老年2型糖尿病患者颈动脉内-中膜厚度与血尿酸、同型半胱氨酸相关性分析

Correlation analysis of carotid intima-media thickness with serum uric acid and homocysteine in elderly patients with type 2 diabetes

目的探讨老年2型糖尿病(T2DM)患者不同程度颈动脉内-中膜厚度(CIMT)与血尿酸(SUA)、同型半胱氨酸(HCY)水平的关系,以期为动脉粥样硬化性心血管疾病的临床干预及早期预测提供依据。方法选取自2020年1月至2021年2月于西安交通大学第二附属医院内分泌科住院的331例T2DM患者为研究对象。依据冠心病诊断标准将患者分为CIMT正常组(CIMT<1.0 mm,n=217)与CIMT增厚组(CIMT≥1.0 mm,n=114)。比较两组患者的一般资料、生化指标,采用Pearson相关分析及二元Logistic回归模型分析SUA、HCY与CIMT的相关性。结果 CIMT增厚组的女性比例、吸烟患者比例、年龄、糖尿病病程、肾小球滤过率、脑卒中发病率、CIMT值、SUA、HCY均显著高于CIMT正常组,冠心病发病率、高密度脂蛋白胆固醇低于CIMT正常组,组间比较,差异均有统计学意义(P<0.05)。相关性分析结果显示,CIMT与年龄(r=0.116)、吸烟(r=0.150)、糖尿病病程(r=0.189)、脑卒中(r=0.173)、SUA(r=0.250)、HCY(r=0.139)呈显著正相关(P<0.05)。二元Logistic回归分析显示,SUA≥420μmol/L与CIMT增厚呈显著正相关,校正混杂变量后,该相关性仍然独立存在(比值比=3.184,95%可信区间:1.520~6.670,P=0.002);HCY≥15μmol/L与CIMT增厚呈显著正相关,在校正混杂变量后,该相关性仍然独立存在(比值比=1.910,95%可信区间:1.041~3.503,P=0.037)。结论在老年T2DM患者动脉粥样硬化进程中,SUA≥420μmol/L、HCY≥15μmol/L可能是其动脉粥样硬化发生发展的独立危险因素,对此类人群及时监测和早期干预,将有助于预防及延缓T2DM大血管病变的发生。

Objective To analyze the correlation between different degrees ofcarotidintima-media thickness(CIMT)and serum uric acid(SUA),homocysteine(HCY)levels in elderly patients with type 2 diabetes(T2 DM),to provide atheoreticalbasisfor clinical intervention and early prediction of atherosclerotic disease.Methods A total of 331 patients with T2 DM who were admitted to the department of endocrinology, the Second Affiliated Hospital of Xi ′an Jiaotong University from January 2020 to February 2021 were selected as the research subjects.According to the diagnostic criteria of coronary heart disease(CHD),the patients were divided into CIMTnormal group(CIMT<1.0 mm, n=217)and CIMT thickening group(CIMT≥1.0 mm, n=114).General data and biochemical indexes of patients in the two groups were compared.Pearson correlation analysis and binary Logistic regression model were used to analyze the correlation between SUA,HCY and CIMT.Results The proportion of female, smoking patients, age, duration of diabetes, glomerular filtration rate, incidence of stroke, CIMT value, SUA and HCY in CIMT thickening group were significantly higher than those in CIMTnormal group(P<0.05).The incidence of coronary heart disease and high density lipoprotein cholesterol in CIMT thickening groupwere lower than those of CIMTnormal group(P<0.05).The results of correlation analysis showed that CIMT was significantly positively correlated with age(r=0.116),smoking(r=0.150),durationofdiabetes(r=0.189),stroke(r=0.173),SUA(r=0.250)and HCY(r=0.139),P<0.05.Binary Logistic regression analysis showed that SUA≥420 μmol/L was positively correlated with CIMT thickening, and the correlation remained independent after adjustment for confounding variables(odds ratio=3.184,95% confidence interval: 1.520-6.670,P=0.002).And HCY≥15 μmol/L was significantly positively correlated with CIMT thickening, andand the correlation remained independent after adjustment for confounding variables(odds ratio=1.910,95% confidence interval: 1.041-3.503,P=0.037).Conclusion SUA≥420 μmol/L and HCY≥15 μmol/l may be the independent risk factors for the development of atherosclerosis in elderly patients with type 2 diabetes.Timely monitoring and early intervention in those patients will help to prevent and delay the occurrence of T2 DM macroangiopathy.