2型糖尿病患者颈动脉内中膜增厚和颈动脉斑块的流行现况和相关因素研究

发布时间：2018-05-11 07:41

本文选题：2型糖尿病 + 颈动脉内中膜增厚　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:分析2型糖尿病患者颈动脉内中膜增厚及颈动脉斑块的流行现况和临床特征,探讨2型糖尿病患者颈动脉内中膜增厚及颈动脉斑块的相关因素,并比较两者相关因素的差异,以期为早期发现高危人群并采取有效的预防或治疗措施,进而减少2型糖尿病并发心血管疾病的发生提供科学研究依据。方法:回顾性查阅2008年1月1日至2013年3月1日天津医科大学代谢病医院住院的2型糖尿病患者(2525例)的病历资料,摘录相关信息,以其中进行颈动脉超声检测内中膜厚度的患者(1167例)为研究对象,分析2型糖尿病住院患者颈动脉内中膜增厚及颈动脉斑块的检出率及临床特征。采用病例对照研究方法,分别以颈动脉内中膜增厚的2型糖尿病患者(604例)及有颈动脉斑块者(162例)作为病例组,以颈动脉内中膜厚度正常的2型糖尿病患者(401例)作为对照组,采用非条件Logistic回归对颈动脉内中膜增厚及颈动脉斑块的相关因素进行单因素和多因素分析,计算比值比(OR)及其95%可信区间(95%CI)。结果:1、1167例2型糖尿病住院患者中,604例有颈动脉内中膜增厚,检出率为51.8%;162例有颈动脉斑块,检出率为13.9%;随着糖尿病患者年龄的增加、病程的延长,颈动脉内中膜增厚和颈动脉斑块的检出率均逐渐增加。2、在2型糖尿病患者中,与颈动脉内中膜厚度正常组相比,颈动脉斑块组及颈动脉内中膜增厚组的年龄较大,在职、退休者的比例较大,糖尿病病程较长,现患冠心病、高血压和糖尿病视网膜病变者的比例较高,收缩压(SBP),血尿素氮(BUN)、血肌酐(CRE)、血纤维蛋白原(FIB)水平较高,颈动脉斑块组的尿蛋白(UPRO)水平较高,吸烟者比例较高,颈动脉增厚组接受胰岛素治疗和口服降糖药治疗者的比例较高,尿微量白蛋白(UMA)水平较高,差异均具有统计学意义(P0.05)。3、单因素Logistic回归分析结果显示:男性、高龄、退休、吸烟、肥胖、糖尿病病程长、胰岛素治疗、口服降糖药治疗、糖尿病视网膜病变、糖尿病肾病、现患高血压和冠心病、血纤维蛋白原水平(FIB)4.0g/L与2型糖尿病患者颈动脉内中膜增厚的高风险相关;男性、高龄、退休、吸烟、糖尿病病程长、糖尿病视网膜病变、现患冠心病和高血压、血尿素氮(BUN)≥8.3 mmol/L、血纤维蛋白原水平(FIB)4.0g/L、C反应蛋白水平(CRP)≥8 mg/L与2型糖尿病患者颈动脉斑块的高风险有关。对上述单因素分析有统计学意义的变量进行多因素非条件Logistic回归分析,结果显示,高龄、男性、肥胖、现患高血压、现患冠心病与2型糖尿病患者颈动脉内中膜增厚的高风险相关;高龄、吸烟、血浆纤维蛋白原4.0g/L和现患冠心病与2型糖尿病患者颈动脉斑块的高风险相关。结论:1、2型糖尿病住院患者中颈动脉内中膜增厚和颈动脉斑块的检出率较高;年龄越大、病程越长的2型糖尿病患者颈动脉内中膜增厚、颈动脉斑块的检出率越高。2、高龄、男性、肥胖、现患高血压、现患冠心病与2型糖尿病患者颈动脉内中膜增厚的高风险相关;高龄、吸烟、高血浆纤维蛋白原水平、现患冠心病与2型糖尿病患者颈动脉斑块的高风险相关;颈动脉内中膜增厚与合并颈动脉斑块的风险因素存在差异,有待于进一步研究。
[Abstract]:Objective: to analyze the current and clinical characteristics of carotid artery thickening and carotid atherosclerotic plaque in patients with type 2 diabetes, and to explore the related factors of carotid artery thickening and carotid artery plaque in type 2 diabetic patients, and to compare the difference between the two factors in order to find early high-risk groups and take effective preventive or therapeutic measures. In order to reduce the incidence of type 2 diabetes complicated with cardiovascular disease, a scientific research basis was provided. Methods: a retrospective review of the medical records of type 2 diabetic patients (2525 cases) hospitalized in the metabolic disease hospital of Medical University Of Tianjin from January 1, 2008 to March 1, 2013 was reviewed, and relevant information was excerpt from which the carotid artery ultrasound was used to detect the thickness of the middle membrane. The detection rate and clinical characteristics of carotid artery middle membrane thickening and carotid artery plaque in patients with type 2 diabetes mellitus (1167 cases) were analyzed. Case control study method was used to treat type 2 diabetes mellitus (604 cases) with carotid artery thickening (604 cases) and carotid plaque (162 cases) as case group with the thickness of carotid artery middle membrane. Normal type 2 diabetic patients (401 cases) were used as the control group. Single factor and multifactor analysis were performed on the carotid artery intima media thickening and carotid artery plaque related factors by non conditional Logistic regression. The ratio Ratio (OR) and 95% confidence interval (95%CI) were calculated. Results: among 11167 hospitalized patients with type 2 