老年糖尿病患者糖化血红蛋白与颈动脉斑块及脉搏波速度相关性研究

发布时间：2018-08-21 11:39

【摘要】：研究背景及目的:老年2型糖尿病的患病率近年来呈快速上升趋势,已成为影响老年人群健康及生活质量的严重公共卫生问题。糖尿病患者发生血管病变的风险显著高于非糖尿病患者,研究糖尿病患者动脉硬化发生的危险因素对于预防其心血管并发症具有重要意义。颈动脉作为人体重要的中型动脉血管,其粥样硬化的发生与否是观察全身动脉粥样硬化的一个窗口。脉搏波速度是一种无创性评价动脉功能,反映机体主动脉、大动脉以及中动脉血管顺应性和僵硬度的经典指标,被认为是心血管事件发生风险和预后的独立预测因子。本研究通过测定老年糖尿病患者糖化血红蛋白、血糖、血压、血脂及颈动脉内中膜厚度、斑块积分、斑块稳定性、脉搏波速度等指标,探讨老年糖尿病患者糖化血红蛋白水平与颈动脉斑块和脉搏波速度的相关性及其影响因素,为预防老年糖尿病患者动脉硬化的发生发展提供一定的依据。研究方法:本研究选择2015年7月至2016年3月于山东大学齐鲁医院老年病科门诊就诊或住院的老年2型糖尿病患者,均符合1999年WHO糖尿病诊断标准,同时排除患恶性肿瘤及血液系统疾病、严重肝肾功能损害、急性感染或其他急性疾病、近期发生过急性心肌梗死、心力衰竭或脑卒中等心脑血管意外、合并躯体功能障碍或认知功能障碍者,共纳入老年糖尿病患者130例,年龄在60～92岁,平均年龄72.38±8.79岁,其中男性59例。对所有研究对象均详细询问病史并查体,记录性别、年龄、既往史等一般资料,测量身高、体质量、血压等指标,并计算体质指数,测定空腹血糖、糖化血红蛋白、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等指标。对患者进行颈动脉超声检查,分别观察并记录颈动脉斑块部位、大小、回声情况,测量颈动脉内中膜厚度(IMT);按照Crouse颈动脉斑块积分标准计算斑块积分;根据超声检查斑块回声情况将颈动脉斑块分类;应用全自动动脉硬化检测仪进行肱踝脉搏波速度(ba-PWV)的检测并记录。根据糖化血红蛋白水平将受检者分为3组:HbAIC7%者49例,为低水平组;7%≤HbAIC8.5%者58例,为中水平组;HbAIC≥8.5%者23例,为高水平组。采用SPSS 20.0软件进行统计学分析。结果:1.糖化血红蛋白低水平组、中水平组与高水平组三组间比较,收缩压、空腹血糖、高密度脂蛋白胆固醇、颈动脉内中膜厚度、斑块积分、斑块稳定性、脉搏波速度有统计学差异。2.组间比较显示,中水平组与低水平组比较,收缩压、空腹血糖、颈动脉内中膜厚度、斑块积分、不稳定斑块比例及脉搏波速度均高于低水平组,高密度脂蛋白胆固醇低于低水平组;高水平组与低水平组比较,体质指数、收缩压、空腹血糖、颈动脉内中膜厚度、斑块积分、不稳定斑块比例及脉搏波速度均高于低水平组,高密度脂蛋白胆固醇低于低水平组;高水平组与中水平组比较,空腹血糖、颈动脉内中膜厚度、斑块积分、不稳定斑块比例均高于中水平组。3.相关性分析显示:颈动脉内中膜厚度与性别(r=0.389,P0.01)、年龄(r=0.296,P0.01)、空腹血糖(r=0.203,P0.05)、糖化血红蛋白(r=0.405,P0.01)、高密度脂蛋白胆固醇有相关性(r=-0.208,P0.05);颈动脉斑块积分与性别(r=0.321.P0.01)、年龄(r=0.355,P0.01)、糖化血红蛋白(r=0.340,P0.01)和高密度脂蛋白胆固醇(r=-0.249,P0.01)有相关性;颈动脉斑块稳定性与体质指数(r=-0.286,P0.01)、收缩压(r=-0.188,P0.05)、糖化血红蛋白(r=-0.368,P0.01)和高密度脂蛋白胆固醇(r=0.405,P0.01)有相关性;脉搏波速度与年龄(r=0.516,P0.01)、收缩压(r=0.521,P0.01)、舒张压(r=0.225,P0.01)、空腹血糖(r=0.181,P0.05)、糖化血红蛋白(r=0.229,P0.01)、甘油三酯(r=-0.253,P0.01)、总胆固醇(r=-0.311,P0.01)、低密度脂蛋白胆固醇(r=-0.244,P0.01)有相关性。4.Logistic回归分析结果显示,性别、年龄和糖化血红蛋白与颈动脉内中膜增厚与否独立相关;性别、年龄、体质指数和糖化血红蛋白与颈动脉粥样硬化斑块积分大小独立相关;年龄、糖化血红蛋白、高密度脂蛋白胆固醇与粥样斑块稳定性独立相关;年龄、收缩压与脉搏波速度大小独立相关。5.颈动脉内中膜厚度与脉搏波速度呈显著正相关(r=0.234,P0.01)。斑块积分和斑块稳定性与脉搏波速度无相关性。结论:1.老年糖尿病患者糖化血红蛋白水平与颈动脉内中膜厚度、斑块积分、不稳定斑块比例、脉搏波速度呈正相关。糖化血红蛋白是颈动脉内中膜厚度、斑块积分、不稳定斑块比例增加的独立危险因素,控制糖化血红蛋白在合理水平有利于延缓老年糖尿病患者动脉硬化的发生、发展。2.老年糖尿病患者颈动脉内中膜厚度与脉搏波速度呈正相关,对于老年糖尿病患者同时进行颈动脉超声和脉搏波速度检查可早期评估其动脉硬化情况,为早期干预和治疗提供依据。3.糖化血红蛋白、收缩压、高密度脂蛋白胆固醇、体质指数是老年糖尿病患者发生动脉硬化的独立危险因素,综合控制血糖、血压、血脂、体质量有助于延缓老年糖尿病患者动脉硬化病变的进展。研究背景及目的:肥胖是多种代谢疾病以及部分肿瘤发生的主要危险因素。随着体质指数的增高,糖尿病的患病风险也增加。多数糖尿病患者存在超重或肥胖,肥胖与糖尿病共存加重机体代谢紊乱,增加其心血管疾病发生风险。目前评价肥胖的常用指标有体质指数、腰围、腰臀比和腰围身高比等。脉搏波速度(PWV)是一种无创性评价动脉功能,反映机体动脉血管顺应性和僵硬度的经典指标,被认为是心血管事件发生风险和预后的独立预测因子。本研究采用肱动脉-踝部动脉脉搏波速度作为评估患者动脉硬化的指标,分析2型糖尿病患者体质指数、腰围、腰臀比和腰围身高比对脉搏波速度的影响及其相关性,为糖尿病患者预防动脉硬化提供一定依据。研究方法:本研究选择2015年7月至2016年3月于山东大学齐鲁医院老年病科门诊就诊或住院的2型糖尿病患者,均符合1999年WHO糖尿病诊断标准,同时排除患恶性肿瘤及血液系统疾病、严重肝肾功能损害、急性感染或其他急性疾病、近期发生过急性心肌梗死、心力衰竭或脑卒中等心脑血管意外、合并躯体功能障碍或认知功能障碍者,共纳入2型糖尿病患者136例,年龄在45～87岁,平均年龄67.40±10.33岁,其中男性61例。对所有研究对象均详细询问病史并查体,记录性别、年龄、既往史等一般资料,测量身高、体质量、腰围、臀围、血压等指标,并计算体质指数、腰臀比、腰围身高比,测定空腹血糖、糖化血红蛋白、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等指标。应用全自动动脉硬化检测仪进行肱踝脉搏波速度的检测并记录。根据不同肥胖标准进行分组分析不同组间脉搏波速度的差异。采用SPSS 20.0软件进行统计学分析。结果:1.男性受检者身高、体重、腰围、腰臀比高于女性,高密度脂蛋白胆固醇低于女性。2.根据腰围、腰臀比、腰围身高比分别分组比较,肥胖组脉搏波速度均高于非肥胖组。根据体质指数分组发现,体重正常组、超重组、肥胖组脉搏波速度逐渐增高,三组间差异有统计学意义。3.控制年龄的影响后,男性脉搏波速度与腰围(r=0.333,P0.01)、腰围身高比(r=0.290,P0.05)呈正相关;女性脉搏波速度与腰围(r=0.449,P0.01)、腰臀比(r=0.397,P0.01)、腰围身高比(r=0.459,P0.01)、体质指数(r=0.302,P0.01)均呈显著正相关。4.Logistic回归分析结果显示,腰臀比和腰围身高比与脉搏波速度增高独立相关。结论:伴有肥胖的2型糖尿病患者脉搏波速度较非肥胖患者增加,腰臀比和腰围身高比是影响动脉弹性的独立危险因素。对2型糖尿病患者进行肥胖相关评估及早期干预可以在一定程度上控制动脉硬化的进展。
