糖代谢异常和亚临床颈动脉粥样硬化的相关性  

Association of abnormal glucose regulation with subclinical carotid atherosclerosis in the healthy

作　　者：刘晓楠[1] 刘阳[1] 孟庆颖[1] 张蔚韡[2] 张龙友[1] 王瑞青[1] 孟莉[1] 郑华光[1] Liu Xiaonan;Liu Yang;Meng Qingying;Zhang Weiwei;Zhang Longyou;Wang Ruiqing;Meng Li;Zheng Huaguang(Health Management Center,Beijing Tiantan Hospital,Capital Medical University National Clinical Research Center for Neurological Diseases,Beijing 100070,China;Beijing Physical Examination Center,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京天坛医院健康管理中心,国家神经系统疾病临床研究中心,北京100070 [2]北京市体检中心,北京100029

出　　处：《中华健康管理学杂志》2021年第2期117-121,共5页Chinese Journal of Health Management

基　　金：国家重点研发计划(2018YFC1311203);首都卫生发展科研专项(2020-2-2244)。

摘　　要：目的调查亚临床颈动脉粥样硬化(SCAS)和糖代谢异常的相关性。方法在2018年9月至2019年6月在北京天坛医院健康管理中心参加体检的人群中,前瞻性连续纳入既往无明确糖尿病病史的体检者,收集人口学信息,高血压、血脂代谢异常等血管危险因素,生活方式及糖化血红蛋白(HbA1C)等生化检查资料。超声医师按照标准操作规程采用盲法评价颈动脉,判断是否存在颈动脉斑块或颈动脉内中膜增厚,分为SCAS组和无SCAS组。采用单因素和多因素Logistic回归分析糖尿病前期、糖尿病与SCAS的相关性。结果共纳入401例符合研究标准的体检者,年龄为(52.2±10.4)岁,女性170例(42.4%),其中糖尿病的患病率为16.4%(66/401),SCAS患病率为48.9%(196/401)。单因素分析显示:年龄≥60岁(OR=5.93,95%CI:3.86~9.09,P<0.01)、高血压(OR=2.76,95%CI:1.84~4.15,P<0.01)、糖尿病前期(OR=1.67,95%CI:1.08~2.58,P<0.05)和糖尿病(OR=3.60,95%CI:1.97~6.58,P<0.01)、吸烟(OR=2.64,95%CI:1.82~3.81,P<0.01)、HDL<1.04 mmol/L(OR=1.58,95%CI:1.04~2.42,P<0.01)和Hcy≥15μmol/L(OR=1.69,95%CI:1.17~4.04,P<0.01)增加SCAS的患病风险,女性(OR=0.53,95%CI:0.39~0.74,P<0.01)降低SCAS的患病风险。校正混杂因素后,糖尿病是SCAS的独立相关因素(OR=2.32,95%CI:1.16~4.67,P<0.05),而糖尿病前期(OR=1.48,95%CI:0.91~2.41,P>0.05)和SCAS的相关性无统计学意义。SCAS的独立相关因素还包括年龄≥60岁(OR=6.04,95%CI:3.13~11.7,P<0.01)、高血压(OR=2.14,95%CI:1.13~3.87,P<0.05)和吸烟(OR=2.19,95%CI:1.21~3.98,P<0.05)。结论在健康体检人群中,糖尿病和SCAS独立相关,糖尿病前期有增加SCAS风险的趋势。Objective To investigate the association of Subclinical Carotid AtheroSclerosis(SCAS)and prediabetes or Diabetes Mellitus(DM)in the healthy people.Methods From September 2018 to June 2019,participants who underwent physical examination in the Health Management Center of Beijing Tiantan Hospitial were enrolled consecutively.The baseline characters were collected prospectively.Carotid Ultrasound was evaluated by radiologists according to the standard operating protocol.Univariable analysis and multivariable logistic analysis were used to estimate the association of prediabetes or DM with SCAS.Results Totally 401 participants were eligible and enrolled.The mean age was(52.2±10.4)years and 43.7%(252/401)of them were females.The prevalence of DM and SCAS were 16.4%(66/401)and 48.9%(196/401)respectively.In the univariate analysis,elder age(≥60 years old)(OR=5.93,95%CI:3.86-9.09,P<0.001),hypertension(OR=2.76,95%CI:1.84-4.15,P<0.01),prediabetes(OR=1.67,95%CI:1.08-2.58,P<0.05)and DM(OR=3.60,95%CI:1.97-6.58,P<0.01),cigarettes smoking(OR=2.64,95%CI:1.82-3.81,P<0.001),lower HDLlevel<1.04 mmol/L(OR=1.58,95%CI:1.04-2.42,P<0.001)and hyperhomocysteinemia(≥15μmol/L)(OR=1.69,95%CI:1.17-4.04,P<0.01)were associated with higher prevalence of SCAS.On the contrary,female sex(OR=0.53,95%CI:0.39-0.74,P<0.001)was associated with lower prevalence of SCAS.In the multivariable logistic analysis,elder age(≥60 years old)(OR=6.04,95%CI:3.13-11.7,P<0.01),hypertension(OR=2.14,95%CI:1.13-3.87,P<0.05),cigarettes smoking(OR=2.19,95%CI:1.21-3.98,P<0.05)and DM(OR=2.32,95%CI:1.16-4.67,P<0.05)were associated with SCAS independently.The association between prediabetes and SCAS was not statistically significant.Conclusions DM is independently associated with SCAS in neurological healthy people,while prediabetes tended to increase the risk of SCAS.

关 键 词：亚临床颈动脉粥样硬化 糖尿病前期 糖尿病 糖化血红蛋白 

分 类 号：R587.1[医药卫生—内分泌] R543.5[医药卫生—内科学]