2型糖尿病患者强化治疗过程中动脉脉搏波传导速度、踝臂指数及颈动脉斑块变化及分析

Changes and analysis of arterial pulse wave velocity,ankle-brachial index and carotid plaque in type 2 diabetes mellitus patients receiving intensive therapy

目的:测定2型糖尿病患者接受强化治疗后动脉脉搏波传导速度(pulse wave velocity,PWV)、踝臂指数(ankle-brachial index,ABI)和颈动脉斑块的变化,探讨其临床意义及其在预防2型糖尿病大血管病变方面的监测作用。方法:选取2012年1月至2014年12月在上海市黄浦区豫园街道社区卫生服务中心随访管理的206例社区2型糖尿病患者,采取随机、对照的干预性研究方法,将患者分为干预组及常规组,比较干预前及24个月后2组患者间血糖、血脂、PWV、ABI和颈动脉超声观察指标的差异。结果:经2年的强化治疗,干预组与常规组间的收缩压、舒张压、尿蛋白、餐后2 h血糖(2h PG)、糖化血红蛋白(hemoglobin A1c,Hb A1c)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、PWV的差异有统计学意义(P<0.05)。干预组血压达标患者比不达标患者的PWV明显降低,差异有统计学意义(P<0.05);糖尿病病程(<5年)者Hb A1c达标者较不达标者PWV明显降低,差异有统计学意义(P<0.05)。结论:PWV、ABI和颈动脉斑块测定能客观反映2型糖尿病患者经强化治疗后血管结构和功能的变化,对监测、防治2型糖尿病的并发症,延缓或阻止动脉粥样硬化病变发展有一定的指导意义。

Objective： To investigate the changes in arterial pulse wave velocity（PWV）, ankle brachial index（ABI）and carotid plaque in type 2 diabetes mellitu patients receiving 2-year intensive therapy,and analyze their clinical significance and monitoring role on the prevention of large blood vessel lesions in type 2 diabetes mellitus patients. Methods：Two hundred and six patients with type 2 diabetes from January 2012 to December 2014 at Yuyuan Community Health Service Center, Huangpu District were enrolled. Patients were randomly divided into 2 groups： patients in group A received intensive therapy for 2 years, while patients in group B were given conventional therapy. Differences in blood glucose, blood lipid, PWV, ABI and carotid artery ultrasound indices between the two groups were compared after 24 months follow up. Results： Differences in systolic blood pressure,diastolic blood pressure,urinary protein,postprandial 2 hours blood glucose（2h PG）, glycosylated hemoglobin（Hb A1c）,low density lipoprotein cholesterol（LDL-C）, PWV were statistically significant between the two groups（P〈0.05）. PWV was significantly lower in blood pressure controlled patients than in uncontrolled patients（P〈0.05）. In patients with course of diabetes 5 years, PWV in those with Hb A1 c controlled was significantly lower than those with Hb A1 c not controlled（P〈0.05）. Conclusions： PWV, ABI and carotid artery plaque can objectively reflect the changes in structure and function of blood vessels for patients with type 2 diabetes mellitus, which has a guiding significance for prevention and delay of diabetic complication such as atherosclerosis.