[Abstract]:BACKGROUND AND OBJECTIVE: The prevalence of type 2 diabetes mellitus in the elderly is increasing rapidly in recent years, which has become a serious public health problem affecting the health and quality of life of the elderly. Cardiovascular complications are of great significance. As an important medium-sized artery, carotid atherosclerosis is a window to observe systemic atherosclerosis. Canonical markers are considered to be independent predictors of risk and prognosis for cardiovascular events. The aim of this study was to investigate the glycosylated hemoglobin levels in elderly diabetic patients by measuring glycosylated hemoglobin, blood glucose, blood pressure, blood lipids and carotid intima-media thickness, plaque score, plaque stability, and pulse wave velocity. The correlation between carotid artery plaque and pulse wave velocity and its influencing factors provide certain basis for preventing the occurrence and development of atherosclerosis in elderly patients with diabetes mellitus. Methods: This study selected the elderly type 2 diabetes mellitus patients from July 2015 to March 2016 in Qilu Hospital of Shandong University who were hospitalized or visited the geriatric department of geriatrics. WHO diabetes diagnostic criteria, excluding malignant tumors and hematological diseases, severe liver and kidney dysfunction, acute infection or other acute diseases, recent occurrence of acute myocardial infarction, heart failure or stroke and other cardiovascular and cerebrovascular accidents, combined with somatic or cognitive impairment, were included in 130 elderly diabetic patients. Fifty-nine of them were male, aged from 60 to 92, with an average age of 72.38 [8.79]. All the subjects were asked for medical history and physical examination, recorded general data such as sex, age, past history, measured height, body mass, blood pressure and other indicators, and calculated body mass index, measured fasting blood glucose, glycosylated hemoglobin, triglyceride, total cholesterol, high density. Degree lipoprotein cholesterol, low density lipoprotein cholesterol and other indicators. Carotid ultrasound examination of patients, respectively observed and recorded the location of carotid plaque, size, echo, measurement of carotid intima-media thickness (IMT); according to Crouse carotid plaque integral standard to calculate plaque integral; according to ultrasound examination of plaque echo will be carotid artery. Pulse plaque classification; brachial-ankle pulse wave velocity (ba-PWV) was measured and recorded by automatic arteriosclerosis tester. According to the level of HbAIC, the subjects were divided into three groups: 49 patients with HbAIC 7% were low level group; 58 patients with HbAIC 7% < HbAIC 8.5% were middle level group; 23 patients with HbAIC > 8.5% were high level group. SPSS 20.0 software was used for the unification. Results: 1. Systolic blood pressure, fasting blood glucose, high-density lipoprotein cholesterol, carotid intima-media thickness, plaque score, plaque stability, pulse wave