多因素干预对新诊断2型糖尿病患者亚临床动脉粥样硬化的影响

Impact of Multifactorial Intervention on Subclinical Atherosclerosis in Patients with Newly-diagnosed Type 2 Diabetes

目的探讨多因素干预对新诊断2型糖尿病患者亚临床动脉粥样硬化发生的影响。方法采用平行、开放的前瞻性研究,对141例新诊断2型糖尿病患者以强化控制血糖、血压、血脂、体重等多种危险因素的干预达标措施,探讨多因素干预以及代谢综合征评分的变化对6年后亚临床动脉粥样硬化发生的影响。结果多因素干预1年后新诊断2型糖尿病患者的代谢综合征总评分改善(P<0.01),干预1年后代谢综合征评分仍≥2分者,6年后亚临床动脉粥样硬化发病率高于0～1分者(P<0.05);干预1年后仍有2分者,6年后74.1%(20/27)发生亚临床动脉粥样硬化,仍有3分者100%(6/6)发生亚临床动脉粥样硬化。Logistic回归分析显示,经年龄、性别校正后,干预1年后代谢综合征总评分为干预6年时亚临床动脉粥样硬化发生的独立危险因素(OR=1.89,95%CI1.19～3.01,P<0.01);且干预1年后是否有中心性肥胖为干预6年后亚临床动脉粥样硬化发生最为显著的影响因素(OR=2.45,95%CI1.19～5.07,P<0.05)。结论新诊断2型糖尿病患者早期代谢因素的干预效果可预测其长期亚临床动脉粥样硬化的发生,而中心性肥胖是促其发生的重要因素。

Aim To explore the impact of multifactorial intervention on incidence of subclinical atherosclerosis（subAs）in patients with newly-diagnosed type 2 diabetes（T2DM）.Methods In the prospective study,141 patients with newly-diagnosed T2DM without subAs were designed to experience the prospective targeted multifactorial intervention,including intensive control of blood glucose,blood pressure,blood lipids and body weight.The influences of multifactorial intervention and change of MS score on incidence of subAs after 6 years were analyzed.Results MS scores after 1 year intervention were significantly improved（P〈0.01）.The incidence rate of patients whose MS scores remained equal to or greater than 2 after 1 year intervention was significantly higher than those whose MS scores were 0 or 1 after 1 year intervention（P〈0.05）.The incidence rate of those whose MS scores remained 2 after 1 year intervention was 74.1%（20/27）,while the incidence rate of those whose MS scores remained 3 after 1 year intervention was 100.0%（6/6）.Multiple stepwise Logistic regression analysis showed that after adjustment of age and sex,MS score after 1 year intervention is independent variable of incidence of subAs after 6 years（OR=1.89,95%CI 1.19～3.01,P〈0.01）.Further analysis revealed that after adjustment of age and sex,central obesity after 1 year intervention was the most marked factor on subAS after 6 years among all the MS components except for hyperglycemia（OR=2.45,95%CI 1.19～5.07,P〈0.05）.Conclusion The early-stage metabolic syndrome intervention efficacy may predict long-term subAs outcome in patients with newly-diagnosed T2DM.Central obesity is the most important factor which deteriorates long-term subAs.