正常高值血压的2型糖尿病患者脉压与颈动脉硬化的关系

Relationship between pulse pressure and carotid atherosclerosis in type 2 diabetes mellitus patients with prehypertension

目的:探讨脉压(PP)对正常高值血压的2型糖尿病患者颈动脉硬化的影响。方法:将192例2型糖尿病患者根据血压分为正常血压组和正常高值血压组,用超声多普勒检查双侧颈动脉中膜厚度及动脉粥样硬化斑块的数量,采用HITACHI 7600全自动生物化学分析仪测定患者高密度脂蛋白胆固醇和低密度脂蛋白胆固醇水平。计算脉压、胰岛素抵抗指数和胰岛素敏感指数,并行单因素相关分析。结果:正常高值血压组收缩压[(131.62±10.41)mmHg,1 mmHg=0.133 kPa]、舒张压[(85.68±7.37)mmHg]和脉压[(44.36±4.24)mmHg]均高于正常血压组[(110.87±8.66)mmHg、(72.15±6.29)mmHg、(36.02±3.28)mmHg],两者比较差异有统计学意义(P<0.05)。同时正常高值血压组颈动脉中膜厚度[(1.03±0.08)mm]大于正常血压组[(0.90±0.05)mm],颈动脉病变的发生率(86.2%)明显高于正常血压组(56.1%,P<0.05)。正常高值血压组患者胰岛素敏感指数(0.83±0.21)较正常血压组(0.97±0.19)明显降低(P<0.01),胰岛素抵抗指数(-3.92±0.54)较正常血压组(-3.66±0.68)明显升高(P<0.05)。相关分析显示,颈动脉中膜厚度与脉压、胰岛素抵抗指数呈正相关,与胰岛素敏感指数呈负相关。结论:脉压和胰岛素抵抗与正常高值血压的2型糖尿病患者颈动脉硬化密切相关。

Objective： To investigate the impact of pulse pressure on carotid atherosclerosis in type 2 diabetes mellitus patients with prehypertension.Methods： One hundred and ninety-two cases of type 2 diabetes mellitus were randomly divided into prehypertension group and normotension group.The numbers and types of their carotid atheromatous plaques and carotid intima-media thickness were examined by ultrasonography.The blood pressure,fasting blood glucose,fasting insulin and lipid level were detected.Pulse pressure,insulin resistance index and insulin sensitive index were calculated.Results： Systolic blood pressure[（131.62±10.41）mmHg],diastolic blood pressure[（85.68±7.37） mmHg],pulse pressure [（44.36±4.24）mmHg],intima-media thickness[（1.03±0.08）mm] and incidences of carotid atherosclerosis（86.2%） in the prehypertension group were higher than those in the normotension group[（110.87±8.66） mmHg,（72.15±6.29） mmHg],（36.02±3.28） mmHg,（0.90±0.05）mm,56.1%]（all P0.05）.Statistically significant differences were also observed in insulin sensitive index and insulin resistance index between prehypertension group[（0.83±0.21）、（-3.92±0.54）] and normotension group[（0.97±0.19）、（-3.66±0.68）]（P0.01）.There was a positive correlation between intima-media thickness with pulse pressure,insulin resistance index.Insulin sensitive index was negatively correlated to intimamedia thichness.Conclusion： Pulse pressure and insulin resistance are closely correlated to carotid atherosclerosis in type 2 diabetes mellitus patients with prehypertension.