2型糖尿病长期随诊中不同降糖药物组合对颈动脉内—中膜厚度变化的可能影响分析

发布时间：2018-06-27 10:38

本文选题：2型糖尿病 + 颈动脉内-中膜厚度　；参考：《北京协和医学院》2017年硕士论文

【摘要】：[背景]近年来,我国成人糖尿病及糖尿病前期患病率逐年增加,患病人数居世界首位,为经济发展带来巨大负担。糖尿病作为一种代谢性疾病,主要损害表现为血管病变,与非糖尿病患者相比,2型糖尿病(type 2 diabetes,T2DM)患者合并大血管病变患病率更高,且大血管病变更为广泛、严重,发病年龄更早。2型糖尿病被证实是心血管疾病的重要危险因素,合并心血管疾病(Cardiovascular disease,CVD)时致死、致残率明显升高。早期筛查、风险评估及干预意义重大。颈动脉位置表浅,作为全身动脉的探测窗口,其内-中膜增厚(carotid intima-media thickness,IMT)、动脉粥样硬化(Atherosclerosis,AS)与冠状动脉粥样硬化有相似的病生理基础,无创性超声检测颈动脉内膜-中膜厚度对预测心血管事件有重要意义。[目的]1.观察入组患者基线特征;2.评估不同降糖药物组合对颈动脉内膜变化的影响。[方法]对来自2012年1月至2016年12月期间在北京协和医院内分泌科门诊规律随诊的158名2型糖尿病患者进行动脉内膜变化及降糖药物使用对动脉内膜变化的影响方面的回顾性研究。2型糖尿病诊断标准根据1999年WHO糖尿病诊断标准。根据2007年欧洲高血压治疗指南,颈动脉IMT0.9mm确定为内中膜增厚,局部IMT≥1.3mm为判定为动脉硬化斑块。通过比较不同年份左右颈内动脉、颈动脉分叉IMT、颈动脉斑块的变化得出动脉IMT及斑块变化差值,除以随访年份数得出颈动脉IMT及斑块平均年变化率,IMT根据数值正负分为“变大”和“变小”。颈动脉内膜斑块根据正、负、零分为“变大”,“变小”,“稳定”。通过问卷调查方式采集基本信息、生活方式及慢性并发症诊断病史。体量指标包括身高、体重、体脂(Fat mas,FAT)、BMI、血压;生化指标包括空腹血糖(Fasting blood glucose,FBG)、空腹胰岛素(Fasting insulin,FINS)、空腹C肽(Fasting C-peptide,C肽)、总胆固醇(Total Cholesterol,TC)、甘油三酯(Triglyeride,TG)、高密度脂蛋白胆固醇(High density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL-C)、HOMAIR(Homeostasis model of assessment,HOMARI)。组间比较采用t-检验、方差分析、卡方检验和配对检验,多因素分析采用多元Logistic回归和多因素线性逐步回归。[结果]158例诊2型糖尿病患者中,男性90例(57%),女性68例(43%)高脂血症患病者148例(94%);高血压患病者83例(53%);有DM家族史者96例(61%);有冠心病者10例(6%);颈动脉内膜增厚者130例(82%);颈动脉斑块者 88 例(56%)。第1组患者 HOMA-IR、FBG、HbA1C%、GA%、C-肽、HDL的P0.05,存在统计学差异,logistics回归示HbA1C%P0.05。第2组患者体重、病程、HbA1C%、C肽的P0.05,组间比较均有统计学差异,logistics回归示DM病程P0.05。第3组患者体重、病程、DBP、FBG、HbA1C%、GA%、C肽、性别、吸烟组间比较P0.05,存在统计学差异,logistics回归示HbA1C%、DM病程P0.05。3组不同降糖药与CIMT及动脉斑块变化之间比较P均0.05,无统计学差异。[结论](1)2型糖尿病患者多数合并高脂血症,高血压,心脑血管疾病发病率高,颈动脉内-中层厚度对预测心血管事件很有帮助。(2)本研究中,2型糖尿病患者不同降糖药物组合对颈动脉内膜变化的影响方面未观察到存在明显差异。(3)2型糖尿病患者病程越长,HbA1c越高,CIMT增厚越明显,而平稳血糖控制有利于减缓内-中膜增长速度。
[Abstract]:[background] in recent years, the prevalence of diabetes and prediabetes in China is increasing year by year. The number of patients in the world is the first in the world, which brings great burden to the economic development. As a metabolic disease, the main damage of diabetes is vascular disease. Compared with non diabetic patients, patients with type 2 diabetes (type 2 diabetes, T2DM) are associated with large vascular disease. The prevalence rate is higher, and the major vascular lesions are more extensive and serious. Early onset age.2 diabetes is proved to be an important risk factor for cardiovascular disease. It is fatal when combined with cardiovascular disease (Cardiovascular disease, CVD), and the rate of disability is significantly increased. Early screening, risk assessment and intervention are of great significance. Carotid intima-media thickness (IMT), atherosclerosis (Atherosclerosis, AS) and coronary atherosclerosis are similar to the physiological basis of coronary atherosclerosis. Noninvasive ultrasound examination of the carotid artery intima medium thickness is important for predicting cardiovascular events. [Objective]1. observation was observed in the group of patients with baseline. Characteristics; 2. evaluate the effect of different combination of hypoglycemic agents on carotid artery intima change. [Methods] retrospective study of the changes in the intima changes of the arteries and the changes of the