2026 年第 1 期 第 21 卷

营养风险状态对老年2型糖尿病合并冠心病患者血糖控制及心血管事件的影响分析

Impact of nutritional risk status on glycemic control and cardiovascular events in elderly patients with type 2 diabetes mellitus complicated with coronary atherosclerotic heart disease

作者：刘琦1李颖文2龙洁儿1潘宗奇2邓勤勤3

英文作者：Liu Qi1 Li Yingwen2 Long Jieer1 Pan Zongqi2 Deng Qinqin3

单位：1广州中医药大学第二附属医院广东省中医院内分泌科，广州510120；2广州中医药大学第二附属医院广东省中医院中医经典科，广州510120；3广州中医药大学第二附属医院广东省中医院检验科，广州510120

英文单位：1Department of Endocrinology the Second Affiliated Hospital of Guangzhou University of Chinese Medicine Guangdong Provincial Hospital of Chinese Medicine Guangzhou 510120 China; 2Classical Theories Department of Traditional Chinese Medicine the Second Affiliated Hospital of Guangzhou University of Chinese Medicine Guangdong Provincial Hospital of Chinese Medicine Guangzhou 510120 China; 3Department of Clinical Laboratory the Second Affiliated Hospital of Guangzhou University of Chinese Medicine Guangdong Provincial Hospital of Chinese Medicine Guangzhou 510120 China

关键词：2型糖尿病；冠心病（冠状动脉粥样硬化性心脏病）；营养风险状态；血糖控制；心血管事件

英文关键词：Type2diabetesmellitus;Coronaryatheroscleroticheartdisease;Nutritionalriskstatus; Glycemiccontrol;Cardiovascularevents

• 摘要：

• 目的 探讨营养风险状态对老年2型糖尿病（T2DM）合并冠心病（冠状动脉粥样硬化性心脏病，CAD）患者血糖控制及心血管事件发生的影响。方法选择2024年6月至2025年6月广东省中医院收治的111例老年T2DM合并CAD患者作为研究对象。采用营养风险筛查量表（NRS 2002）对患者进行营养风险评估，根据评估结果分为营养风险组（n=28）和无营养风险组（n=83）。收集患者基线资料，检测2组血糖指标；同时记录心血管事件发生情况。采用Spearman方法分析营养风险状态与血糖控制及心血管事件发生的相关性。应用多因素Logistic回归分析影响血糖控制不佳和心血管事件发生的危险因素。结果2组并发症数量、C反应蛋白（CRP）、白蛋白水平比较，差异均有统计学意义（均P＜0.05）。营养风险组糖化血红蛋白、空腹血糖、餐后2 h血糖指标均高于无营养风险组（均P＜0.05）。营养风险组血糖控制不佳发生率为60.7%（17/28），高于无营养风险组的24.1%（20/83）（P＜0.05）。营养风险组心血管事件总发生率为53.6%（15/28），高于无营养风险组的19.3%（16/83）（P＜0.05）。Spearman分析结果显示，营养风险状态与血糖控制不佳、心血管事件呈正相关（r=0.386，P=0.005；r=0.425，P=0.002）。多因素Logistic回归分析结果显示，营养风险状态、并发症数量≥2种、CRP水平升高、白蛋白降低均是患者血糖控制不佳、心血管事件的危险因素（均P＜0.05）。结论 营养风险状态显著加剧老年T2DM合并CAD患者的血糖控制恶化并增加心血管事件风险，且营养风险状态与血糖控制不佳、心血管事件呈正相关；多因素分析进一步证实营养风险状态、并发症数量≥2种、CRP升高及白蛋白降低是血糖控制不佳和心血管事件的独立危险因素，提示临床需加强营养筛查与干预以改善预后。

• Objective To explore the impact of nutritional risk status on glycemic control and the occurrence of cardiovascular events in elderly patients with type 2 diabetes mellitus (T2DM) complicated with coronary atherosclerotic heart disease (CAD). Methods A total of 111 elderly patients with T2DM complicated with CAD admitted to Guangdong Provincial Hospital of Chinese Medicine from June 2024 to June 2025 were selected as the research objects. The nutritional risk screening scale (NRS 2002) was used to assess the nutritional risk of patients, who were divided into nutritional risk group (28 cases) and non-nutritional risk group (83 cases) according to the assessment results. Baseline data of patients were collected, and blood glucose indicators of the two groups were detected; meanwhile, the occurrence of cardiovascular events was recorded. Spearman correlation analysis was used to evaluate the correlations between nutritional risk status and glycemic control as well as the occurrence of cardiovascular events. Multivariate Logistic regression analysis was applied to identify the risk factors influencing poor glycemic control and the occurrence of cardiovascular events. Results There were statistically significant differences in the number of complications, C-reactive protein (CRP) level, and albumin level between the two groups (all P＜0.05). The levels of glycated hemoglobin, fasting blood glucose, and 2 h postprandial blood glucose in the nutritional risk group were significantly higher than those in the non-nutritional risk group (all P＜0.05). The incidence of poor glycemic control in the nutritional risk group was 60.7%(17/28), which was significantly higher than 24.1%(20/83) in the non-nutritional risk group (P＜0.05). The total incidence of cardiovascular events in the nutritional risk group was 53.6%(15/28), which was significantly higher than 19.3%(16/83) in the non-nutritional risk group (P＜0.05). Spearman correlation analysis showed that nutritional risk status was positively correlated with poor glycemic control and cardiovascular events (r=0.386, P=0.005; r=0.425, P=0.002, respectively). Multivariate Logistic regression analysis revealed that nutritional risk status, number of complications ≥2, elevated CRP level, and decreased albumin level were independent risk factors for poor glycemic control and cardiovascular events in the patients (all P＜0.05). Conclusion  Nutritional risk status significantly exacerbates the deterioration of glycemic control and increases the risk of cardiovascular events in elderly patients with T2DM complicated with CAD. Moreover, nutritional risk status is positively correlated with poor glycemic control and cardiovascular events. Multivariate analysis further confirms that nutritional risk status, number of complications ≥2, elevated CRP level, and decreased albumin level are independent risk factors for poor glycemic control and cardiovascular events, suggesting that clinical practice should strengthen nutritional screening and intervention to improve prognosis.