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Article(id=1241023937635742411, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409489, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1727193600000, receivedDateStr=2024-09-25, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812763841, onlineDateStr=2026-03-18, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812763841, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812763841, creator=13701087609, updateTime=1773812763841, updator=13701087609, issue=Issue{id=1241023927812682133, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812761500, creator=13701087609, updateTime=1773812858867, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241024336258200259, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241024336258200260, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=392, endPage=397, ext={EN=ArticleExt(id=1241023938394911458, articleId=1241023937635742411, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between baseline blood pressure levels in type 2 diabetic population and the risk of stroke-related death, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the association between blood pressure levels and the risk of stroke-related death in type 2 diabetic population.

Methods

A survey was carried out on 9 708 type 2 diabetic patients who participated in the chronic disease patient health management of basic public health services in Huai’an District and Qing jiang pu District (former Qing he District) of Huai’an city. Multivariate proportional-hazards Cox regression analysis was used to analyze the association between blood pressure levels and the risk of stroke-related death in type 2 diabetic patients, and further stratified analysis was carried out according to smoking, body mass index (BMI), central obesity, and dyslipidemia respectively. The follow-up duration was calculated from December 31, 2013 to December 31, 2020, and death from stroke (I60-I69) was defined as the end-point event.

Results

The follow-up duration was 63 833.8 person-years, and the stroke death density was 5.4 per 1 000 person-years. After adjusting for relevant confounding factors, taking the normal blood pressure group as the reference, the HR value of the stroke-related death risk in the grade III hypertension group was 4.45 (95%CI: 2.09-9.48). The stratified analysis results showed that compared with the normal blood pressure group, among smokers, those with BMI ≥ 24.0 kg/m2, those with central obesity, and those with dyslipidemia, the stroke-related death risks in the grade III hypertension group increased by 3.12 (HR=4.12, 95%CI:1.16-14.67), 1.97 (HR=2.97, 95%CI: 1.26-7.00), 3.19 (HR=4.19, 95%CI: 1.27-13.86), and 5.49 (HR=6.49, 95%CI: 1.97-21.43) times, respectively. Sensitivity analysis was carried out by excluding the baseline stroke patients, participants who died in the first year of follow-up, and those over 80 years old, and a significant positive relationship between blood pressure levels and the risk of stroke-related death was found.

Conclusion

Elevated blood pressure levels will increase the risk of stroke-related death in type 2 diabetic patients, and there is a positive relationship between blood pressure levels and the risk of death. Among type 2 diabetic patients, those with low BMI have a higher risk of stroke-related death than those with high BMI.

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目的

探讨2型糖尿病人群的血压水平与脑卒中死亡风险的关联。

方法

对9 708例淮安市淮安区和清江浦区（原清河区）参与基本公共卫生服务慢性病患者健康管理的2型糖尿病患者开展调查，采用多因素比例风险Cox回归分析血压水平与2型糖尿病患者的脑卒中死亡风险关联，并进一步按吸烟、体质指数、中心性肥胖、血脂异常分别进行分层分析。自2013年12月31日—2020年12月31日计算随访时长，以脑卒中（I60-I69）死亡定义为终点事件。

结果

随访时长63 833.8人年，脑卒中死亡密度为5.4/1 000人年。调整相关的混杂因素后，以正常血压组为参照，Ⅲ级高血压组的脑卒中死亡风险的HR值为4.45（95%CI：2.09～9.48）。分层分析结果发现，同正常血压组相比，吸烟、体质指数≥24.0 kg/m2、中心性肥胖、血脂异常者中，Ⅲ级高血压组的脑卒中死亡风险分别增加3.12（HR=4.12，95%CI：1.16～14.67）、1.97（HR=2.97，95%CI：1.26～7.00）、3.19（HR=4.19，95%CI：1.27～13.86）和5.49（HR=6.49，95%CI：1.97～21.43）倍。排除基线患者脑卒中人群、随访第1年死亡人群及80岁以上人群进行敏感性分析发现，血压水平与脑卒中死亡风险均呈现明显正向关系。

结论

血压水平升高会增加2型糖尿病患者的脑卒中死亡风险，且血压水平与死亡风险呈正向关系。 2型糖尿病患者中，低体质指数者发生的脑卒中死亡风险高于高体质指数者。

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张芹，E-mail:
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梅冬蒙与刘景为共同第一作者

