2型糖尿病血糖控制不达标患者身体活动量与颈动脉内膜中层增厚相关性的研究  

Correlation between levels of physical activity and carotid intima-media thickening in patients with type 2 diabetes mellitus with poor glycosylated hemoglobin control

作　　者：方丹 崔茜 楼青青 孙珍珍 陈晓栋[5] 姚平[6] 袁晓丹[7] FANG Dan;CUI Qian;LOU Qingqing(The College of Nursing,Nanjing University of Chinese Medicine,Nanjing 210023,China)

机构地区：[1]南京中医药大学护理学院,210023 [2]南京医科大学附属常州第二人民医院内分泌科 [3]海南医学院第一附属医院代谢性疾病临床医学研究中心 [4]南京中医药大学附属医院内分泌科 [5]南京中医药大学附属中西医结合医院心血管内科 [6]南京中医药大学附属中西医结合医院内分泌科 [7]南京中医药大学附属中西医结合医院公共卫生科

出　　处：《中国糖尿病杂志》2025年第2期90-97,共8页Chinese Journal of Diabetes

基　　金：国家重点研发计划(2021YFE0204800);国家中医临床研究基地开放课题(JD2019SZ15);2023年度预防医学课题面上项目(Ym2023048);2024年江苏省研究生实践创新计划(SJCX24_0836)。

摘　　要：目的 探讨HbA_(1)c不达标的T2DM患者身体活动量(PA)对颈动脉内膜中层厚度(CIMT)增厚的影响。方法 选取2019年1月至2022年2月于南京中医药大学附属中西医结合医院和南京医科大学附属常州第二人民医院内分泌科住院的HbA1c不达标的T2DM患者2505例,根据代谢当量(MET)分为轻度PA组(1~599 MET-min/w,n=795)、中度PA组(600~1499 MET-min/w,n=1107)和高强度PA组(≥1500 MET-min/w,n=603)。Logistic回归分析PA与CIMT增厚的关系,分层探讨不同PA的BP和LDL-C达标情况对CIMT增厚的影响。结果 限制性立方样条图显示,PA与CIMT增厚的风险存在非线性关系(P<0.05)。Logistic回归分析显示,以中度PA为对照,高强度PA是CIMT增厚的影响因素(OR1.581,95%CI 1.244~2.010,P<0.05)。分层结果显示,轻度PA时,以BP和LDL-C均不达标为对照,任一指标达标及两指标均达标是CIMT增厚的影响因素;仅BP达标为对照,两指标均达标和两指标均不达标及仅LDL-C达标是CIMT增厚的影响因素;仅LDL-C达标为对照,两指标均不达标和仅BP达标是CIMT增厚的影响因素。高强度PA时,两指标均达标是CIMT增厚的影响因素。结论 中度PA为预防HbA_(1)c不达标T2DM患者CIMT增厚的推荐方案,轻度PA与CIMT增厚风险不相关,高强度PA是CIMT增厚风险的影响因素,关注LDL-C达标对避免CIMT增厚尤为重要。Objective To explore the effects of physical activity(PA)on carotid intima-media thickness(CIMT)thickening in patients with type 2 diabetes mellitus(T2DM)with poor HbA_(1)c control.Methods A total of 2505 T2DM inpatients with poor HbAic control who visited the Endocrinology Department of the Integrated Traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Traditional Chinese Medicine and Changzhou Second People's Hospital Affiliated with Nanjing Medical University from January 2019 to February 2022 were enrolled in this study.The patients were categorized into the mild-intensity PA(1~599 MET-min/w,n=795),moderate-intensity PA(600~1499 MET-min/w,n=1107)and high-intensity PA(≥1500 MET-min/w,n=603)based on the metabolic equivalence level(MET).Logistic regression was performed to analyze the relationship between PA and CIMT thickening.Statified analysis was used to investigate the effects of blood pressure(BP)and low-density lipoprotein cholesterol(LDL-C)target status on CIMT thickness in different PA groups.Results Restricted cubic spline plots showed a nonlinear relationship between PA levels and the risk of CIMT thickening(P<0.05).Logistic regression showed that with moderate-intensity PA as the control,while high-intensity PA was the influence factor of CIMT thickening(OR 1.581,95%CI 1.244~2.010,P<0.05).Statified analyses showed that under mild-intensity PA,using neither BP nor LDL-C on target as reference,achievement of either index and both were the influence factor of CIMT thickening.Using BP on target as reference,achievements of both indexes,achievements of neither of both indexes,and achievement of LDL-C only were the influence factor of CIMT thickening.Using LDL-C on target as reference,achievement of neither of them and achievement of BP only were the influence factor of CIMT thickening.Under high-intensity PA,achievement of both indexes was negatively associated with CIMT thickening.Conclusions Moderate-intensity PA is the recommended scheme to prevent CIMT thickening

关 键 词：糖尿病 2型 身体活动 颈动脉内膜中层厚度 代谢当量 

分 类 号：R587.2[医药卫生—内分泌]