糖化血红蛋白对2型糖尿病合并高血压患者颈动脉粥样硬化的影响

Effects of glycosylated hemoglobin on carotid atherosclerosis in patients with type-2 diabetes complicated with hypertension

目的观察2型糖尿病合并高血压患者糖化血红蛋白浓度与颈动脉粥样硬化的关系,探讨2型糖尿病合并高血压患者颈动脉粥样硬化的危险因素。方法检测患者糖化血红蛋白、血脂、肝肾功能水平,进行颈动脉彩超检查。将全部高血压合并糖尿病研究对象按糖化血红蛋白(HbA1c)水平分成3组:HbA1c<7组、7≤HbA1c≤9组、HbA1c>9组,记录颈动脉斑块分布情况、斑块性质、斑块检出率,和计算颈动脉斑块等级积分,对所有数据进行统计学分析。结果随着糖化血红蛋白的升高,颈动脉斑块积分升高,其中HbA1c>9组与HbA1c<7组比较,颈动脉斑块积分差异有统计学意义(P<0.01)。但斑块检出率、斑块分布情况、斑块性质等三组比较差异均无统计学意义(P>0.05)。经过Spearman相关性分析,可知低密度脂蛋白和糖化血红蛋白与斑块积分之间有相关性。把两个变量纳入多因素线性回归模型,结果显示颈动脉斑块积分与糖化血红蛋白浓度变化呈现正相关,与低密度脂蛋白浓度变化呈现负相关,并且差异均具有统计学意义(P<0.01)。结论高血压合并糖尿病患者糖化血红蛋白浓度与其颈动脉斑块发生的危险性呈正相关,提示良好控制血糖,能减少该部分患者颈动脉斑块的发生。在临床工作中应对血糖水平升高的患者予以高度重视,积极进行危险分层管理,控制糖化血红蛋白水平,警惕其心脑血管不良事件发生。

Objective To observe the correlation between the glycosylated hemoglobin concentration and carotid atherosclerosis in patients with type 2 diabetes complicated with hypertension so as to study the risk factors of carotid atherosclerosis in patients with type-2 diabetes complicated with hypertension. Methods The measurements of the glycosylated hemoglobin,blood fat,hepatic and renal function were performed.The carotid arteries were examined by color Doppler ultrasonography.All the subjects with diabetes complicated with hypertension were divided into 3 groups based on the glycosylated hemoglobin level,namely,HbA1c<7 group,7≤HbA1c≤9 group and HbA1c>9 group.The carotid plaque rating scores were calculated,the plaque distribution,property and detection rate were recorded,and a statistical analysis was done for all data. Results As the glycosylated hemoglobin rose,the carotid plaque rating scores increased.Compared the carotid plaque scores of HbA1c>9 group with the HbA1c<7 group,there was statistically significant difference(P <0.01).But comparison of the plaque detection rate,the distribution and the property among the three groups showed that there were no statistically significant differences in all the three groups(P >0.05).The Spearman correlation analysis results showed that the low-density lipoprotein and glycosylated hemoglobin were correlated to the plaque score.The two variables were included into the multi-factor linear regression model and the results showed that,the carotid plaque score was positively correlated to the glycosylated hemoglobin concentration,and was negatively correlated to the low density lipoprotein concentration,and the differences were all statistically significant(P <0.01). Conclusion The glycosylated hemoglobin concentration of the patients with diabetes complicated with hypertension is positively correlated to their risks of carotid plaque,which suggests that a more positive goal of blood glucose control should be recommended for this specific population in order to reduce the occurrence of carotid plaque.In clinical practice,the patients who have an elevated glucose level should be paid with a considerable attention in order to conduct a positive risk stratification management and to control the level of glycosylated hemoglobin,a vigilance should be maintained in respect to the occurrence of cardiovascular and cerebrovascular adverse events.