velocity were significantly different between the low-glycosylated hemoglobin group, the middle-level group and the high-level group. Fasting blood glucose, carotid intima-media thickness, plaque score, unstable plaque ratio and pulse wave velocity were higher in the low-level group than in the low-level group, while high-density lipoprotein cholesterol was lower in the low-level group; body mass index, systolic blood pressure, fasting blood glucose, carotid intima-media thickness, plaque score, unstable plaque ratio and pulse velocity were higher in the high-level group than in the low-level group. Compared with the middle level group, the high level group had higher fasting blood glucose, carotid intima-media thickness, plaque score and unstable plaque ratio. 3. Correlation analysis showed that carotid intima-media thickness and gender (r = 0.389, P 0.01), age (r = 0.296, P 0.01). Fasting blood glucose (r = 0.203, P 0.05), glycosylated hemoglobin (r = 0.405, P 0.01), high-density lipoprotein cholesterol (r = - 0.208, P 0.05), carotid plaque score and gender (r = 0.321.P 0.01), age (r = 0.355, P 0.01), glycosylated hemoglobin (r = 0.340, P 0.01) and high-density lipoprotein cholesterol (r = - 0.249, P 0.01) were correlated. Qualitative correlations were found with body mass index (r = - 0.286, P 0.01), systolic blood pressure (r = - 0.188, P 0.05), glycosylated hemoglobin (r = - 0.368, P 0.01) and high-density lipoprotein cholesterol (r = 0.405, P 0.01); pulse wave velocity and age (r = 0.516, P 0.01), systolic blood pressure (r = 0.521, P 0.01), diastolic blood pressure (r = 0.225, P 0.01), fasting blood glucose (r = 0.181, P 0.05), glycosylated hemoglobin (r = 0.22). 9, P 0.01, triglyceride (r = - 0.253, P 0.01), total cholesterol (r = - 0.311, P 0.01), low density lipoprotein cholesterol (r = - 0.244, P 0.01) were correlated. 4. Logistic regression analysis showed that gender, age and glycosylated hemoglobin were independently correlated with carotid intima-media thickening; gender, age, BMI and glycosylated hemoglobin were independently correlated with carotid artery intima-media thickening. Age, glycosylated hemoglobin, high-density lipoprotein cholesterol and stability of atherosclerotic plaque were independently correlated. Age, systolic blood pressure and pulse wave velocity were independently correlated. 5. Carotid intima-media thickness and pulse wave velocity were positively correlated (r = 0.234, P 0.01). Plaque integration and plaque stability were positively correlated. There was no correlation between HbA1c and carotid intima-media thickness, plaque score, unstable plaque ratio, and pulse wave velocity. HbA1c was an independent risk factor for carotid intima-media thickness, plaque score, and unstable plaque ratio. HbA1c could control glycosylated hemoglobin. Protein at a reasonable level is conducive to delaying the occurrence and development of atherosclerosis in elderly diabetic patients. 2. Carotid intima-media thickness in elderly diabetic patients is positively correlated with pulse wave velocity. Carotid ultrasound and pulse wave velocity examination can be used to evaluate early atherosclerosis in elderly diabetic patients for early intervention and intervention. 