长期强化降血糖及降血脂治疗逆转初发的2型糖尿病患者颈动脉内中膜厚度

目的:探讨初发的2型糖尿病(type 2 diabetes mellitus,T2DM)患者颈动脉内中膜厚度(carotid intima medial thickness ,IMT)的影响因素,并研究血糖及血脂的强化治疗能否逆转T2DM患者的IMT.方法:T2DM患者116例,常规测定收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、体重指数(body mass index,BMI)、腰/ 臀比(waist-to-hip ratio,WHR)、空腹血糖(fasting blood glucose,FBG)、总胆固醇(total cholesterol,TC)、甘油三酯 (triglycerides,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、糖化血红蛋白(hemoglobin A1c,HbA1c),测定餐后2 h血糖(2 h postpradial glucose,2hPG),高分辨血管外超声方法检测IMT,分析IMT与上述指标的相关关系.对其中的89例T2DM患者追踪观察,随机分为强化血糖及血脂治疗组和常规治疗组,1年后再次测定IMT水平.结果: (1)T2DM 患者IMT水平与年龄、SBP、TC、LDL-C呈显著正相关,多元逐步回归分析表明年龄、TC是影响IMT的独立危险因素. (2)T2DM患者血糖及血脂强化治疗后IMT变化值与常规组比较差异有统计学意义,IMT在强化血糖及血脂组呈现下降趋势,而常规治疗组呈现上升的趋势.(3)IMT前后变化值与二甲双胍、磺脲类药物、阿司匹林的使用与否无明显相关,和他汀类药物的使用与否有显著相关,IMT在他汀类药物使用组呈现下降趋势,而他汀类药物未使用组呈现上升趋势.结论:T2DM 患者IMT主要受年龄、TC的影响,强化血糖和血脂可以逆转IMT,他汀类药物使用可有助于逆转IMT.

Long-term intensive glycemic and lipid control ameliorates the carotid intima medial thickness in type 2 diabetes mellitus

OBJECTIVE: To investigate whether long-term intensive glycemic and lipid control would ameliorate the carotid intima medial thickness (IMT) in patients with type 2 diabetes mellitus (T2DM). METHODS: IMT was evaluated on B-mode ultrasonography in 116 patients with T2DM. Body mass index (BMI), waist-to-hip ratio (WHR), fasting blood glucose (FBG), 2 hour postpradial glucose (2hPG), hemoglobin A(1)c(HbA(1)c), total cholesterol(TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C) were also measured. Of all the patients 89 were divided randomly into group of intensive glycemic and lipid control and group of conventional treatment and underwent 1 year clinical interview. RESULTS: (1) IMT in patients with T2DM was significantly correlated with age(r = 0.515,P = 0.000) , SBP (r = 0.208, P = 0.025), TC(r = 0.213,P = 0.022), LDL-C(r = 0.253, P = 0.006) and no correlations were found between IMT and BMI,WHR,FBG, 2hPG ,HbA(1)c, TG and HDL-C. In multivariate regression analysis, age (Beta = 0.527, P = 0.000 )and TC(Beta = 0.243, P = 0.002) were significant independent determinants for IMT. (3) After 1 year the change of IMT in the group of intensive glycemic and lipid control was significantly different compared with the group of conventional treatment (-0.044+/-0.148)mm vs (0.056+/-0.178), P<0.05]. The change of IMT was not significantly associated with the use of Metformin, Sulphonylurea and Aspirin, but significantly associated with the use of statins. The change of IMT in the group using statins was significantly different compared with that in the group without using statins(-0.053+/-0.153)mm vs (0.042+/-0.165)mm, P <0.05]. CONCLUSION: Carotid IMT appears to be closely related to age and TC in the patients with T2DM. long-term intensive glycemic control and lipid control could ameliorate the IMT in patients with T2DM. The improvement of IMT may be associated with the use of statin drug.