2型糖尿病患者颈动脉和下肢动脉粥样硬化分级与心脑血管疾病关系的研究  

Association of carotid artery and lower-extremity artery atherosclerosis and coronary heart disease or cerebral infarction in type 2 diabetes

作　　者：刘珊[1,4] 周翔海[1] 胡萍[1] 庞梦端 段妍[1] 刘艳[1] 刘越素[2] 许林鑫[3] Liu Shan Zhou Xianghai Hu Ping Pang Mengduan Duan Yan Liu Yah Liu Yuesu Xu Linxin(Department of Endocrinology and Metabolism, Peking University People＇s Hospital, 100044, China)

机构地区：[1]北京大学人民医院内分泌科,100044 [2]山西医科大学第二附属医院内分泌科,太原030001 [3]山西医科大学第一附属医院内分泌科,太原030001 [4]石家庄市第二医院内分泌科

出　　处：《中华内分泌代谢杂志》2016年第12期989-994,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的研究住院2型糖尿病患者颈动脉和下肢动脉粥样硬化分级与心脑血管疾病的关系。方法收集1 503例平均年龄（55.8±12.9）岁的住院2型糖尿病患者病历资料，采用血管彩超检查评估颈动脉和下肢动脉内-中膜厚度、粥样硬化斑块和管腔直径，依动脉粥样硬化程度分为4级：无动脉粥样硬化（1级）；动脉内-中膜增厚（2级）；粥样硬化斑块形成（3级）；动脉狭窄≥20%（4级）。冠心病及脑梗塞病史来自病历记录。采用logistic多因素回归分析颈动脉和下肢动脉粥样硬化分级与冠心病、脑梗塞的相关性。结果多因素调整后回归分析显示，与颈动脉1级患者比较，颈动脉3级和4级患者的冠心病患病风险增加[OR＝2.30（95%CI 1.17-4.53），OR＝4.05（95%CI 1.88-8.74）]，脑梗塞患病风险增加[OR＝1.95（95%CI 1.22-3.10），OR＝2.68（95%CI 1.50-4.77）]。与下肢动脉1级患者比较，下肢动脉3和4级患者冠心病患病风险增加[OR＝2.39（95%CI 0.99-5.74），OR＝4.10（95%CI 1.44-11.67）]；下肢动脉2、3和4级患者脑梗塞患病风险增加[OR＝2.20（95%CI 1.05-4.63），OR＝3.60（95%CI 1.82-7.10）和OR＝3.15（95%CI 1.32-7.50）]。与颈动脉和下肢动脉分级均为1或2级患者相比，颈动脉和下肢动脉分级均为3或4级的患者，冠心病和脑梗塞的患病风险均增高；而仅有一个部位动脉分级为3或4级者，其冠心病和脑梗塞患病风险无明显增高。结论可以采用简单的动脉硬化分级方法评估2型糖尿病患者颈动脉或下肢动脉粥样硬化程度。如同时评估颈动脉和下肢动脉粥样硬化，仅当两者均出现斑块或狭窄时，冠心病或脑梗塞的患病风险显著增高。Objective To investigate the association of carotid artery and lower-extremity artery atherosclerosis to coronary heart disease or cerebral infarction in diabetes mellitus. Methods Medical records of 1 503 hospitalized patients with type 2 diabetes aged （55.8±12.9 ） years were collected. Doppler-ultrasound of the carotid and lower-extremity arteries was used to assess the intima-media thickness, plaques, and diameter of the vessels. The degrees of carotid and lower-extremity artery atherosclerosis were classified into free of atherosclerosis （ Grade 1 ） , increased intima-media thickness （ Grade 2 ） , presence of plaques （ Grade 3 ） , and stenosis/〉 20% （ Grade 4 ）. Histories of coronary heart disease and cerebral infarction were obtained from the medical records. Logistic regression analysis was used to estimate OR （ 95% CI） for the presence of coronary heart disease and cerebral infarction. Results Multivariate adjusted ORS （95% CI） for the presence of coronary heart disease were 2.30（ 1.17- 4.53 ） and 4.05 （ 1.88-8.74 ） in patients at Grade 3 and Grade 4 in carotid arteries, respectively, as compared with patients at Grade 1 in carotid arteries. The ORs （95% CI） for the presence of cerebral infarction were 1.95 （ 1.22- 3.10） and 2.68 （ 1.50-4.77 ） in patients at Grade 3 and Grade 4 in carotid arteries, respectively. Multivariate adjusted ORs（95% CI） for the presence of coronary heart disease Were 2.39（0.99-5.74） and 4.10（1.44-11.67） in patients at Grade 3 and Grade 4 in lower-extremity arteries, respectively, as compared with patients at Grade 1 in lower-extremity arteries. For the presence of cerebral infarction, the ORs （95% CI） were 2.20 （ 1.05-4.63 ）, 3.60 （ 1.82-7.10）, and 3.15 （1.32-7.50） in patients at Grade 2, Grade 3, and Grade 4 in lower-extremity arteries, respectively. Patients at Grade 3 or Grade 4 in both vascular locations were at a higher risk of coronary heart disease or cerebral infarction as compare with patients

关 键 词：糖尿病 2型 动脉粥样硬化 冠心病 脑梗塞 颈动脉分级 

分 类 号：R587.2[医药卫生—内分泌] R54[医药卫生—内科学] R743[医药卫生—临床医学]