非糖尿病人糖化血红蛋白及血压水平与颈动脉粥样硬化的发生呈连续相关  

Glycated Hemoglobin and Blood Pressure Related to Carotid Artery Atherosclerosis in Continuum in Non-diabetic Persons

作　　者：朱雯[1] 李勇[1] 俞欢[1] 施海明[1] 李剑[1] 朱军[1] 戚玮琳[1] 罗心平[1] 张凤霞[1] 

机构地区：[1]复旦大学附属华山医院心内科,上海200040

出　　处：《中华高血压杂志》2008年第3期208-212,共5页Chinese Journal of Hypertension

摘　　要：目的分析非糖尿病患者中糖化血红蛋白与血压对于颈动脉粥样硬化的影响。方法采用回顾性横断面研究的方法,分析300名非糖尿病的心脏科病人的糖化血红蛋白、血压与颈动脉粥样硬化的关系。颈动脉粥样硬化以颈动脉超声确定,颈总动脉内膜中膜厚度(IMT)≥0.9 mm 或粥样斑块形成均认为颈动脉超声阳性。结果颈动脉超声阳性组的空腹血糖、2 h 血糖、糖化血红蛋门、收缩压(SBP)均显著高于1阴性组,而两组间舒张压(DBP)无显著差别。而随着糖基化血红蛋白 A1c(HbA1c)或 SBP 的增高,颈动脉超声阳性的患者比例也有明显的增加。在 SBP 相似的悄况下,随着 HbA1c 的增高,颈动脉超声阳性的患者比例也有显著的增加。Logistic 多元回归分析发现,HbA1c 即使有轻度增高也是颈动脉超声阳性的独立预测因子(OR=4.1,P=0.009),且其作用独立于性别、体质量指数、SBP、DBP、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、高敏 C 反应蛋白、空腹血糖、2 h 血糖。结论非糖尿病患者中糖化血红蛋白的轻度升高可能与颈动脉粥样硬化发生率的增加有关,且这种作用独立于其他血精指标及多重危险因素。SBP 与糖化血红蛋白增高对颈动脉粥样硬化有协同作用。Objective To analyze the relationship between glycated hemoglobin, blood pressure and carotid artery atherosclerosis （AS） in non-diabetic patients. Methods To recruite 300 non-diabetic patients and retrospectively study the relationship between glycated hemoglobin HbAlc, blood pressure and carotid artery AS. Carotid AS was determined by carotid ultrasound. Carotid AS was defined as intima-media thickness （IMT） of common carotid artery ~0.9 mm, or occurrence of carotid plaque. Results Compared with the carotid AS negative subjects, the carotid AS positive patients had significant higher fasting glucose, 2 h glucose, HbAlc and systolic blood pressure （SBP） level, without difference in DBP. Higher HbAlc or SBP levels were associated with increased incidence of carotid AS. For patients with similar SBP levels, higher HbAlc was associated with more prevalence of carotid AS. Logistic regression analysis shows HbAlc （OR= 4. 1, P = 0. 009 ） was an independent predictor of carotid AS, after adjusting for sex, BMI, SBP, DBP, LDL-C, HDL-C, hypersensitive C-reactive protein （hsCRP）, and fasting and 2 h glucose. Conclusion These results suggests that even a slight increase of HbAlc may be independently associated with carotid AS in non-diabetic subjects; and the coexistence of elevated systolic blood pressure synergetically enhance the carotid atherosclerosis.

关 键 词：糖化血红蛋白 血压 动脉粥样硬化 

分 类 号：R543[医药卫生—心血管疾病]