intimal changes in the arteria of 158 patients with type 2 diabetes from January 2012 to December 2016 in the Department of Endocrinology, Peking Union Medical College Hospital The diagnostic criteria for type.2 diabetes were based on the 1999 WHO diabetes diagnostic criteria. According to the 2007 European guidelines for hypertension treatment, the carotid IMT0.9mm was determined to be the thickening of the medial membrane, and the local IMT > 1.3mm was judged to be a atherosclerotic plaque. By comparing the carotid artery, the carotid artery bifurcation IMT, the carotid artery plaque and the arterial IMT by comparing the different years of the internal carotid artery. The average annual change rate of carotid artery IMT and plaque was divided according to the number of follow-up years. IMT was divided into "bigger" and "smaller" according to the positive and negative values. The carotid intima plaque was "bigger", "smaller" and "stable" according to the positive, negative, zero points. The basic information, life style and chronic concurrency were collected by questionnaire. The body volume index includes height, weight, body fat (Fat MAS, FAT), BMI, blood pressure, biochemical indexes including Fasting blood glucose (FBG), fasting insulin (Fasting insulin, FINS), fasting C peptide, triglyceride, triglyceride, high density lipoprotein gallbladder High density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (Low density lipoprotein cholesterol, LDL-C), HOMAIR Homeostasis (Homeostasis), variance analysis, chi square test and paired test, multivariate regression and multi factor linear stepwise analysis [results: [results] among patients with type 2 diabetes, 90 (57%) were male, 68 (43%) patients with hyperlipidemia (94%), 83 (53%) patients with hypertension, 96 patients with DM family history, 10 (6%) with coronary heart disease, carotid artery intima thickening and HOMA-IR, FBG, HbA1C%, GA%, patients with carotid artery intima thickening. C- peptide, HDL P0.05, there were statistical differences. Logistics regression showed that the body weight, course of disease, HbA1C%, P0.05 of C peptide in group HbA1C%P0.05. second were statistically different. Logistics regression showed the body weight of the P0.05. third group of DM course. There was no difference in P between the group P0.05.3 and the changes of CIMT and arterial plaque in group P0.05.3. [Conclusion] [Conclusion] [Conclusion] (1) most patients with type 2 diabetes have hyperlipidemia, high blood pressure, high incidence of cardiovascular and cerebrovascular diseases, and the thickness of the carotid artery and middle layer is helpful for the pretest of cardiovascular events. (2) in this study, type 2 diabetes mellitus, type 2 diabetes mellitus (2) There was no significant difference in the effect of different combination of hypoglycemic agents on the changes of carotid artery intima. (3) the longer the course of the patients with type 2 diabetes, the higher the HbA1c, the more obvious the thickening of the CIMT, and the smooth blood glucose control was beneficial to slow the growth of the inner and middle membrane.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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