2型糖尿病患者颈动脉硬化的多因素分析

目的探讨影响2型糖尿病患者颈动脉硬化的多个影响因素。方法收集110例2型糖尿病患者采用彩色多普勒超声诊断仪10 MHz高频探头检测患者双侧颈动脉。按超声检查结果分为4组:颈动脉正常组20例[双侧颈动脉内膜中层厚度(IMT)<0.9 mm];颈动脉内膜增厚组30例(0.9 mm≤IMT≤1.3 mm);稳定斑块组45例(斑块呈强回声,伴或不伴声影);不稳定斑块组15例(斑块呈略低回声,内部或周边有强回声附着)。留取患者空腹血清采用酶联免疫吸附试验(ELISA)测定胰岛素(Ins)、胰岛素原(PI)、可溶性血管细胞间黏附分子-1(sVCAM-1),并同时测定糖化血红蛋白(HbA1c)、血脂系列、C反应蛋白(CRP)及尿微量白蛋白。全部统计资料采用SPSS11.0统计软件进行方差分析、q检验。以颈动脉粥样硬化程度评分为应变量,分别以年龄、甘油三酯(TG)等为自变量做多元逐步回归分析。结果4组间HbA1cI、ns、PI、体重指数(BMI)、CRP等差异无统计学意义;而颈动脉内膜增厚组、稳定斑块组、不稳定斑块组的年龄、TG、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(CHO)及sVCAM-1明显高于颈动脉正常组,且差异有统计学意义,P均<0.01。多元回归分析结果显示患者的年龄、TGs、VCAM-1、LDL-C与颈动脉粥样硬化有相关性。结论在2型糖尿病患者中血清sVCAM-1水平与颈动脉粥样硬化程度相关。sVCAM-1水平可能为2型糖尿病患者大血管病变的标志物,及早检测血清中sVCAM-1浓度可以预测糖尿病大血管病变的发生与发展。

Multifactorialanalysisontype-2diabetics'''' carotid arteriosclerosis

Objective To discuss the multiple factors affecting carotid arteriosclerosis in type 2 diabetes mellitus.Methods One hundred and ten cases of type 2 diabetes were enrolled and their arterial wall thickness and local atherosclerosisinthecarotidarteries(CAs) wereexaminedbyB-mode ultrasonography.Accordingto the result of B-mode ultrasonography,the 110 cases were disparted for four groups:carotid arteries normal;carotid arteries incrassative;stabilized plaque;and unstabilized plaque.The fasting serum insulin,proinsulin,sVCAM-1,HbA_1c,CHO,TG,LDL-C,HDL-C,CRP and microalbuminuria were determined.The relationship between these factors and the grading of carotid arteriosclerosis was analyzed.Results Insulin,proinsulin,HbA_1c,BMI,CRP and microalbuminuria showed no significant difference among four groups.The levels of CHO,TG,LDL-C,HDL-C and sVCAM-1 were lower in normal group than those in other groups.Multiple linear regression showed that the grade of atherosclerosis correlated with age,TG,LDL-C and sVCAM-1.Conclusion sVCAM-1 level is likely to be a marker of the diabetes′complication.