颈动脉内-中膜厚度和血浆同型半胱氨酸与2型糖尿病大血管并发症的关系  

Study on the relationship between carotid intima-media thickness and plasma homocysteine in diabetic patients with macroangiopathy

作　　者：张蕊[1] 何建秋[1] 葛晓春[1] 高宇[1] ZHANG Rui, HE Jianqiu, GE Xiaochun, GAO Yu(Department of Endocrinology,Chengde Medical College Affiliated Hospital, Hebei Chengde 067000,China)

机构地区：[1]承德医学院附属医院内分泌科,河北承德067000

出　　处：《新疆医科大学学报》2018年第11期1380-1383,1387,共5页Journal of Xinjiang Medical University

基　　金：承德市科学技术局项目(201701A089)

摘　　要：目的探讨颈动脉内-中膜厚度和血浆同型半胱氨酸水平与2型糖尿病大血管并发症的关系。方法选取2017年3月-2018年3月于我院内分泌科就诊的T2DM合并与不合并大血管病变的120例患者,分为T2DM合并大血管病变组(A组)和单纯T2DM组(B组),每组60例。对比2组患者颈动脉内-中膜厚度(CIMT)、血浆同型半胱氨酸(Hcy)、体质指数(BMI)、空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿酸(UA)指标的差异;再将T2DM合并大血管病变组再分为颈动脉内-中膜轻度增厚(A1)、中度增厚(A2)、重度增厚(A3)3组,比较各组TC、TG、LDL-C和Hcy水平的差异。对糖尿病大血管病变独立危险因素进行Logistic回归分析。结果 T2DM合并大血管病变患者的UA、Hcy水平高于没有大血管病变的患者(P <0.05);大血管病变的发病率随着Hcy水平的升高而升高(P <0.05);颈动脉内-中膜中度和重度增厚的患者,其血Hcy的含量要明显高于轻度增厚的患者(P <0.05),T2DM患者血清Hcy水平与CIMT呈正相关(r=0.179,P <0.05);T2DM患者大血管病变的独立危险因素为年龄、UA、Hcy;CIMT增厚的独立危险因素为年龄、Hcy。结论颈动脉内-中膜厚度测量和血浆同型半胱氨酸对糖尿病大血管病变有重要意义,检测T2DM患者的Hcy水平对疾病的预防和治疗有重要的帮助。Objective To investigate the relationship between carotid intima-media thickness （CIMT） and plasma homocysteine （Hcy） in diabetic patients with macroangiopathy. Methods From March 2017 to March 2018, 120 patients with and without macroangiopathy were enrolled and divided into two groups： T2DM with macroangiopathy group （group A） and T2DM group （group B）, with 60 cases in each group. Carotid intima-media thickness （CIMT）, plasma homocysteine （Hcy）, body mass index （BMI）, fasting blood glucose （FPG）, postprandial blood glucose （2 hPG）, glycosylated hemoglobin （HbA1c）, triglyceride （TG）, total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C） were compared between the two groups. The T2DM patients with macroangiopathy were divided into three groups： mild , moderate and severe intima-media thickening. The levels of TC, TG, LDL-C and Hcy in each group were compared. Logistic regression analysis was performed of independent risk factors for diabetic macroangiopathy. Results The levels of UA and Hcy in patients with T2DM combined with macroangiopathy were higher than those without macroangiopathy （P 〈0.05）.The incidence of macroangiopathy increased with the increasing of Hcy level （P 〈0.05）.The level of serum Hcy in patients with moderate and severe carotid intima-media thickening was significantly higher than that in patients with mild carotid intima-media thickening （P 〈0.05）.The level of serum Hcy in patients with T2DM was positively correlated with CIMT （r=0.179, P 〈0.05）. The independent risk factors of macroangiopathy in T2DM patients included age, UA and Hcy; and the independent risk factors of CIMT thickening were age and Hcy. Conclusion The measurement of CIMT and Hcy is of great significance for the diabetic angiopathy, and the detection of Hcy in T2DM patients is important for the prevention and treatment of the disease.

关 键 词：糖尿病血管病变 颈动脉内-中膜厚度 血浆同型半胱氨酸 生物学标记 

分 类 号：R587.1[医药卫生—内分泌]