梅冬蒙（1996—）女，硕士，医师，研究方向：慢性病预防与控制；

刘景（1997—）女，本科，医师，研究方向：慢性病预防与控制；

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梅冬蒙（1996—）女，硕士，医师，研究方向：慢性病预防与控制；

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梅冬蒙（1996—）女，硕士，医师，研究方向：慢性病预防与控制；

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刘景（1997—）女，本科，医师，研究方向：慢性病预防与控制；

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Estimating lead-time bias in lung cancer diagnosis of patients with previous cancers[J].Medicine Statistics, 2018, 37(16): 2516-2529., articleTitle=Estimating lead-time bias in lung cancer diagnosis of patients with previous cancers, refAbstract=null)], funds=[Fund(id=1241023948213776765, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, awardId=71974101, language=CN, fundingSource=国家自然科学基金面上项目(71974101), fundOrder=null, country=null), Fund(id=1241023948306051461, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, awardId=K201105, language=CN, fundingSource=江苏省卫生厅医学创新团队科技项目(K201105), fundOrder=null, country=null), Fund(id=1241023948427686287, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, awardId=HAWJ201924, language=CN, fundingSource=淮安市卫生健康科研项目(HAWJ201924), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241023940856968023, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, xref=1., ext=[AuthorCompanyExt(id=1241023940861162328, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, companyId=1241023940856968023, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Huai’an Center for Disease Control and Prevention, Huai’an, Jiangsu 223001, China), AuthorCompanyExt(id=1241023940869550937, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, companyId=1241023940856968023, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.淮安市疾病预防控制中心，江苏 淮安 223001)]), AuthorCompany(id=1241023940974408545, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, xref=2., ext=[AuthorCompanyExt(id=1241023940991185761, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, companyId=1241023940974408545, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.南京医科大学公共卫生学院)])], figs=[ArticleFig(id=1241023947186172203, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, language=EN, label=Figure 1, caption=Sensitivity analysis of blood pressure level and risk of stroke mortality, figureFileSmall=EiPqE76Ola4dRMeB/NrGGg==, figureFileBig=+66RyZF9QuOn4RRTnSkksw==, tableContent=null), ArticleFig(id=1241023947278446900, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, language=CN, label=图1, caption=血压水平与脑卒中死亡关系的敏感性分析

注：调整性别、年龄、吸烟、饮酒、身体活动、病程、BMI、中心性肥胖、血脂异常、脑卒中史、脑卒中家族史。

, figureFileSmall=EiPqE76Ola4dRMeB/NrGGg==, figureFileBig=+66RyZF9QuOn4RRTnSkksw==, tableContent=null), ArticleFig(id=1241023947525910860, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, language=EN, label=Table 1, caption=

Baseline characteristics of research participants (），M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征正常血压正常高值Ⅰ级高血压Ⅱ级高血压Ⅲ级高血压合计F/H/χ2值P值
例数7403 1003 4251 7137309 708
男性249(33.6)1 164(37.5)1 398(40.8)618(36.1)241(33.0)3 670(37.8)28<0.001
年龄(岁)57.0±11.459.9±10.462.5±9.463.6±9.264.3±9.661.6±10.1100.9<0.001
吸烟197(26.6)772(24.9)834(24.4)394(23.0)164(22.5)2 361(24.3)5.70.224
饮酒97(13.1)501(16.2)636(18.6)305(17.8)113(15.5)1 652(17.0)17.50.002
身体活动(MET-h/d)8.7(4.0,17.1)8.0(3.7,16.0)8.0(3.5,16.0)8.0(4.0,16.0)8.0(3.7,14.0)8.0(3.8,16.0)11.20.024
体重指数(kg/m2)23.8±3.125.5±3.526.2±3.626.6±3.626.8±3.825.9±3.6108.4<0.001
病程（年）3.0(1.0,7.0)4.0(1.0,7.0)3.0(1.0,7.0)3.0(1.0,7.0)3.0(1.0,7.0)3.5(1.0,7.0)4.40.357
HbA1c(mmol/L)7.9±2.67.8±2.17.8±1.97.8±1.97.8±2.07.8±2.00.70.603
脑卒中家族史63(8.5)259(8.4)291(8.5)160(9.3)61(8.4)834(8.6)1.50.819
中心性肥胖234(31.6)1 496(48.3)1 812(52.9)1 015(59.3)443(60.7)5 000(51.5)198.7<0.001
血脂异常316(42.7)1 555(50.2)1 850(54.0)999(58.3)426(58.4)5 146(53.0)70.8<0.001
脑卒中史51(6.9)302(9.7)484(14.1)292(17.0)134(18.4)1 263(13.0)100.6<0.001
), ArticleFig(id=1241023947609796947, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, language=CN, label=表1, caption=

