2型糖尿病合并代谢综合征患者颈动脉硬化的影响因素分析

Analysis of the factors affecting carotid atherosclerosis in type 2 diabetes mellitus with metabolic syndrome

目的分析2型糖尿病合并代谢综合征（MS）患者颈动脉硬化的影响因素。方法用超声多普勒检查205例2型糖尿病合并MS患者双侧颈动脉。根据超声特征分为内膜正常组、内膜增厚组、稳定性斑块组、不稳定性斑块组，测定空腹血糖（FPG）、空腹胰岛素（FINS）、餐后两小时血糖（2hPG）、餐后两小时胰岛素（2hINS）、糖化血红蛋白（HbA1c）、血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和尿酸（UA）等指标。分析以上因素与颈动脉硬化程度的相关关系。结果四组间FPG、HbA1c、FINS、2hINS和舒张压（DBP）均无明显差异；而颈动脉内膜增厚组、稳定斑块组、不稳定斑块组的年龄、2hPG、TG、TC、LDL-C、UA、收缩压和脉压明显高于颈动脉正常组，而HDL-C明显低于颈动脉正常组，且差异均有统计学意义（P均〈0．05）。不稳定斑块组的年龄、2hPG、TG、LDL-C及UA均高于其他组；不稳定斑块组的HDL-C均低于稳定斑块组，内膜增厚组及颈动脉正常组。多元逐步回归分析结果显示患者的年龄、TG、LDL—C、2hPG进入回归方程，与颈动脉粥样硬化评分呈正相关。结论2型糖尿病合并MS患者颈动脉硬化程度与年龄、血压、血脂及餐后血糖等多种因素有关，提示2型糖尿病合并MS患者在降低空腹血糖的同时，也应控制餐后血糖，更应重视血压、血脂的干预。

Objective To discuss the factors affecting carotid atheroscleresis in type 2 diabetes mellitus（T2DM） with metabolic syndrome （MS）. Methods The carotid in both sides were delected by color Doppler in 205 cases in T2DM with MS. The patients were divided into normal intima group,thick intima group,stable plaque group and unstable plaque group according to characteristic of hypersound picture. Fasting blood glucose（FPG） ,fasting insulin（FINS） ,2h postprandial blood glucose（2hPG） ,2h postprandial insulin（2hINS） hemoglobin Alc（HbA1c） ,total cholesterol（TC） ,triglyceride（TG）, ：high density lipoprotein cholesterol （ HDL-C ）, low density hpoprotein cholesterol （ LDL-C ） and uric acid （ UA ） were checked. The relationship of these factors with the degree of carotid atherosclerosis was analyzed. Results The levers of FPG,HbA1c,FINS,2hINS and diastolic blood pressure（DBP） showed no significant difference among of four groups. The levels of age,2hPBG,systolic blood pressure（SBP） ,pluse pressure（ PP）, TG,TC ,LDL-C and UA were higher and the levels of HDL-C were lower in normal intima group than those in other three groups. Multiple linear regression showed the degreeth of carotid atherosclerosis was corrected with age,TG, LDL-C and 2hPG. Conclusion Carotid atherosclerosis is significantly correlated with the level of age,TG,LDL-C and 2hPG in type 2 diabetes mellitus with metabolic syndrome.