C反应蛋白对新诊2型糖尿病患者颈总动脉内中膜厚度进展的预测作用

Predicting value of high-sensitive C-reactive protein on progression of common carotid artery intima- media thickness in newly diagnosed type 2 diabetes

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.