老年糖代谢异常患者颈动脉硬化与C反应蛋白的关系

Relationship between carotid atherosclerosis and C-reactive protein in the elderly with abnormal glucose metabolism

目的:了解老年糖代谢异常患者颈总动脉内中膜厚度(IMT)与C反应蛋白(CRP)水平的关系。方法:158例年龄为68～93岁老年非糖尿病患者,每例均行标准75g口服糖耐量试验,同时测定血脂、血清CRP水平、空腹胰岛素等生化指标。超声测定颈总动脉内IMT并了解斑块情况。结果:患者中糖耐量正常者(NGT组)48例,糖耐量异常者(IGT组)71例,2型糖尿病(DM组)39例,3组体重指数、血压、血脂等均无明显差异。3组颈总动脉IMT均值分别为0.72、0.78、0.83mm,DM组及IGT组较NGT组显著升高(P<0.01),DM组与IGT组间差异无显著性,DM组斑块发生率(62%)明显高于其他两组(P<0.01)。3组CRP水平分别为(1.05±0.64)、(1.77±0.82)、(2.03±0.63)mg/dL,并呈上升趋势,两两比较DM组及IGT组较NGT组差异有显著统计学意义(P<0.01),而DM组与IGT组间无明显差异。结论:老年糖耐量异常人群颈总动脉IMT明显增厚,CRP水平明显升高,提示慢性亚临床炎症在2型糖尿病的发生发展过程中起到一定作用。

Objective To evaluate the relationship between carotid intima- media thickness （IMT） and C- reactive protein in the elderly with abnormal glucose metabolism. Method One hundred and fifty-eight subjects aged 68- 93 years, who had no conclusive medical records of diabetes ever before, received 75g oral glucosotolerance test （OGTT）. Serum lipid, CRP levels, and fasting insulin were measured. The IMT of the common carotid artery（CCA） and the carotid plaque were measured by B mode ultrasonography. Results There were 48 patients with normal glucose tolerance （Group NGT, n = 48）, 71 with impaired glucose tolerance （Group IGT, n = 71） and 39 with newly diagnosed type 2 diabetes （Group DM, n = 39）. There were no significant differences among the three groups in BMI,BP, and lipid. The mean value of IMT of CCA in Group NGT was 0.72 mm,which was significantly lower than those in Group IGT and DM （0.78 mm and 0.83 mm）, and there was no significant difference between Group DM and IGT. The incidence of plaque in Group DM was significantly higher than those in Group IGT and NGT. The CRP level in Group NGT was （1.05 ± 0.64）mg/dL, which was significantly lower than those in Group IGT and DM [（1.77 ± 0.82）,（2.03 ± 0.63）mg/dL] respectively. Conclusion IMT and CRP level increased significantly in the elderly with abnormal glucose metabolism, which suggested that chronic inflammation may play an important role in the development of type 2 diabetes.