2型糖尿病病人颈动脉弹性、内中膜厚度变化与糖化血红蛋白相关性及联合降糖干预作用探究

Study on the correlation between the changes of carotid artery elasticity,intima-media thickness and glycated hemoglobin,and effect of combined hypoglycemic intervention in patients with type 2 diabetes mellitus

目的:探讨2型糖尿病(T2DM)病人颈动脉弹性、内中膜厚度变化与糖化血红蛋白(HbA1c)相关性及联合降糖干预作用。方法:选取312例T2DM病人,按照随机数字表法分为观察组与对照组,各156例,对照组给予二甲双胍治疗,观察组给予二甲双胍+沙格列汀治疗。比较2组治疗前后血糖[糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后2 h血糖(2hPG)]水平、颈动脉弹性参数[血管压力应变-弹性系数(Ep)、血管顺应性(AC)、僵化系数(β)]及颈动脉内中膜厚度(CIMT)改善情况和用药安全性。另选取同期276名健康体检者,比较T2DM病人与健康体检者HbA1c水平、颈动脉弹性参数、CIMT,并分析HbA1c水平与Ep、AC、β、CIMT的相关性。结果:T2DM病人HbA1c水平、Ep、β、CIMT明显高于健康体检者(P<0.01)。Spearman相关分析显示,Ep、β、CIMT与HbA1c水平呈正相关关系(r=0.674、0.652、0.713,P<0.05~P<0.01),AC与HbA1c水平无明显相关关系(P>0.05)。2组T2DM病人治疗前HbA1c、FPG、2hPG水平差异均无统计学意义(P>0.05);治疗后均较治疗前降低(P<0.05),且观察组明显低于对照组(P<0.01)。2组T2DM病人治疗前Ep、β、CIMT差异均无统计学意义(P>0.05);治疗后均较治疗前降低(P<0.05),且观察组明显低于对照组(P<0.01)。观察组不良反应发生率(10.90%)与对照组(8.97%),差异无统计学意义(P>0.05)。结论:HbA1c水平与Ep、β、CIMT关系密切,联合降糖干预能显著降低血糖水平,用药安全性高,利于降低大血管病变发生风险。

Objective:To explore the correlation between carotid artery elasticity,intima-media thickness and glycosylated hemoglobin(HbA1c)in patients with type 2 diabetes mellitus(T2DM),and effects of combined hypoglycemic intervention.Methods:A total of 312 patients with T2DM were divided into the observation group and control group according to random number table(156 cases in each group).The control group was treated with metformin,and the observation group was treated with metformin combined with saglitin.The blood glucose levels[including HbA1c,fasting plasma glucose(FPG),2 h postprandial blood glucose(2hPG)],carotid artery elasticity parameters[including blood pressure strain-elastic coefficient(Ep),vascular compliance(AC),rigid coefficient(β)],carotid intima-media thickness(CIMT)and medication safety were compared between two groups before and after treatment.In addition,276 healthy people in the same period were investigated,the HbA1c level,carotid artery elasticity parameters and CIMT were compared between T2DM patients and healthy subjects,and the correlations between HbA1c level and Ep,AC,β,CIMT were analyzed.Results:The HbA1c levels,Ep,βand CIMT in T2DM patients were significantly higher than those in healthy subjects(P<0.01).The results of Spearman correlation analysis showed that Ep,βand CIMT were positively correlated with the HbA1c level(r=0.674,0.652,0.713,P<0.05 to P<0.01),while AC was not significantly correlated with HbA1c level(P>0.05).The differences of the levels of HbA1c,FPG and 2hPG between observation group and control group before treatment were not statistically significant(P>0.05).After treatment,the indexes decreased compared with before treatment,and which in observation group was significantly lower than that in control group(P<0.05 and P<0.01).The differences of the levels of Ep,βand CIMT between the observation group and control group before treatment were not statistically significant(P>0.05).After treatment,the levels of Ep,βand CIMT decreased compared with before treatment,and which in observation group was significantly lower than that in control group(P<0.05 and P<0.01).The incidence rate of adverse reactions in observation group and control group was 10.90%and 8.97%,respectively,and the difference of which was not statistically significant(P>0.05).Conclusions:The level of HbA1c is closely related to Ep,βand CIMT.The combined hypoglycemic intervention can significantly reduce the glucose levels.The medication is safe,and beneficial to reduce the risk of macrovascular disease.