摘要
目的探讨多因素强化干预条件下高敏C反应蛋白(hsCRP)水平对新诊2型糖尿病患者颈总动脉内中膜厚度(CCA-IMT)进展的预测作用。方法超声测量318例2型糖尿病患者及112例健康对照者的CCA-IMT,同时检测高敏C反应蛋白水平,并对170例病程1年以内、不伴动脉粥样硬化的2型糖尿病患者进行干预治疗,探讨影响CCA-IMT进展的危险因素。结果高敏C反应蛋白≥1.16mg/L的2型糖尿病患者CCA-IMT分别高于其他3组高敏c反应蛋白较低者(P〈0.05);2型糖尿病患者CCA-IMT与高敏C反应蛋白呈直线相关(r=0.145,P=0.008);高血压病史、饮酒史、高密度脂蛋白胆固醇、糖化血红蛋白是影响高敏c反应蛋白的独立危险因素;强化干预2年后高敏C反应蛋白水平[0.50mg/L(0.01~6.63mg/L)]较基线值[0.60mg/L(0.04~7.84mg/L)]显著下降(P〈0.01),而CCA-IMT[(0.70±0.21)mm]与基线值[(0.71±0.09)mm]比较差异无统计学意义(P〉0.05);CCA-IMT非进展组患者高敏C反应蛋白降幅[0.07mg/L(-6.47~7.36mg/L)]显著高于进展组患者[0.01mg/L(-7.75~2.93mg/L),P〈0.01]。logistic回归分析显示干预2年后高敏C反应蛋白降幅与CCA-IMT进展独立关联。结论对新诊2型糖尿病患者采取多因素干预,其高敏C反应蛋白水平下降幅度可预测CCA-IMT的进展。
Objective To investigate the predicting value of high-sensitive C-reactive protein (hsCRP) level on progression of intima-media thickness of common carotid artery (CCA-IMT) in patients with newly diagnosed type 2 diabetes (T2DM). Methods CCA-IMT was assessed using non-invasive high resolution B-mode ultrasonography and plasma level of hsCRP was determined with latex-enhanced immunonephelometer method in 318 patients with newly diagnosed T2DM and 112 controls. Multifactorial targeted intervention was implemented for 170 T2DM patients with a length of course equal to or less than one year and without atherosclerosis to disclose factors affecting progression of CCA-IMT. Results CCA-IMT was greater in T2DM patients with hsCRP level at the top quartile than that in those with hsCRP levels at other three quartiles ( P 〈 0. 05 ). CCA-IMT correlated linearly with plasma level of hsCRP in T2DM patients (r = 0. 145, P = 0. 008 ) . Multivariate analysis showed that history of hypertension and alcohol comsumption, plasma levels of high-density lipoprotein-cholesterol ( HDL-C ) and glycosylated hemoglobin Alc (HbAlc) in patients with T2DM were all independent factors associated with their plasma level of hsCRP. Two years after intensive multifactorial intervention, plasma level of hsCRP [0. 50 mg/L (0. 01-6. 63 mg/L) ] significantly lowered in patients of T2DM, as compared to the baseline [0. 60 mg/L (0. 04-7.84 mg/L), P 〈0. 01 ], but no difference in CCA-IMT before [ (0. 71±0. 09) mm] and after [ (0. 70 ± 0. 21 ) mm] intervention was found ( P 〉 0. 05 ). Decrement of hsCRP level in patients without progression of CCA-IMT [0. 01 mg/L( -7.75±2. 93 mg/L) ] was significantly greater than that in those with progression [0. 07 mg/L( - 6. 47 ±7.36 mg/L), P 〈 0. 01 ]. Logistic regression analysis showed that decrement of hsCRP level was independently correlated with CCA-IMT two years after intervention. Conclusion Plasma level of hsCRP could be lowered by multifactorial intervention for patients with T2DM, which could be used to predict progression of CCA-IMT.
出处
《中华全科医师杂志》
2006年第5期278-282,共5页
Chinese Journal of General Practitioners
基金
"十五"国家科技攻关计划项目(2001BA702B01
2001BA702B04)
湖南省科学技术厅科技计划项目(02SSY3065)
关键词
糖尿病
非胰岛素依赖型
C反应蛋白质
动脉硬化
血管内膜
Diabetes mellitus, non-insulin-dependent
C-reactive protein
Arteriosclerosis
Tunica intima