2型糖尿病患者颈动脉内膜中层厚度与体位性低血压及相关危险因素的关系  

Relationship between carotid artery intima-media thickness and orthostatic hypotension and related risk factors in type 2 diabetes mellitus

作　　者：付慧 王博[1] 刘晓燕[2] 李宝新[3] 王翯[3] 张云良[3] Fu Hui;Wang Bo;Liu Xiaoyan(Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院,河北承德067000 [2]承德医学院附属医院内分泌科 [3]保定市第一中心医院内分泌科

出　　处：《临床内科杂志》2018年第9期599-601,共3页Journal of Clinical Internal Medicine

基　　金：河北省医学科学研究重点课题计划（20160282）

摘　　要：目的 通过对2型糖尿病（T2DM）患者中颈动脉内膜中层增厚者进行体位性低血压分析,探讨体位性低血压与T2DM颈动脉内膜中层厚度（cIMT）的相关性,分析T2DM患者cIMT的影响因素.方法 选择住院T2DM患者293例,依据cIMT分为3组：T1组（cIMT〈1.0 mm、内膜正常、回声均匀）、T2组（1.0 mm≤cIMT〈1.5 mm、内膜局限性增厚、回声增强、管腔规则）、T3组（cIMT≥1.5 mm伴或不伴有管腔钙化狭窄）.检测3组患者BMI、血脂、空腹C肽、糖化血红蛋白（HbA1c）、卧立位血压等指标并进行比较.结果 T2DM住院患者中体位性低血压的总发生率为32.76％,T1组、T2组、T3组的发生率分别为18.18％、32.65％和47.91％,两两比较差异均有统计学意义（P〈0.05）.有序logistic回归分析结果提示,T2DM患者年龄大、病程长、BMI高及甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、HbA1c升高为cIMT的独立危险因素,空腹C肽、高密度脂蛋白胆固醇（HDL-C）及载脂蛋白AⅠ（ApoAⅠ）升高为cIMT的独立保护因素（P〈0.05）.结论 T2DM患者中体位性低血压发生率较高,且cIMT增加会影响体位性低血压的发生率,控制影响cIMT的危险因素对T2DM患者体位性低血压的预防有重要意义.Objective To analyze the incidence of postural hypotension in patients of type 2 diabetes mellitus（T2DM） with carotid intima-media thickness（cIMT） ,in order to explore the correlation between postural hypotension and cIMT and the influencing factors of cIMT in T2DM patients. Methods A total of 293 T2DM patients were selected and divided into three groups according to cIMT,T1 group（ cIMT 〈 1.0 mm, normal endometrium, uniform echo）, T2 group （ 1.0 mm ≤ cIMT 〈 1.5 mm, endometrial thickening, echo enhancement, lumen regulation） and T3 group （ cIMT ≥1.5 mm or without calcified stenosis）. All subjects were measured for BMI, blood lipids, fasting C peptide, glycosylated hemoglobin （ HbAlc ） , lying and standing blood pressure and so on. Compare the statistical significance of indicators among the three groups. Results The overall incidence of postural hypotension was 32. 76% in T2DM patients. The incidences of postural hypotension were 18.18% ,32.65% and 47.91% in the T1 ,T2 and 33 group, respectively. The incidences were statistically significant through pairwise comparison （ P 〈 0. 05 ）. Ordered logistic regression analysis suggested that advanced age, long disease duration, high BMI, triglyceride （TG） ,low-density lipoprotein cholesterol （LDL-C） and HbAlc increasing were independent risk factors for cIMT,while fasting C-peptide, high-density lipoprotein cholesterol （HDL-C） and apolipoprotein A I （ ApoA I ） increasing were independent protective factors of cIMT （ P 〈 0.05 ）. Conclusion Orthotopic bypotension in patients with T2DM has a high incidence, and the increase of clMT affects the incidence of orthostatic hypotension, so controlling the risk factors of cIMT is important for the prevention of orthostatic hypotension.

关 键 词：2型糖尿病 颈动脉内膜中层厚度 体位性低血压 影响因素 

分 类 号：R587.2[医药卫生—内分泌]