中老年糖尿病患者抑郁状态与循环炎症指标及血管弹性的关系

Roles of depression and C-reaction protein in early development of cardiovascular disease in the elderly diabetes patients

目的 探讨中老年2型糖尿病患者抑郁状态及C-反应蛋白（CRP）在早期心血管病变中的作用。方法选取符合抑郁症诊断标准的中老年2型糖尿病患者（抑郁＋糖尿病组）196例和中老年单纯2型糖尿病患者（糖尿病组）200例，用汉密尔顿抑郁量表（HAMD）进行评分，并检测血浆中CRP和颈总动脉波强w1、W2、W2d及血管弹性参数p、Ep、AC、Pwv-wI、PwVp、AI的情况。结果抑郁＋糖尿病组CRP为（8．1±2．8）mg／L，糖尿病组为（3．9±3．2）mg／L，两组比较差异有统计学意义（t=6．411，P=0．000）。抑郁＋糖尿病组和糖尿病组w1分别为（10．05±6．82）mmHg·In-1s。和（8．91±4．36）InmHg-m-1·s-3（t=0．817，P=0．100），W2分别为（4．82±1．33）mmHg·m-1·s。和（2．27±1．28）mmHg·m-1·s-3（t=4．256，P—o．021）。抑郁＋糖尿病组与糖尿病组比较，颈总动脉血管弹性参数B（12．58±3．23比8．96±2．24，t=4．634，P=0．019）、Ep（157．94-52．6比118．2±53．1，t=5．512，P=0．007）、PWVB（7．53±1.41比6．68±1．56，t=3．982，P=0．024）、AI（19．26±13．21比15．34±10．23，t=3．213，P=0．037）、PWV-WI（7．59±1_67比6．63±1．45，t=2．613，P=0．046）、AC（0．70±0．19比0．78±0．21，t=4．676，P=0．017）测值，差异均有统计学意义。相关分析显示，血浆中CRP水平及HAMD评分与颈总动脉W2（r-二0．470，P=0．000）及血管弹性参数8（r=0．582，P=0．000）、Ep（r=0．352，P=0．004）、PWV—WI（r=0．233，P=0．019）、PwVB（r=0．340，P=0．007）、AI（r=0．265，P=0．015）呈正相关，与AC呈负相关（r=0．457，P=0．000）；HAMD评分与血浆CRP水平呈正相关（r=0．328，P=0．003）。结论颈动脉波强W2、血管弹性参数p、Ep、Pwv-wI、PwVβ、AI、AC的变化可用于评价老年糖尿病患者心血管疾病发生的风险；抑郁程度和血浆CRP水平升高可加速其进程。

Objective To investigate the role of depression and C-reaction protein （CRP）in the early development of vascular disease in the elderly patients with type 2 diabetes. Methods Totally 396 patients with type 2 diabetes were recruited in the study, including 196 cases with depression and 200 cases without depression. Depression was evaluated by Hamilton depression scale （HAMD）, and CRP was measured using rate nephetometry. The related parameters of wave intensity （WI） such as accelerating wave intensity （Wl）, decelerating wave intensity （W2）, arterial stiffness β, pressurestrain elasticity modulus （Ep）, arterial compliance （AC）, pulse wave velocity -wave intensity（PWV- WI）, pulse wave velocity （PWV） and argumentation index （AI） were detected and compared between the groups. Results The levels of CRP[（8.1±2. 8）mg/L vs. （3.9±3.2） mg/L, t= 6. 411,P= 0.000], W2 [（4.82±1.33） mm Hg. m-1 s-3 vs. （2.27±1.28）mm Hg. m-1 s-3, t=4.256, P=0.021], arterial stiffness 13（12.58±3.23 vs. 8.96＋2.24,t=4.634,P=0.019）, Ep （157.90± 52.64 vs. 118. 244- 53.08,t=5. 512,P=0. 007）, PWVI3（7.53±1.41 vs. 6.68＋1.56,t=3. 982,P= 0.024）, AI（19.264±3.21 vs. 15.34±10.23, t=3.213, P=0.037）and PWV-WI （7.59 ±1.67 vs. 6.634- 1.45, t= 2. 613, P= 0. 046） in cases with depression were higher than the cases without depression, while the AC value was reduced （0.70 ± 0.19 vs. 0. 78 ± 0.21, t = 4. 676, P = 0. 017）.There was no difference in Wl value between the groups. The CRP level and HAMD score were positively associated with W2 （r = 0. 470, P = 0. 000）, stiffness 13 （r = 0. 582, P = 0. 000）, Ep （ r = 0.352, P=0.004）, PWV-WI （r=0.233, P=0.019）, PWVI3 （r=0.340, P=0.007） and AI （r= 0.265, P=0.015）, but negatively related with AC（r=-0.457, P=0.000）. HAMD score was positively correlated with CRP level（r= 0. 328, P= 0. 003）. Conclusions The carotid artery wave intensity W2, blood vessel elasticity parameter 13, Ep, AC, PWV-WI, PWV13 and AI determination can evaluate the risk of cardiovascular diseases in elderly diabetes, and higher CRP level and HAMD score may deteriorate its process.