老年2型糖尿病患者颈动脉粥样硬化与相关危险因素分析

目的 探讨老年2型糖尿病患者颈动脉硬化与其相关危险因素.方法 老年2型糖尿病组(260例)和对照组(206例),分别记录两组患者的年龄、性别、体重指数(BMI)、血压(BP)、糖尿病病程、空腹血糖(FPG)、餐后2 h血糖(PPG)、糖化血红蛋白(HbA1c)、C反应蛋白(CRP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆同醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)等,并同时进行颈动脉彩色多普勒超声检查,测量颈动脉内膜.中层厚度及动脉粥样硬化斑块的大小、位置及数量.采用Logistic回归模型分析颈动脉粥样硬化与各因素的相关性.结果 (1)糖尿病组颈动脉内膜-中层明显增厚者241例(92.6%),对照组43例(20.8%);糖尿病组颈动脉粥样硬化斑块者212例(81.3%),对照组42例(20.3%);糖尿病组颈动脉狭窄为89例(34.2%),对照组3例(0.01%).糖尿病组颈动脉血管病变与对照组比较差异有统计学意义(χ2值分别为249.06、173.32、77.92,均P<0.01);(2)糖尿病组FPG、PPG、TC、TG、LDL-C、ApoB和CRP与对照组比较差异有统计学意义(t值分别为16.99、15.82、15.92、6.43、10.84、3.69、17.09,均P<0.05);而HDL-C、ApoA则降低(t值分别为4.54、37.74,均P<0.05).糖尿病合并颈动脉病变较无颈动脉病变者HbA1c、TG、LDL-C、ApoB和CRP升高(t值分别为3.02、3.26、3.79、9.06、2.50,均P<0.01);(3)Logistic分析显示年龄、性别、病程、LDL-C、HDL-C、TG、收缩压和CRP等因素是老年2型糖尿病患者颈动脉病变发生的独立危险因素(OR值分别为1.063、1.925、1.081、1.039、0.138、1.865、5.145、5.663,均P<0.05).结论 老年2型糖尿病颈动脉病变与多种危险因素有关,早期较好地干预、控制这些危险因素对预防及治疗具有重要的临床意义.

Related factors for carotid artery atherosclerosis in elderly patients with type 2 diabetes

Objective To explore the relationship between the incidence of carotid arterial diseases and related factors in elderly diabetes patients. Methods Two hundred sixty elderly diabetic patients were included in diabetes group and 206 elderly healthy volunteers were included in control group. The age, gender, diabetic duration, fasting plasma glucose (FPG), postprandial glucose (PPG), glycosylated hemoglobin(HbA1c), total cholesterol(TC), total triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein (VLDL), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), blood pressure (BP), body mass index (BMI), Creactive protein (CRP) of the two groups were measured. All patients were examined by color Doppler ultrasonography. The relationship between the incidence of carotid arterial diseases and related factors was analyzed by logistic regressive model. Results (1) The intima-media thickness(IMT) became thickened in 241 cases (92.6%) in diabetes group and 43 cases (20.8%) in control group. The difference between two groups was statistically significant (χ2 = 249.06, P < 0.01). The prevalence rates of carotid plaque were 81.3 % (212 cases) in diabetes group and 20.3% in control group (42 cases) (χ2= 173.32, P < 0.01). The incidences of carotid arteries stenosis were 34. 2% (89 cases) in diabetes group and 0.01% (3 cases) in control group(χ2 =77.92,P <0.01). (2) The levels of FPG, PPG,TC,TG, LDL-C,ApoB and CRP were significantly higher in diabetes group than those in control group (t = 16.99, 15.82, 15.92,6.43,10.84, 3.69,17.09;all P <0.05), but the levels of HDL-C and ApoA were significantly lower in diabetes group than those in control group (t = 4. 54,37.74; both P < 0.05). Compared with diabetes patients without carotid arterial diseases, the levels of HbA1c,TG, LDL-C and ApoB were increased in diabetes patients with carotid artery lesion (t =3.02,3.26,3.79,9.06,2.50;all P <0.01). (3) Logistic regression showed that age, gender, diabetic duration, LDL-C, HDL-C, TG, SBP and CRP were the independent risk factors for carotid arterial diseases in elderly diabetes patients (OR = 1.063, 1.925,1.081,1.039,0.138, 1.865, 5.145,5.663; all P < 0.05). Conclusions Carotid arterial diseases in elderly type 2 diabetes patients are resulted from many factors. Earlier intervention and controlling these factors will have clinic significance for prevention and treatment of type 2 diabetes.