中老年2型糖尿病患者PR间期延长与颈动脉粥样硬化的相关性研究

Correlation of prolongation of PR interval with carotid atherosclerosis in middle-aged and elderly patients with type 2 diabetes mellitus

目的探讨中老年2型糖尿病患者PR间期延长与颈动脉粥样硬化(CAS)病变的相关性。方法选取2019年1月至2021年1月于上海交通大学附属第六人民医院南院内分科住院治疗的中老年2型糖尿病患者537例为研究对象。彩色多普勒超声检测双侧颈动脉内膜-中层厚度(CIMT), 将研究对象分为颈动脉粥样硬化组(CAS组, n=352)和非颈动脉粥样硬化组(NCAS组, n=185), 比较2组患者心电图PR间期差异;PR间期、CAS病变与各临床指标相关性用Pearson或Spearman秩相关分析, PR间期与CAS病变的关系采用多因素logistic回归分析。结果中老年2型糖尿病患者PR间期均值为(164.57±23.02)ms, CAS组PR间期均值显著高于NCAS组的PR间期均值[(169.76±24.28对154.70±16.42)ms, P<0.01]。PR间期与CAS病变呈正相关(r=0.343, P<0.01), 多因素logistic回归分析结果显示, 年龄、低密度脂蛋白胆固醇、血清骨钙素和PR间期均是中老年2型糖尿病患者发生CAS病变的独立影响因素(OR分别为1.079、1.936、0.879、1.039, P<0.05或P<0.01);其中PR间期每延长1 ms, 中老年2型糖尿病患者患CAS风险增加3.9%(OR=1.039, 95%CI 1.006~1.073, P=0.020)。多因素logistic回归分析显示, PR间期≥158 ms的中老年2型糖尿病患者是PR间期<158 ms的中老年2型糖尿病患者患CAS病变的4.072倍(OR=4.072, 95%CI 1.417~11.702, P<0.01)。结论心电图PR间期与中老年2型糖尿病患者CAS病变具有相关性, 应提醒PR间期显著延长的中老年2型糖尿病患者早期进行CAS病变的筛查。

Objective To investigate the relationship between prolonged PR interval and carotid atherosclerosis(CAS)in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 537 middle-aged and elderly inpatients with T2DM in the Southern Branch of the Sixth People′s Hospital of Shanghai Jiaotong University from January 2019 to January 2021 were selected as the research objects.Color Doppler ultrasound was used to detect bilateral carotid artery intima-media thickness(CIMT).The subjects were divided into carotid atherosclerosis group(CAS group,n=352)and non-carotid atherosclerosis group(NCAS group,n=185).The difference in the PR interval of ECG between the two groups was compared.Pearson or Spearman rank correlation analysis was used for evaluating the correlation of PR interval and CAS lesions with various clinical index.The relationship between PR interval and CAS lesions was adopted by multivariate logistic regression analysis.Results The average PR interval of middle-aged and elderly patients with T2DM was(164.57±23.02)ms.The average PR interval in CAS group was significantly higher than that in NCAS group[(169.76±24.28)vs(154.70±16.42)ms,P<0.01].The results of multifactorial logistic regression analysis showed that age,low density lipoprotein-cholesterol,serum osteocalcin,and PR interval were independent factors influencing the development of CAS lesions in middle-aged and elderly patients with T2DM(OR=1.079,1.936,0.879,1.039,respectively,P<0.05 or P<0.01)where each 1 ms increase in PR interval was associated with a 3.9%increase in the risk of CAS in middle-aged and elderly patients with T2DM(OR=1.039,95%CI 1.006-1.073,P=0.020).Multivariate logistic regression analysis showed that middle-aged and elderly type 2 diabetic patients with PR interval≥158 ms were 4.072 times more likely to have CAS lesions than those with PR interval<158 ms(OR=4.072,95%CI 1.417-11.702,P<0.01).Conclusion The PR interval of electrocardiogram is correlated with CAS lesions in middle-aged and elderly patients with T2DM.Middle-aged and elderly type 2 diabetic patients with significantly prolonged PR interval should be reminded to screen for CAS lesions early.