研究对象的基线特征［n（%）()，M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征正常血压正常高值Ⅰ级高血压Ⅱ级高血压Ⅲ级高血压合计F/H/χ2值P值
例数7403 1003 4251 7137309 708
男性249(33.6)1 164(37.5)1 398(40.8)618(36.1)241(33.0)3 670(37.8)28<0.001
年龄(岁)57.0±11.459.9±10.462.5±9.463.6±9.264.3±9.661.6±10.1100.9<0.001
吸烟197(26.6)772(24.9)834(24.4)394(23.0)164(22.5)2 361(24.3)5.70.224
饮酒97(13.1)501(16.2)636(18.6)305(17.8)113(15.5)1 652(17.0)17.50.002
身体活动(MET-h/d)8.7(4.0,17.1)8.0(3.7,16.0)8.0(3.5,16.0)8.0(4.0,16.0)8.0(3.7,14.0)8.0(3.8,16.0)11.20.024
体重指数(kg/m2)23.8±3.125.5±3.526.2±3.626.6±3.626.8±3.825.9±3.6108.4<0.001
病程（年）3.0(1.0,7.0)4.0(1.0,7.0)3.0(1.0,7.0)3.0(1.0,7.0)3.0(1.0,7.0)3.5(1.0,7.0)4.40.357
HbA1c(mmol/L)7.9±2.67.8±2.17.8±1.97.8±1.97.8±2.07.8±2.00.70.603
脑卒中家族史63(8.5)259(8.4)291(8.5)160(9.3)61(8.4)834(8.6)1.50.819
中心性肥胖234(31.6)1 496(48.3)1 812(52.9)1 015(59.3)443(60.7)5 000(51.5)198.7<0.001
血脂异常316(42.7)1 555(50.2)1 850(54.0)999(58.3)426(58.4)5 146(53.0)70.8<0.001
脑卒中史51(6.9)302(9.7)484(14.1)292(17.0)134(18.4)1 263(13.0)100.6<0.001
), ArticleFig(id=1241023947752403289, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, language=EN, label=Table 2, caption=

Cox regression analysis of blood pressure level and risk of stroke mortality

, figureFileSmall=null, figureFileBig=null, tableContent=
基线血压水平随访人年脑卒中死亡人数脑卒中死亡密度
（1/1 000人年）		HR（95%CI）值
模型1a模型2b模型3c
正常血压4 884122.51.001.001.00
正常高值20 620753.61.48 (0.80～2.72)1.29 (0.61～2.72)1.26(0.60～2.66)
Ⅰ级高血压22 5631215.42.19 (1.21～3.96)1.52 (0.73～3.15)1.46(0.70～3.04)
Ⅱ级高血压11 218706.22.55 (1.38～4.70)2.01 (0.96～4.24)1.81(0.86～3.85)
Ⅲ级高血压4 5496614.55.97 (3.23～11.05)4.58 (2.28～9.68)4.45(2.09～9.48)
P趋势值<0.001<0.001<0.001
), ArticleFig(id=1241023947886621026, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, language=CN, label=表2, caption=

血压水平与脑卒中死亡风险的Cox回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
基线血压水平随访人年脑卒中死亡人数脑卒中死亡密度
（1/1 000人年）		HR（95%CI）值
模型1a模型2b模型3c
正常血压4 884122.51.001.001.00
正常高值20 620753.61.48 (0.80～2.72)1.29 (0.61～2.72)1.26(0.60～2.66)
Ⅰ级高血压22 5631215.42.19 (1.21～3.96)1.52 (0.73～3.15)1.46(0.70～3.04)
Ⅱ级高血压11 218706.22.55 (1.38～4.70)2.01 (0.96～4.24)1.81(0.86～3.85)
Ⅲ级高血压4 5496614.55.97 (3.23～11.05)4.58 (2.28～9.68)4.45(2.09～9.48)
P趋势值<0.001<0.001<0.001
), ArticleFig(id=1241023947978895723, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, language=EN, label=Table 3, caption=

