藏族人群高血糖症与颈动脉粥样硬化的关系

Relationship between hyperglycemia and carotid atherosclerosis in Tibetan population

目的:探讨藏族人群高血糖症与颈动脉粥样硬化的关系。方法:以拉萨市藏族人群为研究对象,进行临床调查、生化检查和颈动脉检查。检查并分析449例藏族人的糖耐量,糖基化血红蛋白、血压、血脂、空腹胰岛素含量和颈总动脉内中膜厚度。结果:根据糖耐量试验的结果,将研究对象分为3组:正常糖耐量组(NGT)352例,糖耐量低减组(IGT)62例,糖尿病组(DM)35例。患者糖耐量异常的程度越高,患者年龄越大(P<0.01),高血压发病率越高(P<0.05),胰岛素抵抗指数(HOMA-IR)越大(P<0.001),糖基化血红蛋白值越高(P<0.01),血糖(P<0.001)、甘油三酯浓度(P<0.05)越高,高密度脂蛋白-胆固醇水平越低(P<0.05)。IGT和DM组的颈动脉粥样硬化程度远比NGT组严重(P<0.001)。多元回归分析表明,增龄、胆固醇、甘油三酯、低密度脂蛋白、糖基化血红蛋白和胰岛素抵抗指数的自然对数ln(HOMA-IR)是颈动脉粥样硬化的独立危险因素(P<0.05)。结论:高糖血症的藏族人群动脉粥样硬化程度严重。糖基化血红蛋白、增龄、血脂异常、胰岛素抵抗是颈动脉粥样硬化的重要因素。

Objective： To investigate the relationship between hyperglycemia and carotid atherosclerosis （AS） in Tibetan population. Methods： The subjects were recruited among Tibetan residents living in Lhasa. Glucose tolerance, HbA1c, blood pressure, serum lipid, fasting insulin levels, and common carotid mean intima-media thickness （IMT） were assessed in a random sample of 449 Tibetan cases. Results： Individuals were subdivided into 3 groups according to OGTT results： Normal glucose tolerance （NGT） group （352 cases）, impaired glucose tolerance （IGT） group （62 cases）, and diabetes mellitus （DM） group （35 cases）. Individuals with higher degrees of glucose intolerance were significantly older （P〈0.01）, more prevalence in hypertension （P〈0. 05）, much more severe in insulin resistance （higher HOMA-IR values, P〈0. 001）, and had higher levels of HbA1c （P〈0.01）, plasma glucose （P〈0. 001）,triglyceride （P〈0.05）, and lower levels of HDL cholesterol （P〈0.05）. The carotid atherosclerosis of IGT and DM group was much more severe than that of NGT group （P〈0. 001）. With multivariate regression analysis, age, TC （ total cholesterol）, TG （triglyceride）, LDL-C （low density lipoprotein cholesterol）, HbA1c and In （HOMA- IR） levels were independent risk factors for carotid atherosclerosis （P〈0.05）. Conclusion： Tibetan subjects with hyperglycemia have severe atherosclerotic damage. HbA1c, aging, dyslipidemia, insulin resistance are found to be significant independent risk factors of carotid atherosclerosis.