颈动脉粥样硬化表型与高血压及糖代谢异常的关系研究  

Phenotype of carotid atherosclerosis in association with hypertension and impaired glucose metabolism

作　　者：丁群芳[1] 姜爱侠[1] 罗方[1] 万朝晖[1] 吴锦晖[1] 

机构地区：[1]四川大学华西医院老年科,四川成都610041

出　　处：《实用医院临床杂志》2011年第3期15-18,共4页Practical Journal of Clinical Medicine

摘　　要：目的探讨颈动脉粥样硬化表型与高血压、糖代谢异常、代谢综合征之间的关系。方法收集华西医院老年科住院患者202例,年龄60~85岁。未诊断2型糖尿病（T2DM）者行口服75 g葡萄糖耐量试验（OGTT）试验,根据糖代谢异常状况和是否达到国际糖尿病联盟（IDF）代谢综合征（MS）诊断标准分为糖耐量正常（NGT）组、糖耐量受损（IGT）组、T2DM未合并MS[T2DM/MS（-）]组、T2DM合并MS[T2DM/MS（＋）]组。记录所有受检者的人口学指标、血压、血脂、空腹血糖和胰岛素水平。超声检测受试者颈总动脉内中膜厚度（CCA-IMT）和斑块情况。结果与NGT组相比,IGT组CCA-IMT增加;T2DM组较NGT组和IGT组颈动脉IMT、颈动脉斑块发生率增加;与T2DM/MS（-）组相比,T2DM/MS（＋）组颈动脉IMT轻度增加,IMT异常和斑块发生率轻度降低,但无显著性差异。多元线性回归显示年龄和糖代谢异常不同程度是影响颈动脉IMT的主要因素,Logistic回归显示吸烟、高血压病程是预测颈动脉斑块发生的主要因素,纤维蛋白原是预测内中膜异常的独立因素。结论糖代谢异常和高血压是影响动脉粥样硬化的重要因素,2型糖尿病基础上迭加MS未能见到加重颈动脉粥样硬化程度。Objective To investigate different phenotypes of carotid atherosclerosis in association with hypertension,impaired glucose metabolism and metabolic syndrome（MS） in the elderly.Methods A cross-sectional study consisted of 202 hospitalized patients（60~85 years） was carried out in the department of geriatrics in West China Hospital from 2007 to 2010.OGTT was applied to the subjects without formal diagnosis of type 2 diabetes（T2DM）.Subjects were divided into four groups according to their glucose metabolism and presence or absence of MS as following： NGT group,IGT group,T2DM/MS（-）（T2DM without metabolic syndrome） group,and T2DM/MS（＋）（T2DM with MS） group.Demographic indicators,blood pressure,blood fat,blood-fasting sugar and insulin parameters were carefully collected.Results Compared with NGT group,IGT group was associated with higher CCA-IMT.Comparedwith NGT and IGT group,the T2DM groups had increased incidence of IMT and plaque.Compared with the T2DM/MS（-） group,T2DM/MS（＋） group had increased carotid IMT,mildly lower prevalence of abnormal IMT and plaque.Multiple linear regression showed that age and different stages of glucose metabolism were the main factors which affected carotid artery IMT.Logistic regression showed that smoking and duration of hypertension were the main predictors of carotid artery plaque,and fibrinogen was an independent predictor of abnormal intima-media thickness.Conclusions Abnormal glucose metabolism and hypertension are important factors in the process of atherosclerosis.Metabolic syndrome,when overlapping with T2DM,may not increase the impact of T2DM on atherosclerosis.

关 键 词：高血压 糖代谢异常 颈动脉粥样硬化 代谢综合征 

分 类 号：R544.1[医药卫生—心血管疾病] R543.5[医药卫生—内科学]