Cox regression stratified analysis of blood pressure level and risk of stroke mortality

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组随访人年脑卒中死亡人数HR（95%CI）值交互作用P值
正常血压正常高值Ⅰ级高血压Ⅱ级高血压Ⅲ级高血压
吸烟0.179
是15 3611031.001.65 (0.49～5.58)1.38 (0.41～4.66)1.60 (0.45～5.65)4.12 (1.16～14.67)
否48 4722411.001.05 (0.41～2.73)1.48 (0.59～3.72)1.88 (0.73～4.82)4.65 (1.81～11.98)
BMI(kg/m2)0.252
≥24.044 9882361.000.71 (0.29～1.70)0.83 (0.35～1.93)1.09 (0.46～2.57)2.97 (1.26～7.00)
<24.018 8451081.003.09 (0.72～13.22)3.59 (0.85～15.18)4.23 (0.96～18.77)5.77 (1.19～28.06)
中心性肥胖0.870
是33 0111911.001.25 (0.38～4.13)1.59 (0.49～5.14)1.71 (0.52～5.62)4.19 (1.27～13.86)
否30 8221531.001.37 (0.52～3.60)1.42 (0.55～3.69)2.16 (0.80～5.80)2.17 (1.91～13.99)
血脂异常0.435
是33 9652001.001.81 (0.55～5.92)1.62 (0.50～5.30)2.30 (0.70～7.59)6.49 (1.97～21.43)
否29 8681441.000.90 (0.34～2.40)1.41 (0.55～3.62)1.54 (0.57～4.16)3.06 (1.12～8.39)
), ArticleFig(id=1241023948079559026, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937635742411, language=CN, label=表3, caption=

血压水平与脑卒中死亡风险的Cox回归分层分析

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组随访人年脑卒中死亡人数HR（95%CI）值交互作用P值
正常血压正常高值Ⅰ级高血压Ⅱ级高血压Ⅲ级高血压
吸烟0.179
是15 3611031.001.65 (0.49～5.58)1.38 (0.41～4.66)1.60 (0.45～5.65)4.12 (1.16～14.67)
否48 4722411.001.05 (0.41～2.73)1.48 (0.59～3.72)1.88 (0.73～4.82)4.65 (1.81～11.98)
BMI(kg/m2)0.252
≥24.044 9882361.000.71 (0.29～1.70)0.83 (0.35～1.93)1.09 (0.46～2.57)2.97 (1.26～7.00)
<24.018 8451081.003.09 (0.72～13.22)3.59 (0.85～15.18)4.23 (0.96～18.77)5.77 (1.19～28.06)
中心性肥胖0.870
是33 0111911.001.25 (0.38～4.13)1.59 (0.49～5.14)1.71 (0.52～5.62)4.19 (1.27～13.86)
否30 8221531.001.37 (0.52～3.60)1.42 (0.55～3.69)2.16 (0.80～5.80)2.17 (1.91～13.99)
血脂异常0.435
是33 9652001.001.81 (0.55～5.92)1.62 (0.50～5.30)2.30 (0.70～7.59)6.49 (1.97～21.43)
否29 8681441.000.90 (0.34～2.40)1.41 (0.55～3.62)1.54 (0.57～4.16)3.06 (1.12～8.39)
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2型糖尿病人群基线血压水平与脑卒中死亡风险关系
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梅冬蒙 1 , 刘景 1 , 缪丹丹 1 , 潘恩春 1 , 沈欢 1 , 文进博 1 , 赵倩 1 , 李殿江 2 , 孙中明 1 , 张芹 1
现代预防医学 | 流行病与统计方法 2025,52(3): 392-397
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现代预防医学 | 流行病与统计方法 2025, 52(3): 392-397
2型糖尿病人群基线血压水平与脑卒中死亡风险关系
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梅冬蒙1, 刘景1, 缪丹丹1, 潘恩春1, 沈欢1, 文进博1, 赵倩1, 李殿江2, 孙中明1, 张芹1
作者信息
  • 1.淮安市疾病预防控制中心，江苏 淮安 223001
  • 2.南京医科大学公共卫生学院

