[1]王继政 刘尚全 黄婷 江旭 张梦夏 许莉.血糖波动与颈动脉内膜中层厚度增加的 糖尿病患者形成斑块的相关性研究[J].国际内分泌代谢杂志,2020,40(03):150-153168.[doi:10.3760/cma.j.issn.1673-4157.2020.03.002]
　Wang Jizheng,Liu Shangquan,Huang Ting,et al.Correlation between glycemic fluctuation and carotid artery plaque in patients with type 2 diabetes mellitus with abnormal carotid intima-media thickness[J].International Journal of Endocrinology and Metabolism,2020,40(03):150-153168.[doi:10.3760/cma.j.issn.1673-4157.2020.03.002]
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血糖波动与颈动脉内膜中层厚度增加的 糖尿病患者形成斑块的相关性研究()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
40
期数:
2020年03期
页码:
150-153168
栏目:
论著
出版日期:
2020-05-20

文章信息/Info

Title:
Correlation between glycemic fluctuation and carotid artery plaque in patients with type 2 diabetes mellitus with abnormal carotid intima-media thickness
作者:
王继政1 刘尚全1 黄婷2 江旭1 张梦夏1 许莉1
1安徽医科大学第三附属医院/合肥市第一人民医院内分泌科 230000; 2南京医科大学附属南京医院/南京市第一医院神经内科 210000
Author(s):
Wang Jizheng1;  Liu Shangquan1;  Huang Ting2;  Jiang Xu1;  Zhang Mengxia1;  Xu Li1
1Department of Endocrinology, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, Hefei 230000, China; 2Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210000, China
关键词:
2型糖尿病;  血糖波动;  颈动脉内膜中层厚度;  颈动脉斑块
Keywords:
Type 2 diabetes mellitus;  Blood glucose variability;  Carotid intima-media thickness;  Carotid artery plaque
DOI:
10.3760/cma.j.issn.1673-4157.2020.03.002
摘要:
目的 探讨血糖波动水平与颈动脉内膜中层厚度(CIMT)增加的2型糖尿病(T2DM)患者形成颈动脉斑块的相关性。方法 选取合肥市第一人民医院CIMT增加(>0.9 mm)的T2DM住院患者810例,其中CIMT增加已形成斑块的患者521例(有斑块组),未形成斑块的患者289例(无斑块组)。通过多普勒超声测定CIMT颈动脉斑块; 采用床旁快速血糖监测的结果,计算入院前3 d内血糖水平标准差的平均值来评估血糖波动水平。记录所有受试者血脂、血压、血糖、HbA1c、吸烟及饮酒史、病程、年龄、性别、家族史、双侧颈动脉血管超声等情况,利用单因素分析研究对动脉粥样硬化进展有统计学意义的变量,采用二分类logistic回归评估血糖波动水平对CIMT增加的T2DM患者颈动脉斑块形成的影响。结果 与无斑块组相比,有斑块组年龄更大、收缩压更高、低密度脂蛋白-胆固醇更高、高密度脂蛋白-胆固醇更高、病程长/短比更大,而舒张压更低(χ2/Z/t=-7.977、-2.870、-2.217、-2.378、22.346、-2.192,P均<0.05); 血糖水平的标准差(SDBG)的差异有统计学意义。即血糖波动水平与CIMT增加进展至斑块之间具有相关性(χ2=9.263,P<0.05)。二分类logistic回归模型显示年龄(OR=1.062,95% CI:1.043～1.080,P<0.05)、性别(OR=1.602,95% CI:1.085～2.366,P<0.05)、病程(OR=1.609,95% CI:1.098～2.357, P<0.05)是斑块形成的独立危险因素。血糖波动较大组(5 mmol/L≤SDBG<8 mmol/L)相对于血糖波动正常组斑块形成的差异具有统计学意义,CIMT增加的T2DM患者其血糖波动水平与斑块形成明显相关(OR=1.835,95% CI:1.102～3.055,P<0.05)。结论 血糖波动水平升高是CIMT增加的T2DM患者形成斑块的独立危险因素,较大的血糖波动参与大血管病变的进展。
Abstract:
Objective To investigate the correlation between glycemic fluctuation and carotid artery plaque in patients with type 2 diabetes mellitus(T2DM)with increased carotid intima-media thickness(CIMT).Methods A total of 810 patients with T2DM whose CIMT were greater than 0.9 mm were enrolled in this study including 521 subjects with carotid artery plaque(plaque group)and 289 subjects without carotid artery plaque(non-plaque group)in the First People's Hospital of Hefei. The CIMT and carotid artery plaque were measured with ultrasonography. Using the results of rapid blood glucose monitoring at the bedside within the first 3 days in hospital, the glucose variability was assessed by the standard deviation of blood glucose(SDBG). Blood lipids, blood pressure, blood glucose, glycosylated hemoglobin, history of smoking and drinking, course of disease, age, gender, family history, bilateral carotid vascular ultrasound, etc. were recorded. Statistics of atherosclerosis progression were analyzed by univariate analysis. Variables of academic significance were evaluated by binary logistic regression to assess the effect of blood glucose fluctuations on carotid plaque formation in T2DM patients with increased CIMT.Results Compared with non-plaque group the age, systolic blood pressure, LDL-C, HDL-C, ratio of long duration/short duration were increased whereas the diastolic blood pressure(DBP)was decreased in plaque group(χ2/Z/t=-7.977, -2.870, -2.217, -2.378, 22.346, -2.192, all P<0.05). The SDBG was also different between the two groups. There was a correlation between blood glucose fluctuation levels and increased CIMT progression to plaques(χ2=9.263, P<0.05). Binary logistic regression analysis showed that age(OR=1.062, 95% CI: 1.043-1.080, P<0.05), gender(OR=1.602, 95% CI: 1.085-2.366, P<0.05)and disease duration(OR=1.609, 95% CI: 1.098-2.357, P<0.05)were independent risk factors for plaque formation. The difference in plaque formation between the groups with large blood glucose fluctuations(5 mmol/L≤SDBG<8 mmol/L)and the group with normal blood glucose fluctuations was statistically significant. The level of blood glucose fluctuations in T2DM patients with increased CIMT was significantly related to plaque formation(OR=1.835, 95% CI: 1.102-3.055, P<0.05).Conclusions Elevated blood glucose fluctuation is an independent risk factor of plaque formation in T2DM patients with abnormal CIMT. Larger blood glucose fluctuation is involved in the pathogenesis of macrovascular injury.

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备注/Memo

备注/Memo:
通信作者:刘尚全,Email:lsq_sh@163.com
基金项目:国家自然科学基金(30840106)
Corresponding author: Liu Shangquan,Email:lsq_sh@163.com
Fund program:National Natural Science Foundation of China(30840106)
更新日期/Last Update: 2020-05-20