应用高频超声探讨2型糖尿病患者血糖控制不良与动脉硬化的关系

目的:应用高频超声探讨2型糖尿病(DM)患者血糖持续控制不良在动脉粥样硬化发生发展中的作用。方法:采用彩色多普勒超声仪由专人在单盲条件下测量2 5例血糖良好控制及30例血糖长期控制不满意的2型DM患者双侧颈动脉血管内膜中层厚度(IMT) ,并进行动脉粥样斑块评分。结果:无论是颈动脉IMT还是粥样斑块评分,血糖控制良好组DM患者均明显优于血糖控制不良DM患者(IMT比较:P<0 .0 1;粥样斑块评分比较:P<0 .0 5 ) ;血糖控制良好DM患者血清甘油三酯(TG)水平及平均动脉压(MABP)均较血糖控制不良组低(P<0 .0 1) ,但血清总胆固醇(CH)水平两组差异无统计学意义(P>0 .0 5 ) ;直线相关分析发现入选DM患者IMT与患者空腹血糖(FBG)及糖化血红蛋血Alc(GHb Alc)水平呈正相关关系(P<0 .0 5 ) ,等级相关分析发现粥样斑块评分与FBG水平正相关(P<0 .0 5 ) ,与GHb Alc水平相关关系接近统计学意义(P=0 .0 83)。结论:长期血糖控制不满意加速2型DM患者动脉粥样硬化的发生发展,高血糖本身或通过血脂代谢异常及血压升高促进2型DM患者动脉硬化发生,持续而有效的血糖控制是本病患者治疗的首要措施。

Study of Hight Frequency Ultrasound in the Relationship between Lasting Hyperglycemia and Arteriosclerosis in Patients with Type 2 Diabetes Mellitus

Objective To investigate the role of l as ting hyperglycemia in the pathogenesis of arterioscle-rosis in patients with ty p e 2 diabetes mellitus.Methods 25 type 2 DM patients with glycemia well controlled and 30 patients with glycermia unsatisfied controlled were enrol led in this study. The intima middle thick(IMT)in carotid arteries was measured using color dopplerultrasound by blindness pattem in all the enrolled patients.F urthermore,The severity degree of atheromatous plaque was also evaluated. Results No matter IMT or severity degree of atheromatous plaque in patie nts with glycemia well controlled were lower than those of unsatisfied controlle d(IMT:P<0.01;severity degree of atheromatous plaque:P<0 .05).The levels of seratriglyceride (TG) and mean arterial blood pressur e (MABP)in patients with glycemia satisfied controlled group also lower than tho se of unsatisfied controlled group(P<0.01 separately).But there no significant difference was found in total CH between the two groups patients (P>0.05).Positive correlation was found between IMT and levels o f fasting blood glucose(FBG)and glucosylated hemoglobin Alc(GHbAlc)by Pearson co rrelation analysis(P<0.01).The severity degree of atheromatous plaque was also positive correlation to levels of FBG(P<0.05)an d GHbAlc(P=0.083)by Spearman correlation analysis.Conclu sion Long-term hyperglycemia play an important role in the progress of ar t eriosclerosis in patients with type 2 DM. Hyperglycemia it self or via abnormal metabolism of lipid and hypertension aggravate arteriosclerosis progress in pati ents with type 2 DM effective and stable glycemia controlled is essential in typ e 2 DM treatment.