    • 梅冬蒙（1996—）女，硕士，医师，研究方向：慢性病预防与控制；

    刘景（1997—）女，本科，医师，研究方向：慢性病预防与控制；

通讯作者:

张芹，E-mail:
Relationship between baseline blood pressure levels in type 2 diabetic population and the risk of stroke-related death
Dong-meng MEI1, Jing LIU1, Dan-dan MIAO1, En-chun PAN1, Huan SHEN1, Jin-bo WEN1, Qian ZHAO1, Dian-jiang LI2, Zhong-ming SUN1, Qin ZHANG1
Affiliations
  • Huai’an Center for Disease Control and Prevention, Huai’an, Jiangsu 223001, China
出版时间: 2025-02-10 doi: 10.20043/j.cnki.MPM.202409489
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摘要
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目的

探讨2型糖尿病人群的血压水平与脑卒中死亡风险的关联。

方法

对9 708例淮安市淮安区和清江浦区（原清河区）参与基本公共卫生服务慢性病患者健康管理的2型糖尿病患者开展调查，采用多因素比例风险Cox回归分析血压水平与2型糖尿病患者的脑卒中死亡风险关联，并进一步按吸烟、体质指数、中心性肥胖、血脂异常分别进行分层分析。自2013年12月31日—2020年12月31日计算随访时长，以脑卒中（I60-I69）死亡定义为终点事件。

结果

随访时长63 833.8人年，脑卒中死亡密度为5.4/1 000人年。调整相关的混杂因素后，以正常血压组为参照，Ⅲ级高血压组的脑卒中死亡风险的HR值为4.45（95%CI：2.09～9.48）。分层分析结果发现，同正常血压组相比，吸烟、体质指数≥24.0 kg/m2、中心性肥胖、血脂异常者中，Ⅲ级高血压组的脑卒中死亡风险分别增加3.12（HR=4.12，95%CI：1.16～14.67）、1.97（HR=2.97，95%CI：1.26～7.00）、3.19（HR=4.19，95%CI：1.27～13.86）和5.49（HR=6.49，95%CI：1.97～21.43）倍。排除基线患者脑卒中人群、随访第1年死亡人群及80岁以上人群进行敏感性分析发现，血压水平与脑卒中死亡风险均呈现明显正向关系。

结论

血压水平升高会增加2型糖尿病患者的脑卒中死亡风险，且血压水平与死亡风险呈正向关系。 2型糖尿病患者中，低体质指数者发生的脑卒中死亡风险高于高体质指数者。

2型糖尿病  /  血压水平  /  脑卒中死亡风险  /  观察性研究
Objective

To explore the association between blood pressure levels and the risk of stroke-related death in type 2 diabetic population.

Methods

A survey was carried out on 9 708 type 2 diabetic patients who participated in the chronic disease patient health management of basic public health services in Huai’an District and Qing jiang pu District (former Qing he District) of Huai’an city. Multivariate proportional-hazards Cox regression analysis was used to analyze the association between blood pressure levels and the risk of stroke-related death in type 2 diabetic patients, and further stratified analysis was carried out according to smoking, body mass index (BMI), central obesity, and dyslipidemia respectively. The follow-up duration was calculated from December 31, 2013 to December 31, 2020, and death from stroke (I60-I69) was defined as the end-point event.

Results

The follow-up duration was 63 833.8 person-years, and the stroke death density was 5.4 per 1 000 person-years. After adjusting for relevant confounding factors, taking the normal blood pressure group as the reference, the HR value of the stroke-related death risk in the grade III hypertension group was 4.45 (95%CI: 2.09-9.48). The stratified analysis results showed that compared with the normal blood pressure group, among smokers, those with BMI ≥ 24.0 kg/m2, those with central obesity, and those with dyslipidemia, the stroke-related death risks in the grade III hypertension group increased by 3.12 (HR=4.12, 95%CI:1.16-14.67), 1.97 (HR=2.97, 95%CI: 1.26-7.00), 3.19 (HR=4.19, 95%CI: 1.27-13.86), and 5.49 (HR=6.49, 95%CI: 1.97-21.43) times, respectively. Sensitivity analysis was carried out by excluding the baseline stroke patients, participants who died in the first year of follow-up, and those over 80 years old, and a significant positive relationship between blood pressure levels and the risk of stroke-related death was found.

