40岁以上2型糖尿病患者便秘与早期动脉粥样硬化的相关性  

Relationship between chronic constipation and subclinical atherosclerosis in type 2 diabetic patients aged more than 40 years

作　　者：刘宇[1] 张瑞凤 李如意 张卫 

机构地区：[1]上海交通大学医学院附属仁济医院南院内分泌科,上海201112 [2]上海市闵行区梅陇镇社区卫生服务中心

出　　处：《上海医学》2016年第1期1-5,共5页Shanghai Medical Journal

基　　金：上海市闵行区卫生局科研课题资助项目(2013MW70)

摘　　要：目的探讨社区40岁以上2型糖尿病患者便秘与早期动脉粥样硬化的相关性。方法对上海市闵行区梅陇镇社区建立健康档案的40岁以上1 950的例2型糖尿病患者进行便秘问卷调查和颈动脉超声检查。按照罗马Ⅲ诊断标准定义便秘,颈动脉内中膜增厚或粥样斑块形成定义为早期动脉粥样硬化,BMI≥28kg/m2定义为肥胖。排除便秘问卷缺失和未完成颈动脉超声检查的患者,最终有1 943例研究对象纳入分析。采用多元Logistic回归方法分别在非肥胖和肥胖患者中分析便秘与早期动脉粥样硬化的相关性。结果纳入分析的1 943例2型糖尿病患者的平均年龄为(65.8±7.9)岁,中位糖尿病病程为6.9年,肥胖患病率为22.6%,便秘患病率为14.5%。肥胖便秘的2型糖尿病患者中早期动脉粥样硬化患者的构成比显著高于肥胖无便秘的2型糖尿病患者(校正年龄后P<0.05)。在肥胖的2型糖尿病患者中,模型1校正年龄,与非便秘患者相比,便秘患者早期动脉粥样硬化患病风险增加84%(OR=1.84,95%CI为1.02~3.90,P=0.042);模型2在模型1的基础上校正性别、吸烟、饮酒、糖尿病病程、腰围、臀围、BMI、收缩压,与非便秘患者相比,便秘患者早期动脉粥样硬化患病风险增加113%(OR=2.13,95%CI为1.11~4.10,P=0.023);模型3在模型2的基础上校正血三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、估算的肾小球滤过率(eGFR)、稳态模型评估的胰岛素抵抗指数(HOMA-IR),与非便秘患者相比,便秘患者早期动脉粥样硬化患病风险增加118%(OR=2.18,95%CI为1.10~4.32,P=0.026)。结论在40岁以上的2型糖尿病肥胖患者中,便秘可增加早期动脉粥样硬化的患病风险。Objective To investigate the correlation between chronic constipation and subclinical atherosclerosis in type 2 diabetic patients aged more than 40 years.Methods A total of 1 950 subjects aged 40 years and above from electronic health records of type 2 diabetes in Shanghai Meilong Community were recruited to undergo constipation questionnaire interview and carotid ultrasound.Chronic constipation was defined according to Rome Ⅲ diagnostic criteria.Subclinical atherosclerosis was defined as the presence of elevated carotid intimalmedial thickness or carotid plaques.Obesity was defined as body mass index（BMI）≥28kg/m^2.After excluding those not finishing questionnaire of constipation and ultrasound measurements of carotid,1 943 subjects were included for the final analysis.The multivariate Logistic regression analysis was used to investigate the correlation between chronic constipation and subclinical atherosclerosis in non-obese and obese type 2 diabetic patients.Results The mean age of the 1 943 subjects was（65.8±7.9）years and the median duration of diabetes was 6.9 years.The prevalence rates chronic constipation and obesity were 14.5% and 22.6%,respectively.Obese subjects with chronic constipation were more likely to suffer from subclinical atherosclerosis than obese subjects without constipation（P0.05 after adjustment of age）.In obese type 2 diabetic patients,the risk of subclinical atherosclerosis in those with chronic constipation was increased by 84% as compared with those without constipation in model 1（aged adjusted,OR=1.84,95%CI：1.02-3.90,P=0.042）;the risk of subclinical atherosclerosis in those with chronic constipation was increased by 113% as compared with those without constipation after adjustment of sex,smoking status,drinking status,diabetes duration,waist circumstance,hip circumstance,BMI,and systolic blood pressure based on model 1（OR=2.13,95%CI：1.11-4.10,P=0.023）;the risk of subclinical atherosclerosis in subjects with chronic constipation was increased by 118% as comp

关 键 词：2型糖尿病 便秘 早期动脉粥样硬化 

分 类 号：R587.2[医药卫生—内分泌] R543.5[医药卫生—内科学] R574.62[医药卫生—临床医学]