新诊断2型糖尿病患者脉压与颈动脉内膜-中层厚度的关系

目的对新诊断2型糖尿病患者血压及脉压水平与颈动脉内膜-中层厚度(IMT)的关系进行分析,以期为2型糖尿病患者预防早期心脑血管疾病提供临床依据。方法对中国糖尿病并发症防治研究——CDCPSⅠ期及Ⅱ期研究中1567例新诊断2型糖尿病患者(年龄30～70岁,其中女性698例,40.9%)行B超检查测量颈动脉IMT,并通过对血压的测量,分析血压及不同脉压(PP)对颈动脉IMT的影响,同时分析内膜增厚组(IMT≥0.8 mm)与内膜正常组(IMT<0.8 mm)血压和PP水平有无差异结果(1)合并高血压组与不合并高血压组比较,颈动脉IMT显著增厚[高血压组(0.76±0.15)mm,非高血压组(0.74±0.14)mm,差异有统计学意义(P=0.0006)]。(2)直线相关分析发现,颈动脉IMT与年龄(r=0.19548)、BMI(r=0.07252)、LDL(r=0.06523)、SBP(r=0.11173)、DBP(r=0.05962)、PP(r=0.10592)显著正相关(均为P<0.05)。(3)以PP 50mm Hg为界限将患者分为两组,脉压≥50mm Hg组颈动脉IMT(0.77±0.14)mm较脉压<50mm Hg组(0.74±0.15)mm显著增厚(P=0.0006);即使在非高血压患者,脉压≥50mm Hg组的颈动脉IMT(0.75±0.14)mm较脉压<50 mm Hg组(0.73±0.14)mm也有增厚(P=0.046);在<60岁的患者脉压≥50 mm Hg组的颈动脉IMT(0.75±0.15)mm较脉压<50 mm Hg组(0.73±0.14)mm也有显著增厚(P=0.008)(4)颈动脉IMT≥0.8 mm组SBP、PP均较IMT<0.8 mm组显著升高(P值分别为0.001和0.002),而两组间DBPIMT增厚组(78 2±9.8)mm Hg,正常组(79.1±10.0)mm Hg]差异无统计学意义(P=0.075)。结论在新诊断的2型糖尿病患者,PP与颈动脉IMT的正相关性与SBP相近,而强于DBP。对于PP≥50mm Hg的患者要尽早行颈动脉超声检查测量颈动脉IMT以早期发现可能存在的亚临床动脉粥样硬化性疾病,尽早进行干预治疗。

Relationship between pulse pressure and carotid intima-media thickness in newly diagnosed type 2 diabetes mellitus

Objective To investigate the association between blood pressure （BP） / pulse pressure （PP） and carotid intima-media thickness （cIMT） in patients with newly diagnosed type 2 diabetes mellitus （T2DM） in China. Methods We examined the impact of baseline BP, PP and other cardiovascular risk factors on cIMT in 1567 newly diagnosed T2DM patients （40. 9% women, aged 30-70 years） from Chinese Diabetes Complication Prevention Study （ phase Ⅰ and phase Ⅱ ） cohort. The mean cIMT was measured using an automated B-type ultrasound system. Results （ 1 ） Compared to those without hypertension, the mean clMT value was significantly greater[ （0. 76 ＋± 0. 15 ）mm vs. （0. 74 ± 0. 14） mm, P = 0. 0006 ] in hypertension subgroup. （2） Regression analysis showed that cIMT was positively related to age （r=0.19548）, BMI （r=0.07252）, LDL （r=0.06523）, SBP （r=0.11173）, DBP （r=0.05962） andPP （r= 0. 105 92）, （ all P 〈 0. 05）. The predictive value of SBP and PP for cIMT were similar, and greater than that of DBP. （3） Mean clMT value was much greater in subgroup of PP ≥50 mmHg than in PP 〈 50 mmHg [ （0.77 ± 0. 14）mm vs. （0. 74 ±0. 15）mm, P =0. 0006]. （4） SBP and PP were substantially higher in group of mean cIMT 〉10. 8 mm （P =-0. 001 and P =0. 002 respectively） than in those with cIMT 〈0. 8 mm. And DBP was similar between the two groups [ （78. 2±9. 8） mm Hg vs. （79. 1 ＋± 10. 0） mmHg, P = 0. 075 ]. Conclusions Like SBP, PP is positively correlated with cIMT in patients with newly diagnosed T2DM. For patients with T2DM and PP 〉150 mm Hg, measuring cIMT as early as possible may help to identify those at risk of premature cardiovascular disease.