Conclusion

Elevated blood pressure levels will increase the risk of stroke-related death in type 2 diabetic patients, and there is a positive relationship between blood pressure levels and the risk of death. Among type 2 diabetic patients, those with low BMI have a higher risk of stroke-related death than those with high BMI.

Type 2 diabetes  /  Blood pressure levels  /  Risk of stroke-related death  /  Observational study
梅冬蒙, 刘景, 缪丹丹, 潘恩春, 沈欢, 文进博, 赵倩, 李殿江, 孙中明, 张芹. 2型糖尿病人群基线血压水平与脑卒中死亡风险关系. 现代预防医学, 2025 , 52 (3) : 392 -397 . DOI: 10.20043/j.cnki.MPM.202409489
Dong-meng MEI, Jing LIU, Dan-dan MIAO, En-chun PAN, Huan SHEN, Jin-bo WEN, Qian ZHAO, Dian-jiang LI, Zhong-ming SUN, Qin ZHANG. Relationship between baseline blood pressure levels in type 2 diabetic population and the risk of stroke-related death[J]. Modern Preventive Medicine, 2025 , 52 (3) : 392 -397 . DOI: 10.20043/j.cnki.MPM.202409489
正文
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我国成人糖尿病患病率已高达12.4%，成为威胁居民生命与健康的重大慢性病[1]。心血管病是导致糖尿病患者伤残、死亡的主要病因，且我国人群中心血管疾病特点与欧美不同，主要表现脑卒中发病率、死亡率均相对较高[2-3]。高血压作为糖尿病患者的常见合并症[4-5]，也是脑卒中的首要危险因素，增加糖尿病患者脑卒中的发病和死亡风险[6]。但既往研究主要来源于欧美、日本等国家[7-10]，对中国等发展中国家的指导性不足。本研究利用江苏省“基于社区管理的2型糖尿病队列随访研究”数据，探究2型糖尿病患者基线血压水平与脑卒中死亡风险的关联。
1　对象与方法
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1.1　研究对象
参与基本公共卫生服务慢性病患者健康管理的2型糖尿病患者。使用随机整群抽样方法，在淮安市淮安区和清江浦区（原清河区）33个街道/乡镇中抽取26个，对2013年12月—2014年1月参与基本公共卫生服务慢性病患者健康管理的12 717名2型糖尿病患者开展基线调查，排除没有参加意愿、身体状况较差等不能参与调查的患者，实际完成调查9 806例，患者参与度为77.11%。排除因房屋拆迁、外出务工等原因以及基线血压及其他需纳入分析的关键变量缺失者98例，最终纳入分析9 708例。
1.2　内容和方法
问卷调查方面包括人口学特征、行为及生活方式、病史和用药史等内容。体格检查方面包括身高、体重、腰围、血压等多个指标的测量，并计算体质指数（body mass index, BMI）。实验室检测方面收集调查对象的空腹静脉血，检测糖化血红蛋白（haemoglobinA1c，HbA1c）、总胆固醇、甘油三酯等指标进行检测，具体调查质控、测量方法及所使用的仪器设备具体见本课题组已发表文献[11-12]。
1.3　诊断标准和相关定义
