糖尿病不同病程及血糖控制水平对颈动脉结构及功能的影响

Impact of type 2 diabetes mellitus duration and blood glucose control on carotid arterial wall properties

目的探讨2型糖尿病(T2DM)不同血糖控制水平及患病时间对颈动脉内-中膜形态及功能的影响。方法选取T2DM患者58例,分为3组:病程≤2年为初发组(26例),将病程>2年者根据空腹血糖(FPG)水平分为FPG正常组(FPG<7.1mmol/L,10例)和FPG升高组(FPG≥7.1mmol/L,22例)。另设正常对照组47名。测量双侧颈动脉内-中膜非均匀度(IMI)、颈动脉内-中膜平均厚度(IMTmean),以血管回声追踪技术测量双侧颈动脉内-中膜僵硬度(β)、脉搏波传导速度(PWV),并分析IMI与年龄、血糖水平、病程、血脂及动脉弹性的关系。结果与正常对照组相比,T2DM患者β、PWV、IMI的对数[Ln(β)]、Ln(PWV)、Ln(IMI)]均升高;FPG正常及升高组IMTmean的对数[Ln(IMTmean)]亦增高;FPG升高组较FPG正常组及DM初发组Ln(β)及Ln(PWV)均升高(P均<0.05)。颈动脉IMI与病程、年龄、FPG、TG、SBP呈正相关(r=0.620、0.428、0.303、0.228、0.208,P均<0.05)。结论作为反映血管结构的指标,IMI在早期筛查T2DM、血管结构变化中优于IMT。β、IMI及IMT相结合,可以全面评估在高血糖或合并其他危险因素作用下动脉病变的发生发展程度。

Objective To explore the impact of type 2 diabetes mellitus （T2DM） duration and blood glucose control on carotid arterial wall properties. Methods Totally 58 patients with T2DM were recruited and assigned to different groups, i.e. primary group （n=26, course of T2DM≤2 years）, normal FPG group （n= 10, course of T2DM〉2 years with FPG,（7.1 mmol/L） and high FPG group （n=22, course of T2DM〉2 years with FPG≥7.1 mmol/L）. Meanwhile, 47 healthy participants were enrolled in control group. Intima-media inhomogeneity （IMI） and the mean value of intima-media thickness （IMTmean） were measured with an automatic measuring system, and elastic indexes （β, PWV） were measured by using echo-tracking. Correlation analysis was carried out among IMI and elastic indexes and cardiovascular risk factors. Results Ln（β）, Ln（PWV） and Ln（IMI） were higher in patients with T2DM than those in control group （all P（0.05）. Ln（IMT ） was higher in normal FPG group and high FPG group than that in control group. Ln（β） and Ln（PWV） were higher in high FPG than those in normal FPG and primary group （P〈0.05）. There were significantly positive correlation between IMI and course, age, FPG, TG and SBP （r=0. 620, 0. 428, 0. 303, 0. 228, 0. 208, all P〈0.05）. Conclusion IMI is a new index better than IMT to reflect atherosclerotic wall process. Assessment of structure/function of carotid ar- tery with ultrasound may be helpful to identifying early vascular damage in T2DM with or without other high-risk factors.