3. Glycosylated hemoglobin, systolic blood pressure, high-density lipoprotein cholesterol, body mass index are independent risk factors of atherosclerosis in elderly diabetic patients. Comprehensive control of blood sugar, blood pressure, blood lipid, body mass is helpful to delay the progress of atherosclerosis in elderly diabetic patients. Most diabetic patients are overweight or obese. The coexistence of obesity and diabetes exacerbates metabolic disorders and increases the risk of cardiovascular disease. The most commonly used indicators of obesity are body mass index. WHR, WHR and WHR. Pulse wave velocity (PWV) is a noninvasive evaluation of arterial function, a classical indicator of arterial compliance and stiffness, and is considered an independent predictor of cardiovascular risk and prognosis. To analyze the influence of body mass index (BMI), waist circumference, waist-hip ratio and waist-to-hip ratio on pulse wave velocity in type 2 diabetes mellitus patients, and to provide some basis for prevention of atherosclerosis. Patients with type 2 diabetes mellitus in our hospital met the WHO diagnostic criteria for diabetes mellitus in 1999. Malignant tumors and hematological diseases, severe liver and kidney impairment, acute infection or other acute diseases, recent cardio-cerebrovascular accidents such as acute myocardial infarction, heart failure or stroke, combined with somatic or cognitive impairment were excluded. 136 patients with type 2 diabetes mellitus were enrolled in the study. The average age was 67.40 (+ 10.33) years. Sixty-one of them were male. High ratio, fasting blood glucose, glycosylated hemoglobin, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and other indicators were measured. Brachial-ankle pulse wave velocity was measured and recorded by automatic atherosclerosis tester. Results: 1. The height, weight, waist circumference, waist-hip ratio of male subjects were higher than that of female subjects, and HDL-C was lower than that of female subjects. 2. According to waist circumference, waist-hip ratio and waist-to-height ratio, the pulse wave velocity of obese group was higher than that of non-obese group. There was a significant difference among the three groups. 3. After controlling the influence of age, the pulse wave velocity was positively correlated with waist circumference (r = 0.333, P 0.01), waist circumference height ratio (r = 0.290, P 0.05), waist circumference (r = 0.449, P 0.01), waist-hip ratio (r = 0.397, P 0.01), waist circumference height ratio (r = 0.459, P 0.05). Logistic regression analysis showed that waist-hip ratio and waist circumference-height ratio were independently correlated with the increase of pulse wave velocity. Conclusion: The pulse wave velocity in obese type 2 diabetes mellitus patients was higher than that in non-obese type 2 diabetes mellitus patients, and waist-hip ratio and waist circumference-height ratio were independent risk factors for arterial elasticity. Obesity-related assessment and early intervention in type 2 diabetic patients can control the progression of atherosclerosis to some extent.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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