幽门螺杆菌感染对糖尿病外周动脉硬化及10年心血管事件风险分层的影响

The effect of helicobacter pylori infection on peripheral arterial stiffness and 10-year cardiovascular risk in patients with diabetes mellitus

目的研究幽门螺杆菌(Hp)感染对糖尿病(DM)患者外周动脉硬化、10年心血管风险评分及危险分层的影响。方法以2015年1月—2019年12月于我院体检中心进行13C呼气试验检测Hp感染的DM人群为研究对象,根据检查结果分为DMHp+和DMHp-组。收集2组患者的高血压、高脂血症及吸烟史,体检当日血压、体质量指数(BMI)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)及糖化血红蛋白(HbA1c)。采用臂踝脉搏波速度(baPWV)评估外周动脉僵硬度,Framingham危险评分(FRS)及国人缺血性心血管疾病(ICVD)简易评估模型计算2组人群10年心血管事件的发生风险。结果(1)共纳入研究6767例,其中DMHp+组2789例,DMHp-组3978例。DMHp+组年龄、男性比例、血压、FBG、HbA1c高于DMHp-组(P<0.05),BMI、HDL-C低于DMHp-组(P<0.05)。(2)与DMHp-组相比,DMHp+组baPWV值显著增加(P<0.01),DMHp+组动脉僵硬度重度增加比例高于DMHp-组,动脉僵硬度正常、轻度及中度增加比例低于DMHp-组。(3)DMHp+组Framingham评分及ICVD评分均显著高于DMHp-组(P<0.05)。10年心血管事件风险分层中,DMHp+组Framingham评分及ICVD评分高危比例均高于DMHp-组(P<0.01)。结论Hp感染可促进DM人群的外周动脉硬化,增加其10年心血管疾病发生风险。

Objective To investigate the effect of helicobacter pylori(Hp) infection on peripheral arterial stiffness and10-year cardiovascular risk in patients with diabetes mellitus(DM).Methods DM patients who were tested for Hp infection in physical examination center of our hospital from January 2015 to December 2019 were enrolled in this study.Patients were divided into DMHp+group and DMHp-group according to the Hp results.The hypertension,hyperlipidemia and smoking history were collected,and blood pressure,body mass index(BMI),cholesterol(TC),high-density lipoprotein(HDL-C),low density lipoprotein(LDL-C),fasting blood glucose(FBG) and glycated hemoglobin(HbA1 c) were also collected in the two groups.The peripheral arterial stiffness was measured by brachial to ankle pulse wave velocity(baPWV).The Framingham risk score(FRS) and Chinese ICVD 10-year risk assessment model were used to assess the 10-year cardiovascular risk and stratification.Results(1) A total of 6 767 patients were included in the study,including 2 789 patients in the DMHp+group and 3 978 patients in the DMHp-group.Data of age,percentage of male population,blood pressure,FBG and HbAlc were significantly higher in DMHp+group compared with those of DMHp-group(P <0.05).The BMI and HDL-C level was significantly lower in DMHp+group compared with that of DMHp-group(P <0.05).(2) The right,left and mean baPWV were significantly higher in DMHp+group compared with those of DMHp-group(P <0.01).The percentage of patients with severe peripheral arterial stiffness was higher in DMHp+group than that of DMHp-group.The percentage of patients with normal,mild and moderate peripheral arterial stiffness was lower in DMHp+group than that of DMHp-group.(3) FRS and ICVD scores were significantly higher in DMHp+group than those of the DMHp-group(P <0.05).In the 10-year cardiovascular event assessment model,the percentage population of the high-risk(FRS and ICVD scores) was higher in DMHp+group than that of DMHp-group(P <0.01).Conclusion Hp infection can accelerate pathologic progress of peripheral arterial stiffness and enhance 10-year cardiovascular disease risk in patients with DM.