2型糖尿病患者脑血管病变与周围血管病变的关系探讨

Relationship between cerebrovascular disease and peripheral vascular disease in patients with type 2 diabetes mellitus

目的比较2型糖尿病合并脑血管病变患者与无脑血管病变患者之间颈动脉及下肢动脉病变的发生率,探讨糖尿病外周血管病变与脑血管疾病风险评估关系。方法收集2015年6月至2016年6月昆明市第一人民医院内分泌科收治的2型糖尿病合并脑血管病变患者133例为观察组,无脑血管病变患者66例为对照组,比较两组之间颈动脉和下肢动脉粥样硬化病变的发生率及严重程度,以是否存在脑血管病变作为因变量进行逐步logistic回归,探讨2型糖尿病患者发生脑血管病变的危险因素。结果观察组中存在颈动脉斑块者为66.17%(88/133),多于对照组的42.42%(28/66),且观察组中颈部血管病变严重程度更重,观察组颈动脉内膜毛糙者为24.81%(33/133),无病变者为9.02%(12/133),对照组颈动脉内膜毛糙者为33.33%(22/66),无病变者24.24%(16/66),差异有统计学意义(χ^(2)=14.140,P=0.030)。观察组中存在下肢动脉斑块者为72.93%(97/133),多于对照组的42.42%(28/66),且观察组中下肢血管病变严重程度更重,观察组下肢动脉内膜毛糙者为22.56%(30/133),无病变者为4.51%(6/133),对照组下肢动脉内膜毛糙者为33.33%(22/66),无病变者24.24%(16/66),差异有统计学意义(χ^(2)=24.030,P<0.001)。logistic回归分析表明:年龄、糖化血红蛋白及下肢血管病变是糖尿病患者发生脑血管病变的危险因素,95%CI分别为1.098(1.051~1.146)、1.240(1.015~1.515)、3.802(1.094~13.212)。结论 2型糖尿病合并脑血管病患者,其外周血管病变更严重;高龄、血糖控制欠佳及下肢血管病变是2型糖尿病患者发生脑血管病变的危险因素,且下肢血管病变对糖尿病患者脑血管病变的发生具有一定预测价值。

Objective To compare the incidence of carotid artery and lower extremity arterial disease between patients with type 2 diabetes mellitus complicated by cerebrovascular disease and those with no cerebrovascular disease and investigate the risk relationship between diabetic peripheral vascular disease and cerebrovascular disease.Methods A total of 133 patients with type 2 diabetes mellitus complicated by cerebrovascular disease who received treatment in the Department of Endocrinology,The First People's Hospital of Kunming,China between June 2015 and June 2016 were included in the observation group.Sixty-six type 2 diabetes mellitus patients with no cerebrovascular disease were included in the control group.The incidence and severity of carotid artery and lower extremity arterial disease were compared between the observation and control groups.Stepwise logistic regression was performed taking whether cerebrovascular disease exists as a dependent variable.The risk factors for developing cerebrovascular disease in patients with type 2 diabetes mellitus were investigated.Results The number of patients who had carotid plague in the observation group was significantly higher than that in the control group[66.17%(88/133)vs.42.42%(28/66)].Cervical vascular disease in the observation group was severer than that in the control group.In the observation group,24.81%(33/133)of patients had rough carotid intima,and 9.02%(12/133)of patients had no rough carotid intima.In the control group,33.33%(22/66)of patients had rough carotid intima,and 24.24%(16/66)of patients had no rough carotid intima.There was significant difference in the incidence of rough carotid intima between observation and control groups(χ^(2)=14.140,P=0.030).The proportion of patients who had lower extremity carotid plaque in the observation group was higher than that in the control group[72.93%(97/133)vs.42.42%(28/66)].Lower extremity arterial disease in the observation group was severer than that in the control group.In the observation group,22.56%(30/133)of patients had rough intima of lower extremity arteries and 4.51%(6/133)of patients had no rough intima of lower extremity arteries.In the control group,33.33%(22/66)of patients had rough intima of lower extremity arteries and 24.24%(16/66)of patients had no rough intima of lower extremity arteries.There was significant difference in the proportion of rough intima of lower extremity arteries between observation and control groups(χ^(2)=24.030,P<0.001).Logistic regression analysis showed that age,glycosylated hemoglobin,and the presence of lower extremity vascular disease were the risk factors for cerebrovascular disease[95%CI=1.098(1.051-1.146),1.240(1.015-1.515),3.802(1.094-13.212)].Conclusion Peripheral vascular disease in patients with type 2 diabetes mellitus complicated by cerebrovascular disease is severer than that in patients with type 2 diabetes mellitus but without cerebrovascular disease.Aging,poor blood glucose control and lower extremity vascular disease are the risk factors for developing cerebrovascular disease in patients with type 2 diabetes mellitus.Lower extremity vascular disease has a certain value for predicting the occurrence of cerebrovascular disease in patients with type 2 diabetes mellitus.