社区2型糖尿病人群中糖化血红蛋白与颈动脉斑块的相关性研究

目的 分析社区2型糖尿病人群中糖化血红蛋白和颈动脉斑块危险性的关系。方法 在社区人群中进行横断面调查，经统一问卷调查获得人口学、行为生活方式、疾病史、用药史等信息，并进行糖化血红蛋白检测及颈动脉超声检查。纳入自报有医生明确诊断的糖尿病患者或正在服用降糖药或胰岛素者，年龄≥40岁，共552例。通过单因素和多因素Logistic回归，分析糖化血红蛋白含量与颈动脉斑块相关性，进行分层分析，研究不同特征人群的糖化血红蛋白与颈动脉斑块相关性的差异。结果 纳入的2型糖尿病患者（男218例，女334例）中，颈动脉斑块检出率为41.9%，糖化血红蛋白平均浓度为（7.25±1.53）%。单因素Logistic回归分析中，糖化血红蛋白浓度每升高一个单位，颈动脉斑块危险度的比值比为1.10（95%CI 0.98～1.22，P =0.108），调整了年龄和性别因素后的比值比为1.13（95%CI 1.00～1.26，P =0.047），当调整疾病史、吸烟、饮酒、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、体重指数（body mass index，BMI）、休闲体育锻炼等级、药物服用情况、睡眠时间、卒中家族史后，多因素Logistic回归模型显示，糖化血红蛋白浓度每升高一个单位，颈动脉斑块危险度的比值比为1.16（95%CI 1.02～1.33，P =0.025）。对糖化血红蛋白浓度进行分类处理后，高水平组是低水平组颈动脉斑块检出危险性的1.71倍（95%CI 1.06～2.76，P =0.028），中水平组是低水平组危险性的1.40倍（95%CI 0.87～2.25，P =0.170）。分层分析结果显示，年龄＜60岁组、BMI≥24kg/m2组、伴发高血压组中糖化血红蛋白浓度和颈动脉斑块危险性具有相关性。结论 在社区2型糖尿病人群中，糖化血红蛋白浓度与颈动脉斑块检出呈现相关关系。

Association of HbA1c Levels with Carotid Plaque in Community-based Population with Type 2 Diabetes

Objective To evaluate the association of HbA1c and carotid plaque in community-based type 2 diabetes.
Methods Form the cross-sectional study, information of community-dwelling adults was collected by investigators who were trained uniformly, including demographics, behavior and life style, disease history, medicine condition, HbA1c level, as well as carotid ultrasound. A total of 552 subjects, who self-reported be with type 2 diabetes or had glucose-lowering agents and ≥40 years old, were included. The association of HbA1c level and carotid plaque was explored by using the methods of univariate and multivariate logistic regression models. In addition, stratiifed analysis was used to evaluate the risk of HbA1c level and carotid plaque in population with different characteristics.
Results There were 218 men and 334 women in this study, of which the prevalence of carotid plaque was 41.9% and the mean level of HbA1c was (7.25±1.53)%. In the univariate logistic regression model, the odds ratio of carotid plaque was 1.10 (95%CI 0.98-1.22,P=0.108) for per 1% increase. TheOR was 1.13 (95%CI 1.00-1.26,P=0.047) when adjusting age and gender. After disease history, smoking status, drinking, total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), statins, BMI, physical exercises, medicine treatment, sleep duration, and family history of stroke have been taken into consideration, theOR was 1.16 (95%CI 1.02-1.33,P=0.025) for per 1% increase. When the level of HbA1c was classified as low group, middle group, and high group, serving low group as reference, theOR of high group was 1.71 (95%CI 1.06-2.76,P=0.028), and theOR of middle group was 1.40 (95%CI 0.87-2.25,P=0.170). Stratiifed by age, BMI, and hypertension, the population of <60 years or BMI≥24 or with hypertension were found tending to have relative high risk of association of HbA1c and carotid plaque.
Conclusion HbA1c level is signiifcantly associated with carotid plaque in the community-dwelling with type 2 diabetes.