早期胰岛素泵强化治疗对初诊2型糖尿病患者颈动脉粥样硬化进展的影响  

Effect of Insulin Pump Intensive Therapy on Development of Cervicalis Atherosclerosis in Patients with Type 2Diabetes Mellitus by Preliminary Diagnosis

作　　者：赵田[1,2] 吕肖锋[2] 武晋晓[2] 张天瀛[2] 和瑞婷 向莎[2] 

机构地区：[1]山西医科大学第二临床医学院,太原030001 [2]北京军区总医院内分泌科,北京100700

出　　处：《解放军医药杂志》2016年第5期5-9,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：国家科技重大专项子课题(2011ZX09307-001-08)

摘　　要：目的探讨初诊2型糖尿病(T2DM)患者早期应用胰岛素泵强化治疗对远期颈动脉粥样硬化的影响,为预防糖尿病大血管并发症提供临床依据。方法选取2002年1月—2010年12月于北京军区总医院内分泌科就诊的初诊T2DM患者531例,回顾统计病历资料,根据初诊有无应用胰岛素泵强化治疗分为强化组(273例)和非强化组(258例)。2014年1月—2015年6月进行回访,检测相关临床指标,并采用B超检查观察颈动脉内膜-中膜厚度(IMT),计算粥样斑块检出率。结果 1初诊时两组年龄、男性比例、病程、血压、体量指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、颈动脉IMT、颈动脉粥样斑块检出率差异均无统计学意义(P>0.05);强化组糖化血红蛋白(Hb A1c)显著高于非强化组(P<0.05)。2回访时两组年龄、男性比例、病程、血压、BMI、TC、TG、HDL-C、LDL-C、FPG、Hb A1c比较差异均无统计学意义(P>0.05);强化组颈动脉IMT值、斑块检出率均低于非强化组,差异有统计学意义(P<0.05)。3颈动脉IMT与年龄、Hb A1c、LDLC呈显著正相关(r=0.092、0.235、0.295,P<0.05、P<0.01)。结论初诊T2DM患者早期行胰岛素泵强化治疗可降低远期颈动脉IMT,延缓颈动脉粥样硬化的发生和发展,降低糖尿病合并心血管疾病的发生风险。Objective To investigate the effect of insulin pump intensive therapy on long-term carotid atherosclerosis in early application for patients with type 2 diabetes mellitus（ T2DM） by preliminary diagnosis,and to provide clinical basis for preventing T2 DM large vascular complications.Methods Clinical data of 531 patients with T2 DM by preliminary diagnosis during January 2002 and December 2010 was retrospectively analyzed.The patients were divided into intensive treatment group（ n = 273） and non intensive group（ n = 258） according to the early application of insulin pump intensive treatment.A return visit was performed during January 2014 and June 2015,and related indicators in clinical practice were detected.The carotid artery intima media thickness（ IMT） was observed using type-B ultrasonic,and detection rate of atherosclerotic plaque was calculated.Results 1 There were no significant differences in age,male ratio,course of disease,blood pressure,body mass index（ BMI）,total cholesterol（ TC）,triglyceride（ TG）,high density lipoprotein cholesterol（ HDL-C）,low density lipoprotein cholesterol（ LDL-C）,fasting blood glucose（ FPG）,carotid artery IMT and detection rate of plaque in the two groups by preliminary diagnosis（ P〈0.05）.The glycosylated hemoglobin（ Hb A1c） level in intensive treatment group was significantly higher than that in the non intensive group（ P〈0.05）.2During the return visit,there were also no significant differences in age,male ratio,course of disease,blood pressure,BMI,TC,TG,HDL-C,LDL-C,FPG and Hb A1 c in the two groups（ P〈0.05）;values of carotid artery IMT and detection rate of plaque in intensive group were significantly lower than those in non intensive group（ P〈0.05）.3carotid artery IMT was positively correlated with age,Hb A1 c and LDL-C（ r = 0.092,0.235,0.295,P〈0.05,P〈0.01）.Conclusion Early application of insulin pump intensive therapy can reduce the long-term carotid artery IMT,delay the incidence and development of va

关 键 词：糖尿病 2型 胰岛素输注系统 动脉粥样硬化 颈动脉内膜-中膜厚度 

分 类 号：R587.1[医药卫生—内分泌] R543.5[医药卫生—内科学]