2型糖尿病患者血糖控制与颈动脉内膜中层厚度的相关性研究  

Relationship between carotid intima-media thickness and glycemic control among type 2 diabetes mellitus patients

作　　者：曹亚英 孙可欣[1] 项骁 刘志科[1] 隽娟[1] 杨成[1] 钱捷[1] 杨超[1] 宋菁[1] 黄少平[2] 刘晓芬[3] 李娜 唐迅[1] 李劲[1] 吴涛[1] 陈大方[1] 胡永华[1] 

机构地区：[1]北京大学公共卫生学院流行病与卫生统计学系,北京100191 [2]北京市房山区疾病预防控制中心办公室,北京102401 [3]北京市房山区疾病预防控制中心慢性病防治科,北京102401 [4]北京市房山区科学技术委员会办公室,北京102488

出　　处：《中华疾病控制杂志》2016年第7期647-651,共5页Chinese Journal of Disease Control & Prevention

基　　金：国家自然科学基金(81230066;81102177;81473043)

摘　　要：目的探讨社区2型糖尿病(type 2 diabetes mellitus,T2DM)患者血糖控制与颈动脉内膜中层厚度(carotid intima-media thickness,CIMT)的关系。方法对北京市3个农村社区40岁及以上T2DM患者进行糖化血红蛋白(hemoglobin A1c,Hb A1c)及血生化指标的检测、CIMT测量、其他体格检查以及一般人口学资料的问卷调查。以Hb A1c为血糖控制指标,分析其与CIMT的相关性。结果本次分析共纳入720名T2DM患者,平均年龄为(59.06±7.50)岁,中位糖尿病病程6.3年。相关性分析显示CIMT与Hb A1c呈正相关(r_s=0.182,P<0.001)。血糖控制良好组(Hb A1c<6.5%)、控制一般组(6.5%≤Hb A1c<8.0%)和控制不良组(Hb A1c≥8.0%)CIMT增厚率分别为21.98%、28.94%和38.11%(x^2=13.78,P=0.001)。Logistic回归显示,调整年龄、性别、心脑血管病史、血压、血脂、糖尿病用药及病程因素后,Hb A1c仍为CIMT增厚的危险因素(OR=1.18,95%CI:1.07~1.31);与血糖控制良好组相比,血糖控制不良仍为CIMT增厚的危险因素(OR=2.17,95%CI:1.34~3.51)。结论 T2DM患者血糖控制水平与CIMT显著相关;Hb A1c≥8.0%可能为T2DM患者动脉粥样硬化的危险因素,且作用独立于血压、血脂水平。Objective To explore the relationship between carotid intima-media thickness （CIMT） and glycemic control in community type 2 diabetes mellitus （T2DM） patients. Methods A community-based study for T2DM patients aged over 40 years was conducted in three rural communities in Beijing. Every participant underwent hemoglobin Ale （ HbA1 c） assessment, CIMT measurement, physical examination, biochemical test and a questionnaire investigation. According to the level of HbAle, T2DM patients were divided into well-controlled group, moderately controlled group and poorly controlled group and then the association between CIMT and glycemic control among T2DM patient was analyzed. Results A total of 720 T2DM patients were recruited. The average age was 59. 06 ±7.50 years old and the mean T2DM duration was 6. 3 years. Correlation analysis showed CIMT was positively associated with HbA 1 e （ rs = 0. 182, P 〈 0. 001 ）. The thickness increase rate of CIMT for well-controlled （ HbAlc 〈 6. 5% ） , moderately controlled （6. 5% ≤ HbAlc 〈 8.0% ）, and poorly controlled （ HbA1 c I〉 8.0% ） groups were 21.98%, 28.94% and 38. 11% respectively （%2 = 13.78, P = 0. 001 ）. Logistic regression analysis showed that after adjusting for age, sex, cardio-cerebral vascular disease history, anti-diabetic drug use, T2DM duration, indexes of blood pressure and lipids, the thickness increase rate of CIMT was asso- ciated with HbAlc （ OR = 1.18,95% CI： 1.07-1.31 ）. Compared with the well-controlled group, poor glycemic control re- mained a risk factor for the elevation of CIMT （ OR = 2. 17, 95% CI： 1.34-3.51 ）. Conclusions The level of glycemic control among T2DM patients was associated with CIMT. Poor glycemic control （ HbAlc≥8.0% ） might be a risk factor for the development of atherosclerosis among T2DM patients and its function is independent of blood pressure and lipid level.

关 键 词：糖尿病 2型 动脉粥样硬化 危险因素 

分 类 号：R587.1[医药卫生—内分泌] R181.2[医药卫生—内科学]