297^*	-0.343^*	0.026	0.116	-0.082	0.124	0.280^*	0.007
G	0.287^*	0.143	0.040	0.111	0.197	0.011	1.000	0.581^*	0.123	-0.109	-0.020	-0.330^*	-0.193	0.026	-0.033	0.094	0.476^*	-0.116	-0.012
H	0.256	0.058	0.075	-0.166	0.457^*	-0.029	0.581^*	1.000	0.135	0.058	0.193	-0.161	-0.063	0.175	0.199	0.039	0.257	-0.024	-0.055
I	0.056	0.053	0.171	0.139	0.095	0.117	0.123	0.135	1.000	0.401^*	0.239	-0.343	-0.156	0.539	0.074	-0.094	0.177	-0.042	0.025
J	-0.179	0.007	0.097	-0.206	-0.063	-0.058	-0.109	0.058	0.401^*	1.000	0.827^*	0.181	0.216	0.810	-0.047	-0.178	-0.138	-0.020	-0.096
K	-0.159	0.022	0.065	-0.129	0.081	0.008	-0.020	0.193	0.239	0.827^*	1.000	-0.056	0.006	0.813	-0.084	-0.136	0.007	-0.054	-0.168
L	-0.308^*	-0.102	-0.089	-0.408^*	-0.304^*	-0.297^*	-0.330^*	-0.161	-0.343^*	0.181	-0.056	1.000	0.812^*	-0.165	-0.094	-0.156	-0.469^*	0.016	-0.110
M	-0.311^*	-0.065	-0.058	-0.318^*	-0.168	-0.343^*	-0.193	-0.063	-0.156	0.216	0.006	0.812^*	1.000	-0.014	-0.102	-0.256	-0.339^*	-0.050	-0.073
N	-0.080	-0.010	0.076	-0.025	0.087	0.026	0.026	0.175	0.539^*	0.810^*	0.813^*	-0.164	-0.014	1.000	-0.026	-0.043	0.058	0.048	-0.152
O	0.379^*	-0.032	0.137	0.001	0.340^*	0.116	-0.033	0.199	0.074	-0.047	-0.084	-0.094	-0.102	-0.025	1.000	0.112	0.039	0.020	0.012
P	0.142	-0.198	-0.150	0.005	-0.042	-0.082	0.094	0.039	-0.094	-0.178	-0.136	-0.156	-0.256	-0.043	0.112	1.000	0.456^*	0.136	-0.069
Q	0.268^*	0.072	0.043	0.338^*	0.258^*	0.124	0.476^*	0.257^*	0.177	-0.138	0.007	-0.469^*	-0.339^*	0.058	0.039	0.456^*	1.000	-0.080	-0.065
R	-0.108	-0.134	-0.100	0.127	-0.016	0.280^*	-0.116	-0.024	-0.042	-0.020	-0.054	0.016	-0.050	0.048	0.020	0.136	-0.080	1.000	-0.277^*
S	0.230	0.203	0.135	-0.035	0.151	0.007	-0.012	-0.055	0.025	-0.096	-0.168	-0.110	-0.073	-0.152	0.012	-0.069	-0.065	-0.277^*	1.000

表2

表3

各代谢指标5年变化间的相关性

	△A	△B	△C	△D	△E	△F	△G	△H	△I	△J	△K	△L	△M	△N	△O	△P	△Q	△R	△S
△A	1.000	0.408^*	0.302^*	-0.122	0.088	0.214	0.119	-0.062	0.056	0.001	0.068	-0.269^*	-0.216^*	0.037	0.305^*	0.079	0.051	0.006	0.041
△B	0.408^*	1.000	0.506^*	0.069	0.173	0.224	0.098	0.092	0.094	0.131	0.166	-0.209	-0.045	0.024	-0.001	-0.177	-0.068	-0.061	0.052
△C	0.302^*	0.506^*	1.000	-0.078	-0.010	0.146	-0.104	-0.034	0.108	0.236	0.083	0.011	0.071	0.092	0.073	-0.038	0.051	-0.094	-0.174
△D	-0.122	0.069	-0.078	1.000	0.434^*	0.416^*	0.253	0.172	-0.097	0.069	0.100	0.107	0.023	0.045	-0.192	-0.109	0.076	0.013	0.039
△E	0.088	0.173	-0.010	0.434^*	1.000	0.430	0.213	0.570^*	0.003	0.030	0.184	-0.113	-0.084	0.172	-0.028	-0.051	0.287^*	0.204	-0.047
△F	0.214	0.224	0.146	0.416^*	0.430^*	1.000	0.179	0.150	-0.042	0.004	0.207	-0.203	-0.094	0.149	0.202	-0.103	0.125	0.129	-0.023
△G	0.119	0.098	-0.104	0.253	0.213	0.179	1.000	0.468^*	-0.181	0.163	0.349^*	-0.058	0.035	0.290^*	-0.051	0.000	0.327^*	-0.071	0.213
△H	-0.062	0.092	-0.034	0.172	0.570^*	0.150	0.468^*	1.000	-0.033	0.136	0.287^*	-0.050	0.055	0.259^*	-0.215	0.003	0.192	0.216	0.006
△I	0.056	0.094	0.108	-0.097	0.003	-0.042	-0.181	-0.033	1.000	0.166	0.182	-0.041	0.073	0.166	-0.078	0.078	-0.158	-0.046	-0.140
△J	0.001	0.131	0.236	0.069	0.030	0.004	0.163	0.136	0.166	1.000	0.848^*	0.256	0.252	0.695^*	-0.213	0.034	0.188	-0.061	0.103
△K	0.068	0.166	0.083	0.100	0.184	0.207	0.349^*	0.287^*	0.182	0.848^*	1.000	0.034	0.120	0.824^*	-0.156	0.023	0.258^*	-0.071	0.123
△L	-0.269^*	-0.209	0.011	0.107	-0.113	-0.203	-0.058	-0.050	-0.041	0.256	0.034	1.000	0.725^*	0.022	-0.295^*	0.020	-0.263^*	-0.173	0.081
△M	-0.216	-0.045	0.071	0.023	-0.084	-0.094	0.035	0.055	0.073	0.252	0.120	0.725^*	1.000	0.101	-0.377^*	0.169	-0.262^*	-0.165	-0.001
△N	0.037	0.024	0.092	0.045	0.172	0.149	0.290^**	0.259	0.166	0.695^*	0.824^*	0.022	0.101	1.000	-0.138	0.048	0.257	0.070	0.159
△O	0.305^*	-0.001	0.073	-0.192	-0.028	0.202	-0.051	-0.215	-0.078	-0.213	-0.156	-0.295^*	-0.377^*	-0.138	1.000	-0.024	0.052	-0.046	0.092
△P	0.079	-0.177	-0.038	-0.109	-0.051	-0.103	0.000	0.003	0.078	0.034	0.023	0.020	0.169	0.048	-0.024	1.000	-0.022	0.157	-0.062
△Q	0.051	-0.068	0.051	0.076	0.287^*	0.125	0.327^*	0.192	-0.158	0.188	0.258^*	-0.263^*	-0.262^*	0.257^*	0.052	-0.022	1.000	-0.050	-0.229
△R	0.006	-0.061	-0.094	0.013	0.204	0.129	-0.071	0.216	-0.046	-0.061	-0.071	-0.173	-0.165	0.070	-0.046	0.157	-0.050	1.000	-0.064
△S	0.041	0.052	-0.174	0.039	-0.047	-0.023	0.213	0.006	-0.140	0.103	0.123	0.081	-0.001	0.159	0.092	-0.062	-0.229	-0.064	1.000

表3

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