身体活动水平对2型糖尿病患者颈动脉内膜中层厚度增厚的影响研究

Effect of Physical Activities on the Carotid Intima-media Thickening in Patients with Type 2 Diabetes Mellitus

背景心血管疾病是2型糖尿病(T2DM)患者的主要死亡原因,颈动脉内膜中层厚度(CIMT)增厚可预测心血管疾病的发生。中高水平的身体活动(PA)可改善患者的血糖水平并降低心血管疾病的发生率和死亡风险。探讨这一可改变的生活方式与CIMT的关系可能是预防心血管疾病的有效策略。目的分析不同PA水平与T2DM患者CIMT增厚的关系,为患者推荐个性化活动方案提供科学依据。方法本研究为横断面研究,选取2019年1月—2022年2月于江苏省两家三级甲等医院内分泌门诊就诊的3099例T2DM患者为研究对象,采用国际身体活动量表(IPAQ)短问卷评估患者的PA水平,将患者分为轻度及以下PA组、中度PA组和高强度PA组。通过二元Logistic回归分析探讨PA与CIMT增厚的关系,并按照不同肥胖程度和血压、血脂及糖化达标状况进行分层分析。将PA水平作为连续变量绘制限制性立方样条评价PA与CIMT增厚的剂量反应关系。结果与轻度及以下PA患者(n=981)相比,中度(n=1389)和高强度(n=729)PA患者的年龄较小,糖化血红蛋白(HbA_(1c))和低密度脂蛋白胆固醇(LDL-C)水平较高(P<0.05)。二元Logistic回归分析结果显示,中度PA与发生CIMT增厚的风险呈负关联(OR=0.775,95%CI=0.629~0.956,P<0.05),这种关联独立于社会人口学、生活方式及血脂等生化指标。进一步绘制限制性立方样条结果显示,PA与CIMT增厚的风险之间存在非线性关系(P_(非线性)=0.014)。分层分析结果显示,在体质量正常(n=996)和超重(n=1395)的患者中未发现PA与CIMT的关系(P>0.05);而在肥胖患者(n=708)中仅中度PA与CIMT增厚相关(OR=0.614,95%CI=0.382~0.987,P<0.05);血压、血脂及糖化3项指标均不达标(n=324)和仅1项指标达标(n=1416)的患者,中度PA与发生CIMT增厚呈负相关(P<0.05)。结论PA水平与CIMT增厚存在剂量反应关系,中度PA与CIMT增厚呈负相关,尤其是在肥胖、血压、血脂及糖化控制较差的人群中,而高强度PA对CIMT的影响不显著。

Background Cardiovascular diseases are the main cause of death in patients with type 2 diabetes mellitus(T2DM).Carotid intima-media thickening(CIMT)can predict the occurrence of cardiovascular diseases.Moderate-to-high levels of physical activities(PA)improve glycemic control and reduce the incidence of cardiovascular diseases and mortality.Exploring the relationship between this modifiable lifestyle and CIMT may be an effective strategy to prevent cardiovascular diseases in the early stage.Objective To analyze the correlation between PA at varying levels and CIMT in T2DM patients,and to provide a scientific basis for recommending individualized PA programs to them.Methods This was a cross-sectional study.From January 2019 to February 2022,a total of 3099 T2DM patients visited endocrinology clinics at two tertiary hospitals in Jiangsu Province were selected.PA level in T2DM patients was surveyed using the International Physical Activity Questionnaire(IPAQ).They were assigned into mild and lower PA group,moderate PA group and vigorous PA group.The correlation between PA and CIMT was identified by binary logistic regression.Stratified analyses were performed based on the obesity degree,blood pressure,blood lipids,and hemoglobin A_(1c)(HbA_(1c)).Restricted cubic splines were used to evaluate the dose-response relationship between PA and CIMT with PA level as the continuous variable.Results Compared with those in the mild and lower PA group(n=981),T2DM patients in moderate PA group(n=1389)and vigorous PA(n=729)were significantly younger with higher HbA1c and low-density lipoprotein cholesterol(LDL-C)(P<0.05).Binary Logistic regression analysis showed that moderate PA was negatively correlated with the risk of CIMT,and this correlation was independent of socio-demographic characteristics,lifestyle and blood lipids(OR=0.775,95%CI=0.629-0.956,P<0.05).The results of restricted cubic spline showed a nonlinear relationship between PA level and the risk of high CIMT(P_(nonlinear)=0.014).Stratified analysis showed that PA was not associated with CIMT in T2DM patients with normal weight(n=996)or overweight(n=1395)(P>0.05).However,only moderate PA was associated with CIMT in obese patients(n=708)(OR=0.614,95%CI=0.382-0.987,P<0.05).Moderate PA was negatively associated with CIMT in patients(n=324)who did not meet any of the three indicators(blood pressure,blood lipids and HbA1c)and those(n=1416)who met only one indicator(P<0.05).Conclusion There is a dose-response relationship between PA levels and CIMT in T2DM patients thickening.Moderate PA is significantly negatively associated with CIMT,especially in T2DM patients with poor control of obesity,blood pressure,blood lipids,and glycaemia,while vigorous PA is not correlated with CIMT.