严格血糖控制对新诊2型糖尿病患者颈动脉内膜中膜厚度的影响

The Predicting Effects of Glycemic Control on Common Carotid Artery Intima-Medial Thickness Progression in Newly Diagnosed Type 2 Diabetes Mellitus

目的探讨多危因素强化干预条件下,糖化血红蛋白水平对新诊2型糖尿病患者颈总动脉内膜中膜厚度的预测作用。方法超声测量348例2型糖尿病患者及112例健康对照者颈总动脉内膜中膜厚度,同时检测糖化血红蛋白水平,并对156例病程1年以内、无亚临床动脉粥样硬化的2型糖尿病患者进行干预治疗,探讨影响颈总动脉内膜中膜厚度进展的危险因素。结果2型糖尿病有动脉粥样硬化组糖化血红蛋白水平高于无动脉粥样硬化组(P<0.05);干预后颈总动脉内膜中膜厚度的下降幅度与糖化血红蛋白的下降幅度呈正相关(r=0.166,P=0.041),与基线糖化血红蛋白的水平呈负相关(r=-0.189,P=0.024);颈总动脉内膜中膜厚度进展组糖化血红蛋白下降幅度明显小于非进展组(P=0.023);Logistic回归分析显示糖化血红蛋白的下降幅度越大,颈总动脉内膜中膜厚度的进展越慢。结论对新诊2型糖尿病患者采取多危因素强化干预条件下,基线糖化血红蛋白水平及其干预后的下降幅度能够预测颈总动脉内膜中膜厚度的进展。

Aim To investigate the relationship between glycosylated haemoglobin （HbAlc） levels and intima-media thickness of fire common carotid artery （CCA-IMT） and the predicting effects of HbAlc on CCA-IMT in newly diagnosed type 2 diabetes （T2DM）, Methods The CCA-IMT was assessed using non-invasive high resolution B-mode uhrasonography, Age, sex, metabolic parameters including body mass index （BMI）, fasting plasma glucose （FPG）, HbMc, serum lipids, blood pres- sure, 24 h albuminuria （UALB） and CCA-IMT were compared among T2DM without subclinical atherosclerosis （As） （T2DM group }, T2DM with subclinical atherosclerosis （ As group） and T2DM with clinical atherosclerosis （ CHD group）. The 156 newly diagnosed T2DM （duration≤1 year） without atherosclerosis received the multifactorial targeted intervention, including taking aspirin and controlling blood glucose, blood pressure, blood lipid and body weight. The differences of metabolic control were analyzed between CCA-IMT progressive group and non- progressive group. Logistic regression analysis was used to disclose the cor- relation between the CCA-IMT and macrovascular risk factors. Results HbAlc levels were higher in CHD group fhan those in T2DM group and atherosclerosis group （ P 〈 0.01 ） . CCA-IMT had a linear correlation with HbAlc in T2DM patients （ r = 0. 106, P = 0. 049） . After mu]tifactorial intervention for 2 years, A CCA-IMT had a linear correlation with baseline HbA1 e （r= -0.189, P=0.024）and △HbA1c（ r = 0. 166, P=0.041）. △HbAlc was lower in the CCA-IMT progressive group than those in the CCA-IMT non-progressive group. Logistic regression analysis showed that AHbAlc was closely correlated with CCA-IMT. Conclusions HbAlc level was one of risk factors for CCA-IMT in T2DM. Under the multifactorial intervention for 2 years, baseline HbAlc and AHbAlc may predict the progression of CCA-IMT in patients with newly diagnosed type 2 diabetes.