极速脉搏波技术评价糖化血红蛋白水平与2型糖尿病患者颈动脉脉搏波传导速度的相关性

Correlation Between Glycated Hemoglobin Level and Carotid Pulse Wave Velocity in Type 2 Diabetes Evaluated by Ultrafast Pulse Wave Velocity Technique

目的应用极速脉搏波技术(UFPWV)评价糖化血红蛋白(HbA1c)水平与2型糖尿病(T2DM)患者颈动脉脉搏波传导速度的相关性,为临床早期干预提供依据。资料与方法选取颈动脉内-中膜无增厚及斑块形成的101例T2DM患者作为研究组,根据HbA1c水平分为A组(HbA1c≥7%)和B组(HbA1c<7%);选取55例健康体检者作为对照组。比较所有研究对象的临床生化指标、颈动脉内-中膜厚度(IMT)及脉搏波传导速度(PWV)。结果研究组空腹血糖(FPG)、HbA1c、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、IMT、颈动脉收缩期开始时脉搏波传导速度(BS)及收缩期结束时脉搏波传导速度(ES)均显著高于对照组,差异有统计学意义(P<0.05)。A组、B组HbA1c、IMT、BS、ES均高于对照组,差异有统计学意义(P<0.05);A组HbA1c、BS、ES均高于B组,差异有统计学意义(P<0.05),但两组IMT比较差异无统计学意义(P>0.05)。BS、ES与收缩压(SBP)、舒张压(DBP)、HbA1c、FPG、TC、TG、高密度脂蛋白胆固醇(HDLC)、LDL-C、IMT均具有相关性(P<0.05)。BS的影响因素包括HbA1c、TG、SBP、FPG、TC、HDL-C;ES的影响因素包括HbA1c、TG、LDL-C、HDL-C、FPG、DBP。T2DM患者发生颈动脉弹性变化的临界值分别为BS≤5.29 m/s和ES≤7.85 m/s。对应BS敏感度及特异度分别为76.2%和85.5%;ES的敏感度及特异度分别为93.1%和80.0%。结论UFPWV可以早期、准确、敏感地检测颈动脉的弹性变化。糖尿病患者Hb A1c越高,颈动脉粥样硬化的风险越高。临床可利用Hb A1c值早期预测糖尿病患者动脉弹性的变化,以减少并发症的发生。

Purpose To evaluate the correlation between glycated hemoglobin(HbA1c)level and carotid pulse wave velocity in patients with type 2 diabetes mellitus(T2DM)by using ultrafast pulse wave velocity(UFPWV)to provide a basis for early clinical intervention.Materials and Methods 101 patients with T2DM without carotid intima-media thickening and plaque formation were selected as the study group,and were divided into group A(HbA1c≥7%)and group B(HbA1c<7%)according to HbA1c level.Fifty-five healthy controls served as the control group.The clinical biochemical indicators,carotid intima-media thickness(IMT)and pulse wave conduction velocity(PWV)of all subjects were compared.Results fasting plasma glucose(FPG),HbA1c,total cholesterol(TC),triglycerides(TG),lowdensity lipoprotein cholesterol(LDL-C),IMT,beginning of the systole(BS)and ending of the systole(ES)in the study group were significantly higher than those in the control group(P<0.05).HbA1c,IMT,BS and ES in group A and group B were significantly higher than those in control group(P<0.05).HbA1c,BS and ES in group A were significantly higher than those in group B(P<0.05),but there was no significant difference in IMT between the two groups(P>0.05).There was a correlation between BS,ES and systolic blood pressure(SBP),diastolic blood pressure(DBP),HbA1c,FPG,TC,TG,HDL-C,LDL-C and IMT(P<0.05).HbA1c,TG,SBP,FPG,TC and HDL-C were risk factors affecting BS;HbA1c,TG,LDL-C,HDL-C,FPG and DBP were risk factors affecting ES.The critical values of carotid elasticity in patients with T2DM were BS≤5.29 m/s and ES≤7.85 m/s,the corresponding sensitivity and specificity of BS were 76.2%and 85.5%,those of ES were 93.1%and 80.0%,respectively.Conclusion UFPWV can detect carotid artery elasticity changes early,accurately and sensitively.The higher the HbA1c in diabetic patients,the higher the risk of carotid atherosclerosis.Clinically,HbA1c value can be used to predict the changes of arterial elasticity in diabetic patients early to reduce the occurrence of complications.