基层医院中糖尿病与心血管疾病共病现状与 影响因素分析

Analysis of the Current Situation and Influencing Factors of Comorbidity of Diabetes and Cardiovascular Disease in Primary Hospitals

摘要: 目的：探讨农村地区T2DM患者发生主要不良心血管事件(MACE)的危险因素。方法：采用真实世界观察性研究，纳入488名农村T2DM患者，收集基线资料并随访2年，通过多因素Cox回归分析以识别MACE的危险因素。结果：2年随访期间，51.64%的患者发生MACE，其中基线有MACE病史的患者复发率为73.56%，无MACE病史的患者新发率为39.49%。多因素分析显示，病程、糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)达标率、同型半胱氨酸(HCY)、尿微量白蛋白(MAU)、尿白蛋白/肌酐比值(UACR)和空腹胰岛素(FINS)是MACE的独立危险因素。新型降糖药物使用率低，且与MACE风险增加相关。结论：T2DM病程、血糖控制不佳及肾损害是MACE的重要危险因素。基层医院应推广具有心血管保护作用的降糖药物，以降低MACE风险。

Abstract: Objective: To explore the risk factors for major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) in rural areas. Methods: A real-world observational study was conducted, enrolling 488 rural T2DM patients. Baseline data were collected, and participants were followed for 2 years. Multivariate Cox regression analysis was performed to identify risk factors for MACE. Results: During the 2-year follow-up, 51.64% of patients developed MACE, with a recurrence rate of 73.56% in those with a baseline history of MACE and an incidence rate of 39.49% in those without prior MACE. Multivariate analysis revealed that disease duration, glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C) compliance rate, homocysteine (HCY), urinary microalbumin (MAU), urinary albumin-to-creatinine ratio (UACR), and fasting insulin (FINS) were independent risk factors for MACE. Novel hypoglycemic agents exhibited low utilization rates and were associated with an increased risk of MACE. Conclusion: Prolonged T2DM duration, poor glycemic control, and renal impairment are critical risk factors for MACE. Primary hospitals should promote the use of hypoglycemic agents with cardiovascular protective effects to mitigate MACE risk.