（1）血压分类：根据《中国高血压防治指南（2018修订版）》[13]分为5个血压水平，分别为正常血压（收缩压<120 mm Hg且舒张压<80 mm Hg）、正常高值（收缩压120～139 mm Hg和/或舒张压80～89 mm Hg）、Ⅰ级高血压（收缩压140～159 mm Hg或舒张压90～99 mm Hg）、Ⅱ级高血压（收缩压160～179 mm Hg或舒张压100～109 mm Hg）和Ⅲ级高血压（收缩压≥180 mm Hg或舒张压≥110 mm Hg）。（2）中心性肥胖：男性腰围≥90 cm，女性腰围≥85 cm[14]。（3）吸烟：累积吸过香烟至少100支，调查时仍存在吸烟行为，记为吸烟。（4）饮酒：平均每月饮酒≥1次，调查时仍有饮酒行为，记为饮酒。（5）体力活动：根据患者全天进行体力活动的类型、分级和时长，将其折算为代谢当量（metabolic equivalent，MET-h /d），对各类体力活动赋值如下：高、中、轻等强度体力活动的代谢当量分别记为8、4和1.5 MET，静息行为和睡眠的代谢当量分别记为1.1和1 MET[15-16]。（6）脑卒中史：在基线调查开始前已经被社区/乡镇及以上医院确诊。（7）病程：首次诊断患糖尿病日期为开始时间，基线调查日期为结束时间，计算两个日期的时间间隔记为病程。（8）其他：2型糖尿病、血脂异常等诊断标准均参照我国相关疾病防治指南[17-18]。（9）随访时间：死亡者随访时间自2013年12月31日至实际死亡日期，存活者随访时间自2013年12月31日—2020年12月31日。
1.4　死亡信息收集
死亡数据来源于江苏省慢性病管理信息系统，死亡日期查询截至2020年12月31日。全部的死亡个案均有死亡卡责任报告单位规范开具的死亡医学证明书，报卡人员及时进行网络直报，由市、县（区）两级疾控中心质控审核，严格按照江苏省死亡卡报告流程规范执行，保证死亡数据的完整、准确和可靠，死因分类和编码使用国际疾病分类第10版，本研究终点定义为脑卒中（I60-I69）死亡。
1.5　统计学方法
通过Excel 2007创建数据库，所有统计分析均采用SPSS 20.0。计数资料使用百分比［n（%）］进行描述，χ2检验分析组间差异；正态分布的连续性资料以（均数±标准差）进行描述，单因素方差分析比较组间差异；非正态分布的连续性资料使用四分间距［M（P25，P75）］进行描述，并通过Kruskal-Wallis H检验来分析组间差异。死亡密度等于死亡人数除以随访人年。不同血压水平糖尿病患者脑卒中的死亡风险（hazard ratio，HR）利用Cox回归分析获取。检验水准α=0.05。
2　结果
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2.1　研究对象基线特征
9 708例2型糖尿病患者平均年龄（61.6±10.1）岁，其中男性3 670例，占37.8%。不同血压水平在性别、年龄、饮酒、身体活动、BMI、中心性肥胖、血脂异常和脑卒中史中有明显差异（均P<0.05），见表1。
2.2　多因素比例风险Cox回归分析
队列人群累积随访63 833.8人年，共出现脑卒中死亡344例，死亡密度为5.4/1 000人年。调整相关混杂因素（如性别、年龄、吸烟、饮酒、身体活动、病程、BMI、中心性肥胖、HbA1c、血脂异常、脑卒中史和脑卒中家族史）后，以正常血压组为参照，Ⅲ级高血压组的脑卒中死亡风险增加3.45倍（HR=4.45，95%CI：2.09～9.48）。见表2。
2.3　分层分析
按照吸烟、BMI、中心性肥胖、血脂异常分别进行分层分析。调整其他混杂因素后，在吸烟、中心性肥胖、血脂异常的人群中的结果显示，以正常血压组为参照，Ⅲ级高血压组的脑卒中死亡风险增加3.12（HR=4.12，95%CI：1.16～14.67）、3.19（HR= 4.19，95%CI：1.27～13.86）和5.49（HR=6.49，95%CI：1.97～21.43）倍；在BMI≥24.0 kg/m2患者中，Ⅲ级高血压组的脑卒中死亡风险增加1.97（HR= 2.97，95%CI：1.26～7.00）倍；BMI<24.0 kg/m2患者中，Ⅲ级高血压组的脑卒中死亡风险上升4.77倍（HR=5.77，95%CI：1.19～28.06）。见表3。
2.4　敏感性分析
控制可能的混杂因素后，各血压亚组的脑卒中死亡风险在全人群与排除基线患脑卒中、排除随访第1年死亡、排除80岁以上人群后结果均无改变，提示结果稳定。见图1。
3　讨论
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本研究结果发现，对相关混杂因素进行调整后，血压水平升高会增加2型糖尿病患者的脑卒中死亡风险，相比于血压正常者，正常高值、Ⅰ型、Ⅱ型和Ⅲ型高血压者的脑卒中死亡风险分别增加26%、46%、81%、345%。此外，排除基线患者脑卒中人群、随访第1年死亡人群及80岁以上人群的敏感性分析结果均显示，血压水平与脑卒中死亡风险均呈现明显正向关系，表明本研究得出较为稳定性的结论。
