胰岛素治疗对2型糖尿病患者颈总动脉内-中膜厚度影响的超声研究

Effect of insulin therapy on carotid intima-media thickness in patients with type 2 diabetes:an ultrasonographic study

目的采用彩色多普勒超声研究2型糖尿病患者胰岛素使用前时间(自明确诊断至开始使用胰岛素的时间)、胰岛素使用时间与颈总动脉内-中膜厚度(common carotid artery intima-media thickness,CCA-IMT)的关系。方法2型糖尿病患者252例,包括男性138例,女性114例;年龄22～87岁,平均(59±14)岁;病程为1～43年,平均为(9.3±3.3)年;胰岛素使用时间为0～20年,平均为(4.2±1.5)年;胰岛素使用前时间为0～43年,平均为(7.1±2.3)年。采用二维高频超声检测CCA-IMT,计算双侧颈总动脉内-中膜厚度的均值为CCA-IMT。对影响CCA-IMT的可能危险因素(年龄、胰岛素使用时间、胰岛素使用前时间、空腹血糖值、糖化血红蛋白值、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇)进行多元线性回归分析,确定危险因素。使用偏相关分析方法,控制危险因素对CCA-IMT的影响,观察外源性胰岛素使用前时间、胰岛素使用时间与CCA-IMT之间的关系。结果①年龄、低密度脂蛋白水平、胰岛素使用前时间与CCA-IMT呈线性相关(标准化回归系数β分别为0.580、0.242、0.195,P<0.05),回归方程,Y=0.241+0.008X1+0.060X2+0.005X3(X1为年龄、X2为低密度脂蛋白胆固醇、X3为胰岛素使用前时间)。②控制以上危险因素后,外源性胰岛素使用前时间与CCA-IMT均值呈线性正相关关系(r=0.294,P=0.003)。胰岛素使用时间与CCA-IMT均值呈负相关关系,但无统计学意义(r=-0.091,P=0.376)。IMT为0.60～1.39mm,平均为(0.96±0.19)mm。结论二维高频超声可作为评估胰岛素治疗对2型糖尿病患者动脉粥样硬化性病变影响的重要手段。2型糖尿病患者早期应用胰岛素治疗对延缓其动脉粥样硬化的进展可产生积极影响。

Objective To investigate the correlation between pre-insulin therapy period （the time from definite diagnosis to initiation of insulin therapy） , insulin therapy period and the intima-media thickness of common carotid artery（CCA-IMT） in patients with type 2 diabetes by means of color Doppler uhrasonography （CDU）. Methods Two hundred and fifty-two patients with type 2 diabetes were included in this study, 138 were male and 114 were female, their age ranged from 22 to 87 （mean 59±14） years; the course of disease was 1 to 43 （mean 9.3±3.3） years ; The duration of insulin therapy was 0 to 20 （ mean 4.2±1.5） years ; and preinsulin therapy period was 0 to 43 （ mean 7.1±2.3） years. The CCA-IMT was detected with two-dimensional high-fi＇equency ultra sonography. The mean va]ue of bilateral CCA-IMT was calculated. The possible risk factors [age, duration of insulin therapy, preinsulin therapy period, fasting blood glucose, glycosylated hemoglobin, triglyeeride, total cholesterol （TCH） , low-density lipopro- rein cholesterol （LDL-C） and high-density lipoprotein cholesterol （HDL-C）]that might impact CCA-IMT were analyzed with multiple linear regression, and their risk tactors were identified. Partial correlation analysis was used to control the impact of risk factors on CCA-IMT. The relationship between the preinsulin therapy period, insulin therapy period and CCA-IMT were observed. Results @Age, LDL-C level and preinsulin therapy period were linearly related to CCA-IMT （standardized coefficients Beta = 0.580, 0.242, and 0.195, respectively, P 〈0.05）. The regression equation was Y =0.241 ＋0.008 X1 ＋ 0.060 X2 ＋ 0.005X3 （X1 = age, X2 = LDL-C, X3 = pre-exogenous insulin period）. ②After controlling the above risk factors, the preinsulin therapy period and the mean value of CCA-IMT showed a linear positive correlation （r=0.294, P =0.003） , while the insulin therapy period and the mean value of CCA-IMT showed a negative correlation （ r = - 0.091, P =0.376） , but there was no signifieant differences（r=-0.091, P =0.376）. The IMT was 0.60 to 1.39 mm（ mean 0.96±0.19mm）. Conclusion Two-dimensional high-frequency ultrasound may be used as an important means tor evaluating the effect of the insulin therapy on atheroselerotic lesions in patients with type 2 diabetes. Early start of insulin therapy in patients with type 2 diabetes may have positive effect on slowing the progression of atherosclerosis.