糖尿病对腹主动脉瘤直径及生化指标的影响因素分析

Influencing Factors of Diabetes Mellitus on Abdominal Aortic Aneurysm Diameter and Biochemical Parameters

目的探讨糖尿病及降糖治疗对腹主动脉瘤(AAA)直径及生化指标的影响。方法采用病例对照研究,回顾性分析2015年至2021年北京协和医院诊治的AAA患者的临床资料。研究人群分为AAA合并糖尿病组(n=53)和未合并糖尿病组(n=104),比较两组生化指标和瘤体直径的差异。按照瘤体直径大小进一步分为中小腹主动脉瘤组(SMAAA组)(n=85)和大腹主动脉瘤组(LAAA组)(n=72),分析两组生化指标的差异。结果157例AAA患者中,未合并糖尿病组高血压发病率显著高于合并糖尿病组(χ^(2)=8.147,P=0.004)。AAA合并糖尿病组中瘤体直径、同型半胱氨酸、D-二聚体显著低于未合并糖尿病组,差异有统计学意义(t=-3.148,P=0.002;U=-1.503,P=0.013;U=-3.002,P=0.003)。SMAAA组瘤体直径和D-二聚体显著低于LAAA组,差异有统计学意义(t=-14.406,P<0.001;U=-0.388,P<0.001)。多因素Logistic回归分析显示,糖尿病(OR=0.477,95%CI=0.238~0.955,P=0.037)及降糖治疗(OR=0.477,95%CI=0.238~0.955,P=0.037)未增加AAA瘤体增大的风险。结论糖尿病及降糖治疗可能通过降低D-二聚体或炎症指标水平影响AAA的生长速度。

Objective To investigate the effect of diabetes mellitus and hypoglycemic treatment on the diameter and biochemical parameters of abdominal aortic aneurysm(AAA).Methods A case-control study was conducted to retrospectively analyze the clinical data of AAA patients in Peking Union Medical College Hospital from 2015 to 2021.The AAA patients were classified into a group with diabetes mellitus(n=53)and a group without diabetes mellitus(n=104),and the biochemical parameters and aneurysm diameter were compared between the two groups.According to the aneurysm diameter,they were further classified into a small and medium abdominal aortic aneurysm group(SMAAA group,n=85)and a large abdominal aortic aneurysm group(LAAA group,n=72),and the biochemical parameters between the two groups were compared.Results Among the 157 cases with AAA,the incidence of hypertension in the group without diabetes mellitus was higher than that in the group with diabetes mellitus(χ^(2)=8.147,P=0.004).The aneurysm diameter,homocysteine,and D-dimer in the group with diabetes mellitus were lower than those in the group without diabetes mellitus(t=-3.148,P=0.002;U=-1.503,P=0.013;U=-3.002,P=0.003).The aneurysm diameter and D-dimer in the SMAAA group were lower than those in the LAAA group(t=-14.406,P<0.001;U=-0.388,P<0.001).Multivariate Logistic regression analysis showed that diabetes mellitus(OR=0.477,95%CI=0.238-0.955,P=0.037)and hypoglycemic treatment(OR=0.477,95%CI=0.238-0.955,P=0.037)did not increase the risk of AAA enlargement.Conclusion Diabetes mellitus and hypoglycemic therapy may affect the growth rate of AAA by lowering D-dimer and inflammatory indexes.