单纯2型糖尿病患者颈动脉粥样硬化斑块形成及其稳定性影响因素分析

Analysis of influencing factors of carotid atherosclerosis plaque formation and stability in simple type 2 diabetic patients

目的:探讨单纯2型糖尿病(T2DM)患者颈动脉粥样硬化斑块形成及其稳定性的相关影响因素,为其早期预防和治疗提供科学依据。方法:选取单纯T2DM体检患者249例,根据颈动脉彩色多普勒超声探查结果分为硬化组、稳定斑块组和不稳定斑块组,比较3组患者理化指标及生活方式的差异,并采用单因素分析和多因素Logistic回归分析筛选单纯T2DM患者颈动脉粥样硬化斑块形成及其稳定性的相关影响因素。结果:单因素分析,硬化组和斑块组患者年龄、空腹血糖、糖化血红蛋(HbA1c)、非高密度脂蛋白胆固醇(NHDL-C)、单核细胞/高密度脂蛋白比值(MHR)、吸烟比例(%)、T2DM病程和高密度脂蛋白胆固醇(HDL-C)各数值比较差异有统计学意义(P<0.05)。稳定斑块组和不稳定斑块组患者餐后血糖(PBG)、收缩压(SBP)、低密度脂蛋白胆固醇(LDL-C)、HbA1c、MHR、吸烟和HDL-C数值比较差异有统计学意义(P<0.05)。Logistic回归分析,高年龄、HbA1c、NHDL-C、MHR和吸烟是形成斑块的危险因素,高HDL-C是斑块形成的保护性因素(年龄:OR=1.62,P=0.011;HbA1c:OR=1.25,P=0.027;HDL-C:OR=0.65,P=0.009;MHR:OR=3.50,P=0.000;吸烟:OR=2.28,P=0.009;NHDL-C:OR=1.39,P=0.028)。高SBP、LDL-C、MHR和吸烟是不稳定斑块形成的危险因素,高HDL-C为不稳定斑块形成的保护性因素(SBP:OR=1.57,P=0.003;LDL-C:OR=1.99,P=0.000;MHR:OR=3.88,P=0.000;吸烟:OR=2.01,P=0.001;HDL-C:OR=0.53,P=0.001)。结论:对单纯T2DM患者并发颈动脉粥样硬化斑块患者,强调血脂、血压的达标及戒烟并提高HDL-C水平,可有效预防颈动脉硬化斑块的形成及稳定斑块。

Objective:To explore the related influencing factors of carotid atherosclerosis(AS)plaque formation and stability in the patients with type 2 diabetes mellitus(T2DM),and to provide scientific evidence for early prevention and treatment.Methods:A total of 249 cases of simple T2DM patients were selected.According to the results of carotid artery color Doppler ultrasound,they were divided into AS group,stable plaque group and unstable plaque group.The differences in physicochemical indexes and life style of the patients were compared between three groups;univariate analysis and Logistic regression analysis were used to screen the related influencing factors of carotid AS plaque formation and stability of the T2DM patients.Results:The univariate analysis showed that age,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),non-high density lipoprotein cholesterol(NHDL-C),monocyte/high density lipoprotein ratio(MHR),smoking ratio(Smoking%),T2DM disease course,high density lipoprotein protein cholesterol(HDL-C)had significant differences between AS group and plague group(P<0.05).There were significant differences in the values of postprandial blood glucose(PBG),systolic blood pressure(SBP),low density lipoprotein cholesterol(LDL-C),HbA1c,MHR,Smoking%and HDL-C of the patients in stable plaque group and unstable plaque group(P<0.05).The Logistic regression analysis showed that high age,HbA1c,NHDL-C,MHR and smoking were the risk factors of the plaque formation and high HDL-C was a protective factor of plaque formation(Age:OR=1.62,P=0.011;HbA1c:OR=1.25,P=0.027;HDL-C:OR=0.65,P=0.009;MHR:OR=3.50,P=0.000;Smoking:OR=2.28,P=0.009;NHDL-C:OR=1.39,P=0.028).High SBP,LDL-C,MHR and smoking were the risk factors of unstable plaque formation,and high HDL-C was a protective factor of unstable plaque formation(SBP:OR=1.57,P=0.003;LDL-C:OR=1.99,P=0.000;MHR:OR=3.88,P=0.000;Smoking:OR=2.01,P=0.001;HDL-C:OR=0.53,P=0.001).Conclusion:For the patients with simple T2DM and carotid AS plaque,blood lipid,blood pressure and smoking cessation should be emphasized and HDL-C level should be increased,which can effectively prevent the formation of AS plaque and stabilize the plaque.