2型糖尿病患者颈动脉粥样硬化与尿微量白蛋白的关系

The Relationship Between Microalbuminuria and Carotid Atherosclerosis in Type 2 Diabetic Patients

目的探讨2型糖尿病患者颈动脉硬化与尿微量白蛋白的关系。方法收集109例2005年至2008年在本院住院的2型糖尿病患者,采用彩色多普勒超声诊断仪10MHz高频探头检测患者双侧颈动脉,按超声检查结果分为4组:颈动脉正常组30例[双侧颈动脉内膜中层厚度(CIMT)<0.9mm];颈动脉内膜增厚组30例(0.9mm≤CIMT≤1.3mm);稳定斑块组23例(斑块呈强回声,伴或不伴声影);不稳定斑块组26例(斑块呈略低回声,内部或周边/有强回声附着)。同时测定血肌酐、空腹血糖(FPG)、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)、高密度脂蛋白胆固醇(HDL)、尿微量白蛋白(MAU),记录血压并计算体质量指数,比较四组患者MAU的差异。结果各组年龄、性别、体质量指数、血压、血肌酐比较差异无统计学意义(P(0.05),MAU值各组与CIMT<0.9mm组间差异有显著性(P<0.01),尤其是不稳定斑块组与正常组差异最显著(P<0.01),不稳定斑块组与稳定斑块组、内膜增厚组,稳定斑块组与内膜增厚组差异也有统计学意义(P<0.05),不稳定斑块组与正常组在病程、FPG、Hba1c、TC、TG、LDL、HDL比较差异均有统计学意义(P<0.05),稳定斑块组与内膜增厚组除TC、MAU差异有统计学意义外(P<0.05),其余指标差异均无统计学意义(P(0.05)。结论2型糖尿病患者颈动脉硬化程度与尿微量白蛋白水平呈正相关,MAU可预测2型糖尿病患者心血管疾病的风险。

Objective To evaluate the relationship between microalbuminuria and carotid atherosclerosis in type 2 diabetic patients. Methods Microalbuminuria （MAU） and carotid intimamedia thickness（ CI- MT） were measured in 109 cases of type 2 diabetic patients who were in our hospital from 2005 to 2008. Colordopple rultrasound examination with 10MHz was used to measure their CIMT. Cases were divided into 4 groups by their CIMT： 30 cases with CIMT 〈0.9 mm, 30cases with 0.9 mm≤CIMT≤1. 3 mm, 23 cases with stable spots, 26 cases with unstable spots . Body mass index（BMI）, fasting plasma glucose（FPG）, glycosylated hemoglobin A1 C（ HbA1C ）, triglyceride （TG）, total cholesterol（TC）, low-density lipoprotein cholesterol（LDL）, high-density lipoprotein cholesterol （HDL）, MAU, blood creatinine （Cr） were valued at the same time. The relation between MUA and CIMT were studied. Results There were no significant differences among the groups in age, sex, BMI, blood pressure and Cr（P 〉 0.05）. All the other three groups were significantly different with the group CIMT 〈 0.9 mm in the value of MUA（ P 〈 0.01）, especially with the group of unstable spots（ P = 0. 0032）. There were also significant differences between the unstable spots group and the CIMT 〈 0.9 mm group with the course of disease, FPG, Hbalc, TC, TG, LDL and HDL（P 〈0.05）. There were no significant differences between the stable spots group and CIMT0.9 ~ 1.3 mm group, especially with TC, and MAU value（ P = 0. 043, P = 0.027）. Conclusion Microalbuminuria can predict subclinical atherosclerosis to some extent.