2型糖尿病患者合并代谢紊乱与血管并发症相关性分析

Correlation between metabolic disorders and vascular complications in patients with type 2 diabetes mellitus

目的观察2型糖尿病(T2DM)患者合并代谢紊乱发生情况及其与血管并发症的相关性。方法采用2004年中华医学会糖尿病学分会(CDS)关于代谢综合征诊断标准,对230例T2DM患者按合并代谢紊乱多少分为单纯T2DM组(T2DM组,n=60)、T2DM合并1种代谢紊乱组(MS1组,n=97)、T2DM合并2种代谢紊乱组(MS2组,n=50)和T2DM合并3种代谢紊乱组(MS3组,n=23)四组,比较四组患者临床及生化检查指标,观察颈动脉内膜-中层增厚(C-IMT增厚)、糖尿病视网膜病变(DR)及糖尿病肾病(DN)发生率,采用多因素Logistic回归模型分析血管并发症与合并代谢紊乱关系。结果 T2DM合并1种代谢紊乱患者占42.2%、合并2种代谢紊乱患者占21.7%、合并3种代谢紊乱患者占10.0%。与T2DM组患者比较,合并其他代谢紊乱组患者的体质指数(BMI)、胰岛素抵抗指数(HOMA-IR)、空腹血糖(FBG)、餐后2小时血糖(2hPG)、血尿酸(UA)、三酰甘油(TG)及总胆固醇(TC)水平显著增高,差异均有统计学意义(P<0.05)。与MS1组患者比较,MS2组患者BMI、SBP、DBP、FBG、2hPG、UA、TG、TC及低密度脂蛋白胆固醇(LDL-C)水平增高,高密度脂蛋白胆固醇(HDL-C)水平降低,差异有统计学意义(P<0.01);MS3组患者BMI、SBP、DBP、HOMA-IR、FBG、2hPG、UA及TG水平升高,HDL-C水平降低,差异有统计学意义(P<0.01)。与MS2组患者比较,MS3组患者SBP、DBP、FBG、2hPG及UA水平升高,差异有统计学意义(P<0.01)。随代谢紊乱组份的增加,C-IMT增厚、DR及DN等血管并发症的发生率增加(P<0.01)。分别以C-IMT增厚、DR、DN为自变量,以BMI、SBP、DBP、FBG、2hPG、TG及HDL-C为因变量,采用二分类Logistic回归分析,结果显示SBP、DBP及2hPG是C-IMT增厚的独立危险因素;DBP和TG是DR的独立危险因素;SBP和TG是DN的独立危险因素。结论 2型糖尿病合并其他代谢紊乱与C-IMT增厚、DR及DN的发生相关。

Objective To observe the occurrence of metabolic disorders in patients with type 2 diabetes mellitus （T2DM） and correlation between metabolic disorders and vascular complications. Methods According to the diagnostic standard of metabolic syndrome （2004） of the Chinese Diabetes Society （CDS） of Chinese Medical Association, all patients （n=230） were divided into T2DM group （n=60）, group of T2DM complicating 1 metabolic disorder complication （MS1 group, n=97）, group of T2DM complicating 2 metabolic disorder complications （MS2 group, n=50） and group of T2DM complicating 3 metabolic disorder complications （MS3 group, n=23）. The clinical and biochemical indexes were compared, and incidence rates of carotid artery intima-media thickening （CA-IMT）, diabetic retinopathy （DR） and diabetic nephropathy （DN） were observed in 4 groups. The relationship between vascular complications and complicating metabolic disorders were analyzed by using Logistic regression model. Results The patients in MS1 group accounted for 42.2%among all patients, those in MS2 group for 21.7%, and those in MS3 group for 10.0%. The levels of BMI, HOMA-IR, FBG, 2hPG, UA, TG and TC all increased significantly in MS1 group, MS2 group and MS3 group compared with T2DM group （P〈0.05）. The levels of BMI, SBP, DBP, FBG, 2hPG, UA, TG, TC and LDL-C increased and HDL-C level decreased in MS2 group compared with MS1 group （P〈0.01）, and the levels of BMI, SBP, DBP, HOMA-IR, FBG, 2hPG, UA and TG increased and HDL-C level decreased in MS3 group compared with MS1 group （P〈0.01）. The levels of SBP, DBP, FBG, 2hPG and UA increased in MS3 group compared with MS2 group （P〈0.01）. As metabolic disorders increased, the incidence rates of CA-IMT, DR and DN also increased （P〈0.01）. Dichotomy Logistic regression analysis, taking CA-IMT, DR, and DN as independent variables and BMI, SBP, DBP, FBG, 2hPG, TG and HDL-C as dependent variables, showed that SBP, DBP and 2hPG were independent risk factor of CA-IMT, DBP and TG were independent risk factor of DR, and SBP and TG were independent risk factor of DN. Conclusion T2DM complicating other metabolic disorders are correlated to occurrence of CA-IMT, DR and DN.