颈动脉斑块分级评价颈动脉斑块与血糖及血脂关系

Carotid plaque grading to evaluate the relationship between carotid plaque and glycated hemoglobin and blood lipid

目的糖化血红蛋白(glycosylated hemoglobin,HbA1c)反映过去6~8周血糖平均水平,是糖尿病患者血糖控制效果的金标准,HbA1c与颈动脉内中膜厚度密切相关。本研究分析社区人群颈动脉板斑块分级与HbA1c相关性,探讨HbA1c在预防和监测颈动脉粥样硬化中作用。方法选取2017-03-01-2018-03-01某社区96例体检者为研究对象,应用颈动脉超声检查将其分为无斑块组(对照组)和有斑块组(病例组)。并依据斑块分级(carotid plaque score,CPS)标准将病例组分为Ⅰ级、Ⅱ级和Ⅲ级三组。比较两组及不同级别斑块组HbA1c、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)和L/H的差异,并进一步分析HbA1c与颈动脉斑块相关性。结果社区人群颈动脉病例组的HbA1c水平为(6.42±1.54)%,高于对照组的(5.57±1.14)%,t=2.985,P=0.004。Ⅰ、Ⅱ和Ⅲ级患者HbA1c水平分别为(5.51±1.24)%、(6.45±1.49)%和(7.32±1.45)%,F=5.424,P=0.007;HDL-C分别为(1.70±0.46)、(1.34±0.37)和(1.32±0.14)mmol/L,F=5.267,P=0.008;LDL-C分别为(2.61±0.98)、(2.88±0.82)和(3.59±1.01)mmol/L,F=4.277,P=0.019;L/H分别为1.63±0.69、2.23±0.63和2.76±1.78,F=9.170,P<0.001。结论社区人群颈动脉有斑块组HbA1c水平高于无斑块组。颈动脉分级增高,HbA1c、LDL-C、L/H水平升高,HDL-C水平降低。

OBJECTIVE Glycosylated hemoglobin(HbA1c)reflects the average level of blood glucose in the past 6 to 8 weeks and is the gold standard for blood glucose control in diabetic patients.HbA1c is closely related to carotid intima-media thickness.This study analyzed the correlation between carotid plate plaque grading and HbA1c in the community,and explored the role of HbA1c in preventing and monitoring carotid atherosclerosis.METHODS A total of 96 medical examiners from a community from March 1,2018 to March 1,2017 were selected as the research object,which were divided into non-plaque group and plaque group by carotid ultrasound examination.According to the carotid plaque score(CPS)standard,the plaque components were divided into three groups:gradeⅠ,gradeⅡand gradeⅢ.The differences of HbA1c between non-plaque group,plaque group and plaque group at different levels were compared,and the correlation between HbA1c and carotid plaque was analyzed.RESULTS The HbA1c level of the carotid plaque group in the community was(6.42±1.54)%,which was higher than that of the non-plaque group(5.57±1.14)%,t=2.985,P=0.004.The HbA1c levels of patients with gradeⅠ,ⅡandⅢwere(5.51±1.24)%,(6.45±1.49)%and(7.32±1.45)%,F=5.424,P=0.007.Levels of high density lipoprotein cholesterol(HDL-C)were(1.70±0.46),(1.34±0.37)and(1.32±0.14)mmol/L,F=5.267,P=0.008.Levels of low density lipoprotein cholesterol(LDL-C)were(2.61±0.98),(2.88±0.82)and(3.59±1.01)mmol/L,F=4.277,P=0.019.L/H were 1.63±0.69,2.23±0.63 and 2.76±1.78,respectively,F=9.170,P<0.001.CONCLUSIONS The level of HbA1c in carotid artery plaque group in community is higher than that in non-plaque group.Levels of HbA1c,LDL-C and L/H increased and HDL-C levels decreased along with the increasing of carotid artery grading.