四种干预方案对新诊2型糖尿病亚临床动脉粥样硬化的影响

Effects of four regimens on subclinical atherosclerosis in newly diagnosed type 2 diabetic patients

目的探讨四种干预方案对新诊断2型糖尿病(T2DM)亚临床动脉粥样硬化(AS)的影响。方法采用前瞻性、病例对照研究设计,将170例(156例完成随访)无AS的新诊断T2DM患者随机分为四组:A组(强化降糖+降压治疗)、B组(强化降糖+降压+调脂治疗)、C组(在B组基础上加服维生素E0·2g/d)及D组(在B组基础上加服复方丹参滴丸30丸/d)。多因素干预2年,随访观察四组亚临床AS的发生情况及其代谢的控制情况。结果B组、C组、D组亚临床AS发生率均显著低于A组;TC和LDL-C水平较基线下降,均显著低于A组,达标率亦显著高于A组;但B、C、D组间差异无统计学意义;分析显示亚临床AS的发生与干预方案有关。结论在强化降糖、降压基础上加用调脂治疗更有利于减少新诊断T2DM患者亚临床AS的发生,口服维生素E或复方丹参滴丸对其亚临床AS的发生无保护作用。

Objective To investigate the effects of four regimens on subclinical atherosclerosis （AS） in newly diagnosed type 2 diabetic patients. Methods A prospective and case-controlled study was used. One handred and seventy newly diagnosed type 2 diabetic patients without AS were divided into 4 groups： group A （intensive blood glucose and blood pressure control）, group B（intensive blood glucose and blood pressure and blood lipid controls）, group C （vitamin E was prescribed based on B regimen）, and group D（Compound Danshen Pill was prescribed based on B regimen）. The incidence of subclinical AS and status of metabolic control at two years of intervention were compared among four groups. Results In group B, C and D, the morbidities of subclinical AS were significantly lower than that in group A（27.5%, 33.3%, 27.5% vs 56.8%, all P〈0.05）. In the three groups above, serum TC and LDL-C levels were significantly decreased as compared with baseline, and lower than those in group A （P〈0. 001 and P〈0.01 ,respectively）. Their targeted frequencies of TC and LDL-C were significantly higher than those in group A（P〈0.05）. But no difference was found in these status among group B, C, D （P〉0.05）. Logistic regression analysis showed that the risk factors related to subclinical AS development were intervention regimens. Conclusions The regimen of blood lipid control added to the intensive blood glucose and blood pressure interventions was more effective to reduce the incidence of subclinical AS in newly diagnosed type 2 diabetic patients. No beneficial effect on subclinical AS in those patients was found in 2-year supplementation of vitamin E and compound Danshen pill.