不同性别糖尿病患者双侧颈动脉僵硬度的对照研究

Comparative study of stiffness between bilateral carotids in different gender patients with type 2 diabetes mellitus

目的评价不同性别2型糖尿病患者双侧颈动脉僵硬度的差异。方法 2型糖尿病患者64例,依据性别分为男(37例)、女(27例)2组。采用超声射频技术获取受检者左、右侧颈动脉血管僵硬度参数(α、β)、脉搏波速度(PWV)和颈动脉内-中膜厚度(CIMT)。计算左、右颈动脉僵硬参数值之差,获取α差值(αdiff)、β差值(βdiff)、脉搏波速度差值(PWVdiff)参数。比较左、右侧颈动脉结构和功能的差异,分析其相关因素。结果男性糖尿病患者左、右侧CIMT分别为(674.7±145.6)μm和(653.6±117.2)μm,女性患者左、右侧CIMT分别为(637.7±171.2)μm和(624.6±157.2)μm,不同性别糖尿病患者左、右侧CIMT差异均无统计学意义(t值分别为-0.767、-0.701,P均>0.05)。男性糖尿病患者左、右侧α分别为5.1±2.7和4.2±1.7,β分别为10.5±5.4和8.6±3.4,左侧α和β均高于右侧,且差异均有统计学意义(t值分别为2.229、2.244,P均<0.05)。男性糖尿病患者αdiff、βdiff和PWVdiff均与收缩压、颈动脉窦部收缩压、尿素和肌酐呈正相关(αdiff:r值分别为0.497、0.639、0.541、0.619,βdiff:r值分别为0.495、0.639、0.540、0.620,PWVdiff:r值分别为0.478、0.643、0.520、0.593,P均<0.05)。女性糖尿病患者αdiff、βdiff和PWVdiff均与身高和体重呈负相关(αdiff:r值分别为-0.579、-0.669,βdiff:r值分别为-0.579、-0.672,PWVdiff:r值分别为-0.570、-0.684,P均<0.05);与颈动脉窦部收缩压、低密度脂蛋白胆固醇、尿素呈正相关(αdiff:r值分别为0.538、0.621、0.651,βdiff:r值分别为0.537、0.620、0.650,PWVdiff:r值分别为0.529、0.621、0.642,P均<0.05)。结论不同性别2型糖尿病患者双侧颈动脉僵硬度有差异,男性左侧颈动脉僵硬度高于右侧,女性左、右侧间无明显差异。双侧颈动脉僵硬度差值受不同的危险因素作用权重不同。

Objective To preliminarily evaluate the stiff difference of the bilateral carotids in men and women with type 2 diabetes mellitus.Methods Sixty-four patients with type 2 diabetes mellitus were divided into two groups according gender.The stiffness(α and β),pulse wave velocity(PWV)and carotid intima media thickness(CIMT)of bilateral carotid were measured by ultrasound radio-frequency technique.Moreover,the difference of β,α and PWV between bilateral carotids was calculated and the βdiff,αdiff and PWVdiff were obtained.The structure and function of bilateral carotids were compared,the βdiff,αdiff and PWVdiff were analyzed and the correlative factors were discussed.Results For male patients,the CIMT of left and right carotids was(674.7±145.6) μm and(653.6±117.2)μm,respectively.For female patients,the CIMT of left and right carotids was(637.7±171.2)μm and(624.6±157.2)μm,respectively.There was no significant difference between male and female(t=-0.767 and-0.701,both P>0.05).For male,the α and β of left carotid were higher than those of right carotid(α:5.1±2.7 and 4.2±1.7,t=2.229,P<0.05;β:10.5±5.4 and 8.6±3.4,t=2.244,P<0.05);but for female,the α,β and PWV had statistical difference between left and right carotids.For men,αdiff,βdiff and PWVdiff were positively related with SBP,Loc-Psys,blood urea nitrogen and serum creatinine(αdiff:r=0.497,0.639,0.541 and 0.619;βdiff:r=0.495,0.639,0.540 and 0.620;PWVdiff:r=0.478,0.643,0.520 and 0.593;all P<0.05),but for women,αdiff,βdiff and PWVdiff were negatively related to height and weight and positively related to Loc-Psys,LDL-C and blood urea nitrogen(αdiff:r=-0.579,-0.669,0.538,0.621 and 0.651;βdiff:r=-0.579,-0.672,0.537,0.620 and 0.650;PWVdiff:r=-0.570,-0.684,0.529,0.621 and 0.642;all P<0.05).Conclusions For patients with type 2 diabetes mellitus,there is significant difference between stiffness of left and right carotids.For male patients,the stiffness of left carotids is higher than that of right carotids,but for women there is no significant difference between bilateral carotids.The weight of risks acting on bilateral carotids is different.