糖代谢异常人群颈动脉粥样硬化危险因素分析  

Correlation research on serum levels of homocysteine,uric acid and other risk factors with carotid atherosclerosis in patients with abnormal glucose metabolism

作　　者：曲歌乐[1] 钱玉英[1] 周英智[1] 朱红[1] 

机构地区：[1]首都医科大学宣武医院综合科

出　　处：《疑难病杂志》2016年第12期1228-1233,共6页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的分析糖代谢异常人群颈动脉粥样硬化危险因素。方法选取健康体检者61例作为正常对照组（NGT）,糖耐量减低（IGT）和/或空腹血糖受损（IFG）的患者33例作为糖尿病前期组（IGR）.明确诊断为2型糖尿病的患者90例作为2型糖尿病组（T2DM）,比较各组间同型半胱氨酸（Hcy）、尿酸（UA）、三酰甘油（TG）、总胆固醇（TC）、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）、糖化血红蛋白（HbA_（1c））及血压（DBP、SBP）水平的差异,分析各指标之间的相关性,并对影响颈动脉粥样硬化斑块形成的危险因素进行Logistic回归分析。结果 IGR组和T2DM组的TG、Hcy、UA、FPG、HbA_（1c）、SBP、DBP值均高于NGT组（F=15.224、2.785、5.501、28.392、45.617、6.770、4.397,P〈0.05）,HDL-C低于NGT组（F=7.102,P=0.001）,但IGR组与T2DM组之间的差异无统计学意义（P〉0.05）,3组间的性别、年龄TC、LDL-C值差异无统计学意义（P〉0.05）。颈动脉粥样硬化不同情况的分布在3组间两两比较有显著性差异（χ~2=29.604,P=0.000）。在糖代谢异常人群中行Pearson相关分析发现Hcy水平与UA呈正相关（r=0.220,P=0.015）,同时UA水平与HDL-C、HbA_（1c）呈负相关（r=-0.234、P=0.009、-0.181,P=0.045）,与TG呈正相关（r=0.262,P=0.003）。Logistic回归分析表明TG（OR=4.193,95%CI1.504~11.693）及HbA_（1c）（OR=0.247,95%CI 0.085~0.722）水平升高是糖代谢异常患者颈动脉粥样硬化斑块形成的独立危险因素。结论 TG、HbA_（1c）是糖代谢异常患者颈动脉粥样硬化性斑块形成的独立危险因素,Hcy、UA水平在糖代谢异常人群中明显升高,同时关注糖代谢异常人群的血脂、血压、血糖及Hcy、UA水平对糖尿病大血管并发症的预防有积极的意义。Objective To analyze the risk factors of carotid atherosclerosis in the abnormal glucose metabolism.Methods Sixty-one healthy cases were selected as normal control group（NGT）,33 patients with impaired glucose tolerance（IGT） or / and impaired fasting glucose（IFG） were selected as pre diabetes group（IGR）,90 patients diagnosed as type 2diabetes were selected as type 2 diabetes mellitus group（T2DM）.Plasma Hey,UA,TG,TC,HDL-C,LDL-C,FPG,HbA_（1c）,SBP,DBP were compared among the three groups and the correlations between the indexes were analyzed,in addition,the Logistic regression analysis on the risk factors of carotid atherosclerotic plaque formation was given.Results TG,Hey,UA,FPG,HbA_（1c）,SBP,DBP of IGR group and T2 DM group were higher than NGT group（F =15.224,P = 0.000;F =2.785,P =0.001;F =5.501,P =0.005;F =28.392,P =0.000;F =45.617,P =0.000;F =6.770,P =0.000;F = 4.397,P =0.014） while HDL-C of IGR group and T2 DM group was lower than NGT group（F =7.102,P =0.001）,but there were no significant differences of these indexes between IGR group and T2 DM group（P 〉0.05）.Changes of LDLC,TC were not obvious among the three groups（P 〉0.05）.Changes of carotid artery atherosclerosis were obvious among the three groups（χ~2 =29.604,P =0.000）.In the subjects with abnormal glucose metabolism,Pearson correlation analysis revealed that the level of Hcy was positively correlated with UA（r =0.220,P =0.015）,while the level of UA was negatively correlated with HbA_（1c）,HDL-C（r =-0.234,P =0.009;r =0.181,P =0.045）,and was positively correlated with TG（r =0.262,P =0.003）.Logistic regression analysis revealed that TG（OR =4.193,95%CI 1.504-11.693） and HbA_（1c）（OR =0.247,95%CI 0.085- 0.722） levels were independent risk factors for carotid atherosclerotic plaque formation in patients with abnormal glucose metabolism.Conclusion TG,HbA_（1c）.are independent risk factors for the formation of abnormal glucose metabolism in patients with carotid atherosclerotic plaque

关 键 词：同型半胱氨酸 尿酸 糖尿病 颈动脉粥样硬化 糖代谢异常 

分 类 号：R587.1[医药卫生—内分泌]