diabetes, 604 cases had carotid intima-medium increase. The detection rate was 51.8%, 162 cases with carotid artery plaque, the detection rate was 13.9%, with the increase of age, the extension of the course, the thickening of the carotid artery and the detection rate of carotid artery plaque were gradually increased by.2. In type 2 diabetic patients, the carotid artery plaque group and the carotid intima-medium membrane were compared with the normal carotid artery middle membrane thickness group. The age of the thickening group is larger, the proportion of the retirees is larger, the course of diabetes is longer, the proportion of the patients with coronary heart disease, hypertension and diabetic retinopathy is higher, the systolic pressure (SBP), blood urea nitrogen (BUN), serum creatinine (CRE), blood fibrinogen (FIB) level is higher, the level of urinary protein (UPRO) in the carotid plaque group is higher, and the proportion of smokers is higher. Higher in the carotid artery thickening group, the ratio of insulin therapy and oral hypoglycemic agents was higher, and the urinary microalbumin (UMA) level was higher, and the difference was statistically significant (P0.05).3. The single factor Logistic regression analysis showed that male, senior, retired, smoking, obese, long course of diabetes, insulin treatment, oral hypoglycemic medicine, Diabetic retinopathy, diabetic nephropathy, hypertension and coronary heart disease, the blood fibrinogen level (FIB) 4.0g/L is associated with the high risk of the thickening of the carotid artery in type 2 diabetic patients; male, senior, retired, smoking, long course of diabetes, diabetic retinopathy, coronary heart disease and hypertension, blood urea nitrogen (BUN) more than 8.3 mmol/L The blood fibrinogen level (FIB) 4.0g/L, C reactive protein level (CRP) or more than 8 mg/L was associated with the high risk of carotid plaque in type 2 diabetic patients. Multivariate non conditional Logistic regression analysis of statistically significant variables in the single factor analysis showed that high age, male, obesity, hypertension, coronary heart disease and type 2 sugar The high risk related to the thickening of the middle carotid artery of the carotid artery in patients with urinary disease; age, smoking, plasma fibrinogen 4.0g/L and high risk of carotid plaque in patients with type 2 diabetes. Conclusion: the prevalence of carotid artery thickening and carotid plaque in patients with type 1,2 diabetes mellitus is higher; the older the age, the longer the course of disease is 2. The thickening of the carotid artery middle membrane in patients with type 2 diabetes, the higher the detection rate of carotid artery plaque is, the higher the age, the male, the obesity, the high blood pressure, and the high risk associated with the thickening of the carotid artery in the patients with type 2 diabetes; the older, the smoking, the high plasma fibrin plain water, the higher carotid plaque in the patients with type 2 diabetes Risk related; the risk factors of carotid intima-media thickening and carotid plaques are different, which need further study.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R181.3

【参考文献】