新诊2型糖尿病亚临床动脉粥样硬化进展的影响因素  

Risk factors for the progress of subclinical atherosclerosis in newly diagnosed type 2 diabetics with multifactorial intervention

作　　者：刘志文[1] 周智广[1] 唐炜立[1] 周启昌[2] 刘玉华[1] 周卫东[1] 宁洁[1] 陈小燕[1] 谭宜[2] 王志远[2] 彭健[1] 

机构地区：[1]中南大学湘雅二医院代谢内分泌研究所中南大学湘雅二医院内分泌科中南大学糖尿病中心 [2]中南大学湘雅二医院超声诊断科,长沙410011

出　　处：《中华全科医师杂志》2006年第8期470-474,共5页Chinese Journal of General Practitioners

基　　金："十五"国家科技攻关计划资助项目(2001BA702B01)

摘　　要：目的探讨多因素干预条件下新诊2型糖尿病患者亚临床动脉粥样硬化(AS)进展的危险因素。方法前瞻性观察156例年龄35～70岁、病程在1年以内、无亚临床动脉粥样硬化的2型糖尿病患者在采取以抗血小板为基础的强化血糖、血脂、血压、体重等综合达标干预措施的2年中各代谢指标和亚临床动脉粥样硬化的动态变化,比较强化干预2年后发生与未发生亚临床动脉粥样硬化的患者间代谢控制的差异,采用logistic回归分析探讨亚临床动脉粥样硬化进展的危险因素。结果156例患者经2年的综合强化干预,颈总动脉和股动脉血管内中膜厚度与基线比较差异无统计学意义,但显著高于1年时的对应值(P＜0．01)；干预2年时,45例(28．8%)患者检出有血管内中膜厚度异常或动脉粥样硬化斑块,高于干预1年时的18例(11．5%,P＜0．01)；糖化血红蛋白、总胆固醇、高密度脂蛋白胆固醇、稳态模型的胰岛素抵抗指数与干预1年时的对应值比较有升高趋势(P＜0．01)；糖化血红蛋白的达标率亦显著低于干预1年时(P＜0．01)。亚临床动脉粥样硬化组糖化血红蛋白和低密度脂蛋白胆固醇的达标率低于无动脉粥样硬化组(P＜0．01)。logistic回归分析显示,低密度脂蛋白胆固醇达标可使亚临床动脉粥样硬化发生的相对危险度减少83%,糖化血红蛋白达标使相对危险度减少59%,但随访2年时,年龄每增加10岁使相对危险度增加82%。结论多因素强化干预并不能完全阻止新诊2型糖尿病亚临床动脉粥样硬化的发生,随着时间的推移,亚临床动脉粥样硬化呈进展趋势,血糖、血脂亦呈上升趋势；低密度脂蛋白胆固醇和糖化血红蛋白是否达标以及年龄是影响新诊2型糖尿病患者发生亚临床动脉粥样硬化的主要危险因素。Objective To investigate risk factors for the progress of subclinical atheroselerosis （AS） in newly diagnosed type 2 diabetics with multifactorial intervention. Methods One hundred and fiftysix patients of type 2 diabetes, aged 35 - 70 years, with course of less than one year and without subclinical AS, were observed prospectively. After two-year intervention based on anti-platelet therapy integrated with intensive control of blood glucose, blood lipid, blood pressure and body weight, dynamic changes in all metabolic indicators and subclinical AS in the patients and differences between those with subclinical AS and without it were analyzed to study the risk factors for its progress by logistic regression analysis. Results There were no significant differences in intima-medial thickness （IMT） of common carotid artery （CCA） and femoral artery （FA） in the patients between baseline and two years after intervention, but those in them were significantly increased two years after intervention than those one year aft er intervention （P 〈0. 01 ）.Two years after intervention, increased IMT or atheroselerotie plaques could be found in 45 of 156 patients （28.8%）, significantly higher than those one year after intervention （11.5%, P 〈 0. 01 ）. Levels of glyeosylated hemoglobin A1c （HbA1c）, total eholersterol （TC）, high-density lipoprotein-eholesterol （HDL-C） and HOMA-insulin resistance （IR） showed an increased trend two years after intervention, as compared with those one year after intervention （ P 〈 0. 01 ）. Proportions of those with normal level of HbAle two years after intervention was significantly lower than that one year after intervention （ P 〈 0. 01 ） . Proportions of those with normal level of HbAle and low-density lipoprotein-eholesterol （LDL-C） were significantly lower in patients with subclinical AS than those without it two years after intervention （P 〈0.01）. Logistic regression analysis showed that relative risk （RR） for subclinical AS c

关 键 词：糖尿病 非胰岛素依赖型 干预性研究 血管内膜 动脉硬化 危险因素 

分 类 号：R587.1[医药卫生—内分泌]