初诊2型糖尿病患者亚临床动脉粥样硬化的超声检查及危险因素分析  

Ultrasonic examination of subclinical atherosclerosis and its risk factors in the elderly with newly diagnosed type 2 diabetics

作　　者：陈小燕[1] 周智广[1] 傅朝[2] 谭少珍[1] 刘明辉[2] 唐炜立[1] 邓志明[1] 朱旭萍[1] 刘石平[1] 苏欣[1] 颜湘[1] 冯琼[1] 

机构地区：[1]中南大学湘雅二医院内分泌科代谢内分泌研究所 [2]中南大学湘雅二医院超声诊断科,长沙市410011

出　　处：《中华老年医学杂志》2004年第8期525-527,共3页Chinese Journal of Geriatrics

基　　金：国家"十五"攻关基金项目 ( 2 0 0 1BA70 2B0 1;2 0 0 1BA70 2B0 4);湖南省科技厅基金项目 ( 0 2SSY3 0 65 )

摘　　要：目的　探讨初诊 2型糖尿病 (2型DM )患者亚临床动脉粥样硬化 (AS)的发生情况、危险因素及老年患者的临床特点。　方法　采用无创性高分辨超声血管成像技术筛查 2 5 5例、病程≤ 1年 2型DM患者的颈总动脉、髂总动脉及股动脉内中膜厚度 (IMT)及AS斑块。分别比较老年组与中青年组、老年组有无亚临床AS者在性别、体重指数、腰臀比、血压、血脂谱、糖化血红蛋白水平、胰岛素抵抗等方面的差异。采用Logistic回归分析方法分析初诊 2型DM患者亚临床AS发生的危险因素。　结果　老年组亚临床AS 14例 (17 3% ) ,中青年组 16例 (9 2 % ,P <0 0 1)。股动脉亚临床AS检出率高于颈总动脉及髂总动脉 (分别为 8 6 %、4 7%和 0 4 % ,P <0 0 0 1)。与中青年组收缩压水平〔(12 0± 2 2 )mmHg〕比较 ,老年组较高〔(12 6± 19)mmHg ,P <0 0 5〕 ;老年组无AS与亚临床AS比较 ,舒张压水平较高 (P <0 0 0 1)。Logistic回归分析显示亚临床AS发生的危险因素为老龄化、胰岛素抵抗、舒张压水平增高及低水平的高密度脂蛋白胆固醇 (P <0 0 5 )。　结论　初诊 2型DM患者部分存在亚临床AS ,老年患者罹患率更高 ;不同部位亚临床AS的发生率存在差异 ;初诊 2型DM伴亚临床AS的老年患者舒张压水平增高 ,其危险因素为老龄化、胰岛素抵抗、?Objective To investigate the prevalence of subclinical atherosclerosis (AS), its risk factors, and the clinical characteristics of the aged patients with a newly diagnosed type 2 diabetic. Methods Two hundred and fifty-five patients with diabetes (duration≤1 year) were examined. Noninvasive high resolution B mode ultrasonography was used to measure the intima medial thickness (IMT) and atherosclerotic plaques of common carotid artery (CCA), common iliac artery(CIA) and femoral artery (FA) in all subjects. Gender,body mass index,waist to hip ratio,blood pressure,lipid profile,glycosylated hemoglobin,insulin resistance index and status of smoking,history of hypertension and dyslipidemia were compared between the aged and middle aged groups (≥60 and between 35 and 59 years old respectively ), and those with or without subclinical AS in the aged group. Results Thirty patients (11.8%) showed subclinical AS,including 14 in the aged group(17.3%,14/81) and 16 in the middle aged group(9.2%,16/174). Compared with middle aged patients,the aged patients had higher systolic blood pressure((125.5±19.0) mmHg vs (120.4±21.5) mmHg,P<0.05), and more patients with subclinical AS(P<0.001). The aged patients with subclinical AS had higher diastolic blood pressure(P<0.001). Logistic stepwise regression analysis showed four risk factors including age, insulin resistance, higher diastolic blood pressure and low HDL-C level(P<0.05)in subclinical AS. Conclusions About one tenth patients with newly diagnosed type 2 diabetic suffers from subclinical AS,but it is more prevalent in the aged patients (17.3%). The incidence of subclinical AS in this population was different,subclinical AS was more frequently seen in FA. The aged diabetic patients with subclinical AS is mainly characterized by significantly higher diastolic blood pressure. Aging, insulin resistance, higher distolic blood pressure and lower HDL-C are risk factors relating to subclinical AS in patients with newly detected type 2 diabetes.

关 键 词：2型糖尿病 动脉粥样硬化 超声检查 危险因素 DM 动脉硬化 血管中膜 

分 类 号：R445.1[医药卫生—影像医学与核医学]