老年糖尿病患者胰岛素第一相分泌与颈动脉粥样硬化的相关性  

Correlation between First Phase Insulin Secretion and Carotid Atherosclerosis in Elderly Patients with Type 2 Diabetes Mellitus

作　　者：周熙琳[1] 王丹丹 杨婕[1] 石群[1] ZHOU Xi-lin;WANG Dan-dan;YANG Jie;SHI Qun(Chongming Branch of Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai,202150,China)

机构地区：[1]上海交通大学医学院附属新华医院崇明分院,上海202150

出　　处：《现代生物医学进展》2021年第20期3997-4000,共4页Progress in Modern Biomedicine

基　　金：上海市科学技术委员会科研项目(10411956600)。

摘　　要：目的:探讨老年糖尿病患者胰岛素第一相分泌与颈动脉粥样硬化(CAS)的相关性。方法:回顾性分析选择2020年5月~2020年10月我院收治的160例老年T2DM患者(T2DM组)、50例健康体检者(对照组)的临床资料。根据餐后30 min胰岛素测定胰岛素增值(△INS),将T2DM患者分为低△INS组(n=77)、高△INS组(n=83),另根据是否并发CAS,分为CAS组(n=92)和非CAS组(n=68)。比较各组基本资料、血糖、血脂指标及△INS,采用多因素logistic回归分析△INS与CAS发生的相关性。结果:与对照组比较,高、低△INS组斑块检出率、颈动脉内-中膜厚度(cIMT)明显升高(P<0.05);低△INS组斑块检出率、cIMT均较高△INS组明显升高(P<0.05)。CAS组和非CAS组老年T2DM患者的年龄、病程、SBP、HDL-C、LDL-C、TC、FPG、HOMA-IR及△INS比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,病程、HOMA-IR是T2DM患者并发CAS的独立危险因素,而HDL-C、△INS则是保护性因素(P<0.05)。结论:老年T2DM患者普遍存在第一相胰岛素分泌受损,且与CAS密切相关。加强第一相胰岛素分泌监测,并定期行颈动脉超声检查,对于老年T2DM患者血糖控制及CAS早期防治具有重要临床意义。Objective: To explore the correlation between the first phase insulin secretion and carotid atherosclerosis(CAS) in elderly patients with type 2 diabetes mellitus(T2 DM). Methods: A total of 160 elderly patients with T2 DM(T2 DM group) who were admitted to Chongming Branch of Xinhua Hospital from May 2020 to October 2020 and 50 healthy subjects(control group) were selected.The clinical data of the two groups were retrospectively analyzed. According to insulin increment(△INS) after postprandial insulin for30 min,T2 DM patients were divided into low △INS(n=77) and high △INS(n=83). In addition, the patients in the T2 DM group were divided into CAS group(n=92) and non-CAS group(n=68) according to whether there was concurrent CAS. Basic data, blood glucose and blood lipid indexes and △INS were compared between the groups, and the correlation between △INS and CAS was analyzed by multivariate logistic regression. Results: Compared with the control group, the plaque detection rate and c IMT were significantly increased in the high and low △INS group(P<0.05). Low △INS group had higher plaque detection rate and carotid intima-media thickness(c IMT)(P<0.05). There were significant differences in the age, course of disease, SBP, HDL-C, LDL-C, TC, FPG, HOMA-IR and△INS between the CAS group and the non-CAS group(P<0.05). Multivariate logistic regression analysis showed that disease course and HOMR-IR were independent risk factors of CAS occurrence in T2 DM patients, while HDL-C and △INS were protective factors(P<0.05). Conclusions: Impaired secretion of the first phase insulin is common in elderly patients with T2 DM, which is closely related to CAS.Strengthening the monitoring of the first-phase insulin secretion and regular carotid artery ultrasound examination are of great clinical significance for blood glucose control and early CAS prevention and treatment in elderly T2 DM patients.

关 键 词：2型糖尿病 老年 胰岛素第一相分泌 颈动脉硬化 相关性 

分 类 号：R587.2[医药卫生—内分泌] R543[医药卫生—内科学]