2型糖尿病患者的血管并发症与血糖控制及其危险因素的相互关系

目的 通过观察2型糖尿病患者血糖控制,以了解糖尿病血管并发症及其相关危险因素之间有无差别,并进行回归分析进一步明确糖尿病患者大血管与微血管并发症相关危险因素的异同,以期指导临床.方法 将258例确诊2型糖尿病的住院患者,根据入院血糖控制情况以糖化血红蛋白(HbA1c)>7%为观察组,HbA1c ≤7%为对照组.观察两组间大血管并发症颈动脉内-中膜厚度、微血管并发症尿微量白蛋白/肌酐比值、空腹C肽、胰岛素抵抗指数(HOMA-IR)、纤维蛋白单体、血清25羟维生素D3[25(OH)D3]、胱抑素C、C反应蛋白、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、体重指数及患者年龄、发病时间等有无差异,并对大血管及微血管并发症分别进行二分类Logistic回归分析.结果 两组间血糖高低未见与相关炎症指标有关,大血管及微血管并发症差异无统计学意义,但HDL-C,LDL-C及C肽、HOMA-IR、年龄均差异有统计学意义(P=0.002、<0.001、<0.001、<0.001、0.019).微血管并发症的二分类Logistic回归分析提示与25(OH)D3、胱抑素C有关.二分类Logistic回归分析提示大血管并发症与低密度脂蛋白胆固醇 、胱抑素C有关.结论 胱抑素C对糖尿病大血管及微血管并发症有预测意义.患者摄入足量维生素D对微血管并发症及LDL-C的达标对大血管并发症的控制与发生有积极意义.

The relationship between vascular complications and bloodglucose control and risk factors in patients with type 2 diabetes mellitus

Objective By observing glycemic control in patients with type 2 diabetes, to understand the difference between diabetes vascular complications and their associated risk factors,then carry out regression analysis to further clarify the macrovascular and microvascular complications in diabetes-related risk factors similarities and differences, with a view to guiding clinical.Methods 258 patients diagnosed as type 2 diabetes were included in the study,according to the situations of blood glucose control.These patients were randomly divided into observation group(HbA1c>7%) and control group(HbA1c≤7%).Macrovascular complication of carotid wall intima-media thickness(MIT),and microvascular complication of urinary microalbumin and urinary creatinine ratio(A/C),the fasting C peptide, Homeostasis model assessment for insulin resistance index(HOMA-IR),fibrin monomer, 25(OH)D3,cystain C(Cys C),C-reactive protein and low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C), body mass index, age,onset time,were compared between two groups, macrovascular and diabetic vascular microvascular complications were analyzed by binary Logistic regression analysis respectively.Results There was no relationship between blood glucose level and inflammatory index in the two groups,and no significant differences was found in macrovascular and microvascular complications between two groups, but differences was found in HDL-C,LDL-C and fasting C peptide,insulin resistance index(HOMA-IR), age(P=0.002,<0.001,<0.001,<0.001,0.019, respectively).The binary logistic regression analysis showed that microvascular complications were associated with 25(OH)D3, Cys C.The macrovascular complications were associated with LDL-C, Cys C.Conclusion The concentration of Cys C has predictive significance of diabetic macrovascular and microvascular complications.Sufficient vitamin D has positive effects on the control and occurrence of microvascular complications, and LDL-C level reaching the standard has positive effects on the control and occurrence of macrovascular complications.