共患高血压是2型糖尿病患者的主要特征，相关调查性研究指出，在我国，70%以上的糖尿病患者共存高血压、血脂异常等心脑血管疾病的高危因素[19-20]，本研究纳入分析的9 708例2型糖尿病患者中，仅有740例患者血压处于正常水平，60.44%患者为Ⅰ～Ⅲ型高血压，本研究结果与全国性调查结果基本一致。目前，我国高血压人群最主要的心血管风险仍是脑卒中，研究证实，收缩压每下降10 mm Hg或者舒张压每下降5 mm Hg，脑卒中发生率平均减少41%[13,21-24]。高血压预防、检测、评估和治疗联合全国委员会在2003年第7份报告中就已建议收缩压≥130 mm Hg的2型糖尿病患者开始药物治疗[25]。大量研究表明，控制血压水平可以有效的预防或者减轻2型糖尿病人群发生心血管疾病的风险[26-28]。另外，有研究者对2型糖尿病人群进行血压控制试验，将收缩压水平降低至120 mm Hg以下，虽然对心血管结局和全因死亡率影响并不显著，但会显著降低脑卒中的发生率[29]。一项针对我国北方老年高血压人群的研究显示，收缩压处于130～140 mm Hg将有利于降低脑卒中和心肌梗死事件的发生风险，而当收缩压<120 mm Hg时，脑卒中和心肌梗死发生风险不降反增[30]。提示在临床实践中，对老年高血压患者血压控制应有适度要求。
分层分析结果发现，在2型糖尿病患者中，BMI≥24.0 kg/m2对Ⅲ级高血压者脑卒中死亡风险增加1.97倍，而当BMI<24 kg/m2时脑卒中死亡风险则增加4.77倍。目前，多数学者将“低BMI与心血管疾病死亡的高风险相关”的说法称为“肥胖悖论”[31-34]。有研究提出在外周或冠状动脉疾病患者中，BMI与心血管死亡率呈负相关[35]，高BMI脑卒中患者的存活率明显高于体重正常者[36]。Wolfram Doehner[37]在有心血管合并症的2型糖尿病患者中发现，超重和肥胖患者的死亡率低于正常体重者。氨基末端B型钠尿肽前体（NH2-terminal pro-B-type natriuretic peptide，NT-Pro-BNP）作为急慢性心血管病患者死亡率的预测因子，尤其是在心力衰竭、冠心病、高血压、糖尿病等疾病的诊断、危险分级及预后评估等方面取得了显著成效，Antigone Oreopoulos医生[38]团队在研究指出，低BMI的慢性心力衰竭患者NT-Pro-BNP水平更低。另外，肥胖的2型糖尿病患者机能较差，一旦出现相对较小的心血管系统障碍，身体反应会很强烈，所以，相比于BMI较小者，肥胖的患者更倾向于在更早期被诊断出心血管疾病[39-41]。
本研究也存在相对较短的随访时间、不能充分排除混杂因素、危险因素在观察期间不可控等问题。
综上所述，本研究认为血压水平升高会增加2型糖尿病患者的脑卒中死亡风险，且血压水平与脑卒中死亡风险呈正向关系。低BMI导致2型糖尿病患者发生的脑卒中死亡风险高于高BMI。在2型糖尿病患者随访管理相关工作中，应将患者血压有效控制在理想范围。
基金
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  • 国家自然科学基金面上项目(71974101)
  • 江苏省卫生厅医学创新团队科技项目(K201105)
  • 淮安市卫生健康科研项目(HAWJ201924)
文献
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2025年第52卷第3期
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doi: 10.20043/j.cnki.MPM.202409489
  • 接收时间：2024-09-25
  • 首发时间：2026-03-18
  • 出版时间：2025-02-10
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  • 收稿日期：2024-09-25
基金
国家自然科学基金面上项目(71974101)
江苏省卫生厅医学创新团队科技项目(K201105)
淮安市卫生健康科研项目(HAWJ201924)
作者信息
    1.淮安市疾病预防控制中心，江苏 淮安 223001
    2.南京医科大学公共卫生学院

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