初诊2型糖尿病患者颈动脉内中膜厚度在强化干预治疗后的变化及影响因素分析

Effect of Intensive Multifactorial Intervention on the Progression of Carotid Intima-Media Thickness in Incipient Patients with Type 2 Diabetes

目的探讨长期强化干预是否能逆转初诊2型糖尿病(T2DM)患者颈动脉内中膜厚度(IMT),并分析影响IMT变化的因素。方法选取175例初诊T2DM患者,给予强化血压、血糖、血脂治疗,随访3年,定期监测,每月监测血压、空腹血糖(FBG)、餐后2 h血糖(2 hPG);每半年监测体质量、腰围、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、血脂〔三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)〕及血尿酸;每年监测IMT。计算体质指数(BMI)、FBG变异系数(CV-FBG)、2 hPG变异系数(CV-2hPG)、胰岛素抵抗指数(HOMA-IR)。了解初诊T2DM患者IMT增厚组与IMT正常组的临床资料间的差异。随访3年,强化干预治疗后,根据IMT的变化值分为IMT减少组和IMT增加组,分析影响IMT变化的因素。结果 (1)T2DM患者在初诊时,IMT增厚组患者年龄及有高血压病史者所占比例均显著高于IMT正常组(P<0.01)。(2)初诊时及随诊第3年,T2DM患者IMT平均值比较,差异有统计学意义(P<0.05)。(3)随诊3年后,IMT减少组患者的BMI、腰围、收缩压、舒缩压、CV-2 hPG、血尿酸水平均显著低于IMT增加组(P<0.05)。(4)线性回归分析显示:高血压病史、CV-2 hPG、BMI与IMT变化呈正相关(P<0.05)。结论经过长期综合强化干预治疗,可以逆转初诊T2DM患者颈动脉IMT;高血压、2 hPG波动增加和超重是引起颈动脉IMT增加的危险因素。

Objective To investigate whether intensive multifactorial intervention can improve carotid intima-media thickness（IMT） in incipient patients with type 2 diabetes mellitus（T2DM） and to analyze factors influencing IMT.Methods 175 incipient T2DM patients were treated with intensive multifactorial intervention that targeted hyperglycemia,hypertension and dyslipidemia and were followed up for three years.Blood pressure（BP）,fasting blood glucose（FBG） and 2-hour postprandial blood glucose（2 hPG） were measured per month.Glycated hemoglobin（HbA1c）,fasting insulin（FINS）,total cholesterol（TC）,triglyceride（TG）,high density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,uric acid（UA）,body mass index（BMI） and waist circumference（WC） were monitored twice a year.Carotid IMT was measured per year.Insulin resistance index（HOMA-IR）,coefficient of variation of fasting blood glucose（CV-FBG） and coefficient of variation of 2-hour postprandial blood glucose（CV-2 hPG） were calculated.Clinical data of IMT increasing group and IMT normal group in T2DM patients at the first diagnosis were analyzed.After three years following up,the patients were divided into IMT increasing group and IMT decreasing group according to the progression of IMT and the associated factors were analyzed.Results（1） According to the first diagnosis,patients in the IMT increasing group were significantly older than the IMT normal group and had significantly higher proportion of hypertension（P0.01）.（2） IMT at the first diagnosis and the third year following up showed statistically significant differences（P〈0.05）.（3） After three years following up,BMI,WC,SBP,DBP,CV-2 hPG and UA value in the IMT increasing group were significantly higher than the IMT decreasing group（P〈0.05）.（4） Multivariate regression analysis showed that history of hypertension,2 hPG-CV and BMI were positively correlated with IMT changes（P〈0.05）.Conclusion Intensive multifactorial intervention can improve the carotid IMT in diabetic patients.Hypertension,2 hPG-CV and BMI are significant risk factors for the increase of IMT.