Abstract：Objective To evaluate the association between aortic arterial stiffness and target organ damage,including renal function decline and left ventricular diastolic dysfunction among elderly diabetic patients and to provide theoretical basis for early prevention and intervention. Methods Brachial-ankle-artery pulse wave velocity（baPWV）reflecting aortic arterial stiffness was observed in 151 diabetic patients with（n=78）or without hypertension（n=73）. Clinical data were collected,cardiac structure and function were assessed by echocardiography. Estimated glomerular filtration rate（eGFR）was calculated by CKD-EPI fomula. Results Of 151 subjects,the average age was（75.05±10.13）years and the average baPWV values was（1 803.85±491.04）mm/s. Patients with both diabetes and hypertension had significantly higher baPWV values[（2006.49±536.70）mm/s]than that of diabetic patients[（1596.96±331.02）mm/s,P<0.01]. Multiple linear regression analysis demonstrated that baPWV was negatively associated with E/A ratio and eGFR（β'=-0.249,-0.225,P<0.05）,but positively associated with hypertension（β'=2.008,P<0.05）. By applying area under the receiver operator characteristic curve,baPWV had powerful predictive power for renal impairment（AUC=0.695,95%CI：0.548-0.842）and left ventricular diastolic dysfunction （AUC=0.687,95%CI：0.532-0.842）. Conclusion Patients with both diabetes and hypertension had significantly higher baPWV values than that of diabetic patients. Higher baPWV was independently associated with greater burden of sub-clinical disease in renal impairment and left ventricular diastolic dysfunction.
[1] BRAGG F,HOLMES M V,IONA A,et al. Association between diabetes and cause-specific mortality in rural and urban areas of China[J]. JAMA,2017,317（3）：280-289. [2] BRUNSTRÖM M,CARLBERG B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus：systematic review and meta-analyses[J]. BMJ,2016, 352：i717. [3] 纪峰. 中国成人心血管疾病危险因素的流行病学研究[D]. 北京：北京协和医学院,2011. [4] CARDOSO C,SALLES G. Aortic stiffness as a surrogate endpoint to micro- and macrovascular complications in patients with type 2 diabetes[J]. International Journal of Molecular Sciences,2016, 17（12）：2044. [5] 刘东升,蔡定军,庄恒成. 2型糖尿病及血脂与颈动脉硬化的关系研究[J]. 浙江预防医学,2014,26（7）：671-674. [6] 陶萍华,吕晓玲,叶雄伟,等. 体检人群血浆致动脉硬化指数及超敏C反应蛋白与血糖水平的关系研究[J]. 浙江预防医学,2014,26（5）：463-466. [7] MUNAKATA M. Brachial-ankle pulse wave velocity：background,method,and clinical evidence[J]. Pulse （Basel）, 2016,3（3-4）：195-204. [8] 仲恒,徐丽梅. 脉搏波传导速度的临床应用研究进展[J]. 解放军医药杂志,2015,27（9）：53-56. [9] 岳洪峰,张长群. 脉搏波传导速度的临床应用价值及研究进展[J]. 实用心脑肺血管病杂志,2014,22（8）：4-6. [10] JI E,KIM Y S. Prevalence of chronic kidney disease defined by using CKD-EPI equation and albumin-to-creatinine ratio in the Korean adult population[J]. Korean J Intern Med,2016,31（6）：1120-1130. [11] NAGUEH S F,SMISETH O A,APPLETON C P,et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography：An update from the American society of echocardiography and the European Association of Cardiovascular Imaging[J]. European Heart Journal Cardiovascular Imaging,2016,29（4）：277-314. [12] 欧映伟,隋志敏,冯林,等. 老年人糖化血红蛋白与脉搏波传导速度的相关性[J]. 中国老年学杂志,2013,33（18）：4570- 4571. [13] SHAN Y,LIN J,XU P,et al. The combined effect of hypertension and type 2 diabetes mellitus on aortic stiffness and endothelial dysfunction：an integrated study with high-resolution MRI[J]. Magn Reson Imaging,2014,32（3）：211-216. [14] TOMIYAMA H,HASHIMOTO H,TANAKA H,et al. Synergistic relationship between changes in the pulse wave velocity and changes in the heart rate in middle-aged Japanese adults：a prospective study[J]. Journal of Hypertension,2010,28（4）：687-694. [15] LAURENT S,BOUTOUYRIE P. The structural factor of hypertension：large and small artery alterations[J]. Circ Res,2015,116（6）：1007-1021. [16] 王戏丹,卜智斌. 二维斑点追踪成像技术在2型糖尿病合并高血压患者左心室功能评估中的价值[J]. 中华全科医学,2016,14（11）：1924-1926,1935.
