2型糖尿病合并微量蛋白尿患者颈动脉CDFI超声表现与实验室检查的相关性

Relationship between Color Doppler Flow Imaging of Common Carotid Artery and Laboratory Examination in Patients with Type 2 Diabetes Mellitus and Microalbuminuria

目的探讨2型糖尿病(T2DM)合并微量蛋白尿(MA)患者的颈动脉彩色多普勒(CDFI)超声表现与实验室检查各项指标结果关系。方法将178例T2DM患者按尿白蛋白排泄率(UAER)分为2组,UAER≥30～300 mg·d-1为合并MA组(T2DM1组,104例),UAER<30 mg·d-1者为不合并MA组(T2DM2组,74例),对2组患者均进行颈动脉CD-FI超声检查,包括颈动脉内-中膜厚度(IMT)、动脉粥样斑块情况(低/等回声、强回声及混合回声)等;实验室检查包括餐后2 h血糖(2 hPG)、空腹血糖(FPG)、UAER、尿酸(URIC)、血肌酐(CREA)、糖化血红蛋白(HbAlc)、血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)及体质指数(BMI)等指标。对2组CDFI的表现(IMT、动脉粥样斑块情况)及实验室各项检测指标进行比较。结果 2组患者颈动脉斑块检出数目及斑块回声比较差异无统计学意义(χ2=0.645,P>0.05)。2组斑块检出率排序为低/等回声>混合回声>强回声(均P<0.05)。T2DM1组IMT厚度、BMI、UAER、2 hPG、CREA、HbA1c、TC均高于T2DM2组(均P<0.05)。2组FPG、URIC、TG、LDL、HDL比较差异均无统计学意义(均P>0.05)。Pearson相关分析结果:IMT与UAER、CREA、HbAlc及病程呈正相关,(r=0.315、0.320、0.463及0.354,均P<0.05)。多元线性回归分析结果 :病程、UAER、HbAlc是IMT增厚的独立预测因子(r=0.362、0.240、0.395,均P<0.05)。结论 CDFI超声能够准确地检出T2DM合并MA患者颈动脉IMT及粥样斑块;IMT增厚情况与UAER、CREA、HbAlc及病程密切相关。

Objective To study the relationship between color Doppler flow imaging （CDFI） of common carotid artery and laboratory indicators in patients with type 2 diabetes mellitus （T2DM） and microalbuminuria （MA）. Methods A total of 178 patients with T2DM were divided into two groups according to urinary albumin excretion rate （UAER）： T2DM1 group （UAER 〉130-300 mg·d-1, 104 patients with MA） and T2DM2 group （UAER〈30 mg ·d-l, 74 patients without MA）. The CDFI of common carotid artery was performed to measure carotid artery intima-media thickness （IMT） and atheromatous plaques （low/equal echo, dense echo and mixed echo）. Laboratory examination was carried out to detect 2-hour postprandial blood glucose（2 hPG）, fasting plasma glucose （FPG）, UAER, uric acid （URIC）, creatinine （CREA）, glycosylated hemoglobin Alc （HbAlc）, total cholesterol （TC）, triglyeeride（TG）, low-density lipoprotein （LDL）, high-denslty lipoprotein（HDL） and body mass index （BMI）.CDFI manifestations and laboratory indicators were compared between the two groups. Results There were no significant differences in the number of carotid artery plaques and plaque echo betweenthe two groups （X2=0.645, P〉0.05）. The sequence of detection rate was low/equal echo〉mixed echo〉 dense eeho （all P〈0.05）. Compared with T2DM2 group, IMT, BMI, UAER, 2 hPG, CREA, HbAlc and TC obviously increased in T2DM1 group （P〈0.05）. No significant differenees in FPG, URIC, TG, LDL and HDL were found between the groups （P〉0.05）. Pearson eorrelation analysis showed that UAER, CREA, HbAle and disease eourse were positively correlated with IMT（r=0.315, 0.320, 0.463 and 0.354, respeetively; all P〈0.05）. Multivariate linear regression analysis showed that disease course, UAER and HbAlc were the independent predictors of IMT thickening （r=0.362, 0.240 and 0.395, respectively; all P〈0.05）. Conclusion CDFI can accurately detect the IMT and atheromatous plaque of eommon carotid artery in patients with T2DM and MA. IMT thiekening is closely related to UAER, CREA, HbAle and disease course.