老年2型糖尿病合并高血压伴同型半胱氨酸升高患者高敏C反应蛋白与颈动脉硬化和血钙、磷的关系

The relationship of hypersensitive C reactive protein with carotid atherosclerosis and serum calcium and phosphorus in elderly patients with type 2 diabetes mellitus with hypertension and increased homocysteine

目的探讨老年T2DM合并高血压伴同型半胱氨酸(Hcy)升高患者高敏C反应蛋白(hsCRP)与颈动脉硬化及血钙(Ca2+)、磷(P3-)的关系。方法多普勒超声检查颈动脉内-中膜厚度(CIMT),将105例患者分为颈总动脉正常组(n=30,CIMT<0.9mm)、颈总动脉硬化组(n=30,0.9mm≤CIMT<1.2mm)及颈总动脉斑块组(n=45,CIMT≥1.2mm);另将颈总动脉斑块组进一步分为稳定斑块亚组20例和不稳定斑块亚组25例。检测各组脂蛋白(LP)、hsC-RP、Hcy、Ca2+、P3-等浓度。采用Logistic回归分析CIMT的危险因素。结果颈总动脉斑块组hsC-RP[(16.88±5.31)vs(11.56±5.52)mg/L]、Hcy[(19.47±10.18)vs(14.93±3.41)μmol/L]、CIMT[(0.98±0.09)vs(0.93±0.05)mm]均高于颈总动脉硬化组(P<0.05),血Ca2+[(2.24±0.3)vs(2.26±0.16)mmol/L]、P3-[(1.19±0.25)vs(1.13±1.14)mmol/L]比较,差异无统计学意义(P>0.05)。颈总动脉硬化组和颈总动脉斑块组血清LP、HbA1c均高于颈总动脉正常组(P<0.05)。颈总动脉斑块组TC高于颈总动脉正常组[(4.32±1.10)vs(3.69±0.67)mmol/L,P<0.05]。Pearson相关性分析示,CIMT与hsC-RP、Hcy呈正相关(r=0.560、0.452,P均<0.01)。Logistic回归分析示,CIMT与hsC-RP、Hcy独立相关(OR=1.501、1.523,P均<0.01)。结论老年T2DM合并高血压患者血清hsC-RP、Hcy水平不仅是颈动脉硬化的独立相关因素,且与其动脉硬化斑块的稳定性相关。

Objective To investigate the relationship of hypersensitive C reactive protein with carotid atherosclerosis and serum calcium and phosphorus in elderly patients with type 2 diabetes mellitus plus hypertension and increased homocysteine . Methods A total of 105 subjects were enrolled .Carotid intima-media thickness（CIMT） was determined by doppler ultrasound .All the participants were divided into three groups ：control group （n=30 ,CIMT〈0.9 mm） ,common carotid sclerosis group （n=30 ,0.9 mm≤CIMT〈1.2 mm） and common carotid plaque group （n=45 ,CIMT ≥1.2 mm） .Common carotid plaque group was again divided into stable plaque subgroup （n= 20）and unstable plaque subgroup （n=25） .Serum hypersensitive C reactive protein （hsC‐RP ） , homocysteine （Hcy ） ,calcium and phosphorus levels were detected .Logistic regression was used to evaluate the risk factors for CIMT . Results The level of hsC‐RP [（16.88 ± 5.31 ） vs （11.56 ± 5.52 ） mg/L ] ,Hcy [（19.47 ± 10.18 ） vs （14.93 ± 3.41 ）μmol/L] and CIMT[（0.98 ± 0.09） vs （0.93 ± 0.05） mm] were significantly higher in common carotid plaque group than in common carotid sclerosis group （P〈0.05）. There were no significant difference in Ca2＋ [（2.24 ± 0.3） vs（2.26 ± 0.16） mmol/L] ,P3 - [（1.19 ± 0.25） vs （1.13 ± 1.14） mmol/L] between the two groups（P〉0.05）.The levels of lipoproteins （LP） and HbA1 c were significantly higher in common carotid sclerosis group and common carotid plaque group than in the control group （P〈0.05）.The TC was higher in common carotid plaque group than in the control group[（4.32 ± 1.10） vs （3.69 ± 0.67）mmol/L , P〈0.05].Pearson correlation analysis showed than CIM T was positively associated with hsC‐RP and Hcy （r=0.560 ,0.452 ,P〈0.01）. Logistic regression analysis showed that CIMT is independently associated with hsC‐RP and Hcy（OR=1.501 ,1.523 ,P〈0.01）. Conclusion The levels of serum hsC‐RP and Hcy were not only independent risk factors for carotid artery atherosclerosis but also related to the stability of atherosclerosis plaque in the patients with type 2 diabetes mellitus with hypertension .