2型糖尿病患者平均动脉压与臂踝脉搏波传导速度的相关性

Correlation between mean arterial pressure and brachial-ankle pulse wave velocity in patients with type 2 diabetes mellitus

目的:探讨2型糖尿病(T2DM)患者平均动脉压(MAP)与臂踝脉搏波传导速度(BaPWV)的相关性。方法:选取T2DM患者979例,应用电子血压计测量患者右上臂血压,计算MAP,采用三分位数法分为低MAP组(MAP<92.4 mmHg,n=327),中MAP组(92.4 mmHg≤MAP<102.4 mmHg,n=326),高MAP组(MAP≥102.4 mmHg,n=326)。应用欧姆龙动脉硬化检测仪测定BaPWV及踝肱指数。采用多元线性回归及Logistic回归模型分析MAP与BaPWV的相关性。绘制ROC曲线评估MAP对T2DM患者发生动脉硬化的预测价值。结果:T2DM患者随着MAP增加BaPWV逐渐升高(P<0.01)。相关分析显示,T2DM患者MAP与年龄、体重指数、腰臀比、胰岛素抵抗指数、三酰甘油、BaPWV呈正相关。线性回归显示,在校正相关危险因素后,MAP与BaPWV仍呈正相关(P<0.01)。Logistic回归分析显示,校正其他混杂因素后MAP与T2DM患者BaPWV独立相关(OR为1.160,95%CI:1.132~1.188)。MAP预测T2DM患者发生动脉硬化的ROC曲线下面积为0.786(95%CI:0.759~0.811,P<0.01),最佳临界值为94.4 mmHg(敏感度为75.0%,特异度为69.2%)。结论:MAP有望成为预测T2DM患者动脉硬化风险的简易实用的指标。

Objective:To explore the correlation between mean arterial pressure(MAP)and brachial-ankle pulse wave velocity(BaPWV)in patients with type 2 diabetes mellitus(T2DM).Methods:A total of 979 patients with T2DM were recruited for this study.Electronic sphygmomanometer was used for measuring blood pressure in the right arms,and MAP was calculated.Based on MAP,patients were divided into low MAP group(MAP<92.4 mmHg,n=327),medium MAP group(92.4 mmHg≤MAP<102.4 mmHg,n=326)and high MAP group(MAP≥102.4 mmHg,n=326).The BaPWV and ankle-brachial index were measured by Omron arteriosclerosis detector.The correlation between MAP and BaPWV were evaluated by multiple linear regression analysis and Logistic regression analysis.The ROC curve of MAP was drawn to evaluate its predictive value for arterial stiffness in T2DM.Results:BaPWV level was gradually elevated with MAP in T2DM patients(P<0.01).Correlation analysis indicated that MAP was positively correlated with age,body mass index,waist-to-hip ratio,insulin resistance index,triglyce-ride,and BaPWV.Multiple linear regression demonstrated that MAP was positively associated with BaPWV after adjustment for associated risk factors(P<0.01).Logistic regression analysis showed that MAP was independently associated with BaPWV in T2DM patients after adjustment for other confounders(OR=1.160,95%CI:1.132-1.188).The area under the ROC curve of MAP for predicting arterial stiffness was 0.786(95%CI:0.759-0.811,P<0.01),and take the best cut-off value of 94.4 mmHg(the sensitivity of was 75.0%,and the specificity was 69.2%).Conclusion:MAP is expected to be a simple and practical indicator to predict the risk of atherosclerosis in patients with T2DM.