老年2型糖尿病患者颈动脉粥样硬化与斑块形成的相关危险因素

Related risk factors of carotid atherosclerosis plaque formation in the elderly patients with type 2 diabetes mellitus

目的:探讨老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者颈动脉粥样硬化(atherosclerosis,AS)与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:选取中国科学技术大学附属第一医院收治的262例老年T2DM患者,根据颈动脉彩色多普勒超声探查结果分为正常组、硬化组、稳定斑块组和不稳定斑块组,比较4组患者临床资料和生化指标的差异,并采用单因素分析和多因素logistic回归分析筛选老年T2DM患者颈动脉粥样硬化和斑块形成相关影响因素。结果:正常组、硬化组、斑块组病程、血清空腹血糖(fasting blood-glucose,FBG)、糖化血红蛋白(HbA1c)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、总胆红素(total bilirubin,TBIL)、直接胆红素(direct bilirubin,DBIL)、游离三碘甲状腺氨酸(free triiodothyronine,FT3)、游离甲状腺激素(free thyroxine,FT4)、25(OH)VD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病程、血清HbA1c,HDL-C,LDL-C和25(OH)VD数值比较差异有统计学意义(P<0.05)。Logistic回归分析:病程长、高FBG和LDL-C是斑块形成的危险因素,高FT3,HDL-C,TBIL和25(OH)VD是保护因素。结论:血清FT3,25(OH)VD和TBIL水平下降促进老年T2DM患者颈动脉粥样硬化与斑块形成。

Objective:To explore the related influencing factors of carotid atherosclerosis(AS) plaque formation and stability in the elderly patients with type 2 diabetes mellitus(T2DM),and to provide scientific evidence for early prevention and treatment.Methods:A total of 262 elderly patients with T2DM were selected.According to the results of carotid artery color Doppler ultrasound,they were divided into a normal group,an AS group,a stable plaque group and an unstable plaque group.The differences of clinical data and biochemical indicators of patients were compared between the 4 groups;univariate analysis and logistic regression analysis were used to screen the related influencing factors of carotid AS plaque formation and stability of the elderly T2 DM patients.Results:The analysis showed that the disease course,serum fasting blood glucose(FBG),hemoglobin A c(HbA1c),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),total bilirubin(TBIL),direct bilirubin(DBIL),free triiodothyronine(FT3),free thyroxine(FT4),25(OH)VD has significant differences among the normal group,the AS group and the plaque group(P<0.05).The significant differences in the levels of the disease course,serum HbA1c,HDL-C,LDL-C and 25(OH)VD in the stable plaque group and the unstable plaque group(P<0.05).The logistic regression analysis showed that the long disease course,high FBG and LDL-C were the risk factors of plaque formation,high FT3,HDL-C,TBIL,25(OH)VD were protective factors of plaque formation.Conclusion:The decrease of serum FT3,25(OH)VD and TBIL level is promoting AS plaque formation in elderly T2DM patients.