中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (12): 969-974.doi: 10.3969/j.issn.1671-4091.2025.12.001

• 临床研究 •    下一篇

合并2型糖尿病的血液透析患者血糖控制水平与血压变异度的相关性及预后研究

尹 韬   李月红   温 雯   

  1. 102218 北京，1清华大学附属北京清华长庚医院肾脏内科
  • 收稿日期:2025-04-14 修回日期:2025-08-19 出版日期:2025-12-12 发布日期:2025-12-12
  • 通讯作者: 李月红 E-mail:lyha01051@btch.edu.cn

Correlation between glycemic control levels and blood pressure variability with prognosis in hemodialysis patients complicated with type 2 diabetes

YIN Tao, LI Yue-hong, WEN Wen   

  1. Department of Nephrology, Beijing Tsinghua Changgung Hospital affiliated to Tsinghua Universit, Beijing 102218, China
  • Received:2025-04-14 Revised:2025-08-19 Online:2025-12-12 Published:2025-12-12
  • Contact: 102218 北京，1清华大学附属北京清华长庚医院肾脏内科 E-mail:lyha01051@btch.edu.cn

摘要： 目的  探讨2型糖尿病(type 2 diabetes mellitus，T2DM)维持性血液透析(maintenance hemodialysis，MHD)患者血糖控制水平与血压变异度(blood pressure variability，BPV)的相关性，并分析不同糖化血红蛋白(hemoglobinA1c，HbA1c)分组患者的预后。 方法  回顾性分析2024年1月于北京清华长庚医院肾脏内科规律血液透析的T2DM患者的临床资料，按HbA1c水平分为3组：HbA1c＜7%，HbA1c 7%～8%，HbA1c＞8%。比较不同HbA1c水平患者的血压波动情况并探讨BPV的独立影响因素。2024年1月—2025年1月进行队列随访，分析1年随访期间HbA1c稳定患者的临床预后。 结果  共纳入70例T2DM血液透析患者，其中男性45例，女性25例，平均年龄(62.79±11.70)岁，中位透析龄52.94(30.25，68.75)月。HbA1c＜7%(n=33)、HbA1c 7%～8%(n=18)和HbA1c＞8%(n=19)组透析期血糖(H=19.259，P＜0.001)、血糖变异度(glycemic variability，GV)(H=15.291，P＜0.001)，透析期收缩压(H=11.253，    P=0.004)、收缩压变异度(systolic blood pressure variability，SBPV)(H=11.560，P=0.003)、预混胰岛素应用(χ²=7.412，P=0.025)、重度冠状动脉狭窄[冠状动脉病变报告和数据系统(coronary artery disease reporting and data system,CAD-RADS)冠状动脉分级≥4级](χ²=7.665，P=0.022)、脑梗死[美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分≥2分](χ²=7.084，P=0.029)等比较差异有统计学意义。SBPV与GV呈正相关(r=0.267，P=0.026)。Logistic回归显示HbA1c达标(HbA1c 7%～8%)(OR=0.147，95% CI：0.032～0.678，P=0.014)、透析龄(OR=1.040，95% CI：1.011～1.070，P=0.006)、心率变异性[主要指标全部窦性心搏RR间期(standard deviation of NN intervals，SDNN)](OR=0.975，95% CI：0.954～0.996，P=0.022)为影响SBPV的独立影响因素。随访1年，HbA1c分组未改变者(n=59)中HbA1c 7%～8%(n=12)的患者心脑血管不良事件发生率最低[与HbA1c＜7%(n=29)(χ²=-2.225，P=0.026)及HbA1c＞8%(n=18)组(χ²=-2.661，P=0.023)比较]，平均住院时间短[与HbA1c＜7%组(t=-2.921，P=0.026)比较]。 结论  T2DM血液透析患者血糖变异度与血压变异度呈正相关，透析期间GV大的患者BPV也大；HbA1c 7%～8%的患者预后较好，HbA1c达标、透析龄、SDNN为影响透析期SBPV的独立影响因素。

关键词: 2型糖尿病, 血液透析, 糖化血红蛋白, 血糖变异度, 血压变异度

Abstract: Correlation between glycemic control levels and blood pressure variability with prognosis in hemodialysis patients complicated with type 2 diabetes     YIN Tao1, LI Yue-hong1, WEN Wen1    1Department of Nephrology, Beijing Tsinghua Changgung Hospital affiliated to Tsinghua Universit, Beijing 102218, China
Corresponding author: LI Yue-hong, Email: lyha01051@btch.edu.cn
【Abstract】Objective  To investigate the relationship between blood pressure variability and blood pressure control in patients with type 2 diabetes mellitus (T2DM) undergoing maintenance hemodialysis (MHD). BPV), and to analyze the prognosis of patients with different glycosylated hemoglobin (HbA1c) groups.  Methods  The clinical data of T2DM patients with regular hemodialysis in the Department of Nephrology of Beijing Tsinghua Changgung Hospital from January 2024 were retrospectively analyzed. Patients were divided into three groups according to HbA1c levels: HbA1c < 7%, HbA1c7%～8%, and HbA1c > 8%. Blood pressure fluctuations were compared among the different HbA1c patients, and independent influencing factors of BPV were explored. A cohort follow-up study was conducted from January 2024 to January 2025 to compare and analyze the clinical prognosis of patients with stable HbA1c over the one-year follow-up period.  Results  A total of 70 T2DM patients on hemodialysis were enrolled, including 45 males and 25 females, with a mean age of (62.79±11.70) years and a median dialysis vintage of 52.94 (30.25, 68.75) months. Statistically significant differences were observed among the groups in dialysis blood glucose (H=19.259, P<0.001), glycemic variability (GV) (H=15.291, P<0.001), dialysis systolic blood pressure (H=11.253, P=0.004), systolic blood pressure variability (SBPV) (H=11.560, P=0.003), premix insulin use [(χ²=7.412, P=0.003). P=0.025], severe Coronary Artery stenosis (Coronary Artery Disease Reporting and Data System (CAD-RADS) ≥4) (χ²=7.665, P=0.022), cerebral infarction (National Institutes of Health Stroke Scale (NIHSS) score ≥2 points) (χ²=7.084, P=0.029) between the two groups were statistically significant. SBPV was positively correlated with GV (r=0.267, P=0.026). Logistic regression analysis showed that HbA1c (HbA1c7%～8%) (OR=0.147, 95% CI: 0.032～0.678, P=0.014), dialysis duration (OR=1.040, 95% CI: 1.011～1.070, P=0.006), standard deviation of NN intervals (SDNN) (OR=0.975, 95%CI: 0.954～0.996, P=0.022) were the independent influencing factors of SBPV. When comparing the groups defined by HbA1c (< 7%, 7%～8%, and >8%), patients with HbA1c 7%-8% had lower incidence of cardiovascular and cerebrovascular adverse events (χ²=7.500, P=0.024) and shorter average length of hospital stay (F=3.344, P=0.042).   Conclusion   There is a positive correlation between blood glucose variability and blood pressure variability in T2DM patients undergoing hemodialysis. Patients with larger GV during hemodialysis also have higher BPV. Patients with HbA1c levels 7%-8% have a better prognosis. HbA1c, dialysis age and SDNN are independent influencing factors for SBPV during dialysis.

Key words: Type 2 diabetes mellitus, Hemodialysis, Hemoglobin A1c, Glycemic variability, Blood pressure variability

中图分类号: