脑卒中高危人群空腹血糖水平对颈动脉斑块形成的影响及中医证型分布特征
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摘要
[目的]研究脑卒中高危人群空腹血糖(FBG)水平对颈动脉斑块形成的影响及中医证型分布特征。[方法]选取2012年6月至2015年3月北京王佐镇、蒲黄榆、方庄、花乡、大红门、东铁营社区卫生服务中心符合脑卒中高危诊断者5 090例作为研究对象,进行统一的问卷调查、体格检查、实验室检验、颈动脉超声检查、中医症状采集;依据FBG水平分级标准;比较不同FBG水平对颈动脉斑块形成的影响、不同FBG水平下斑块形成者中医证型分布特征。[结果]在有无颈动脉斑块形成的人群间,FBG分级水平结果存在统计学差异(P<0.01);以正常血糖(NFG)为基准,校正其他危险因素和影响因素后,空腹血糖受损(IFG)斑块形成风险为NFG的1.352倍[95%C(I1.165,1.570),P<0.01],糖尿病(DM)斑块形成风险为NFG的1.552倍[95%CI=(1.328,1.814),P<0.01];在IFG痰湿证有斑块例数所占百分比大于无斑块例数所占百分比(P<0.05),在DM血瘀证、内火证有斑块例数所占百分比大于无斑块例数所占百分比(P<0.05)。[结论] IFG和DM可能都是颈动脉斑块形成的独立危险因素,与其他证型比较,IFG人群中痰湿证,DM人群中血瘀证、内火证,可能与颈动脉斑块形成具有更强的相关性。
[Objective] To study the effects of different fasting blood glucose(FBG) levels on carotid plaque formation and the distribution characteristics of traditional Chinese medicine(TCM) syndrome types in population with high risk of stroke. [Methods]From June 2012 to March 2015,5 090 patients with diagnosis of high risk of stroke from community health service centers of Wangzuozhen,Puhuangyu,Fangzhuang,Huaxiang,Dahongmen,and Dongtieying in Beijing were selected,applied unified questionnaire,physical examination,laboratory examination,carotid artery ultrasound examination,and TCM symptoms collection. The effects on carotid plaque formationof groups with different FBG levels and the distribution characteristics of TCM Syndrome Types were analyzed.[Results] There was a significant difference shown in the result of FBG level between patients with or without carotid plaque formation(P<0.01). After adjusting other risk factors and influencing factors,impaired fasting glucose(IFG)was 1.352 times the plaque formation risk of normal fasting glucose(NFG)[95%CI(1.165,1.570),P<0.01],and diabetes mellitus(DM) was 1.552 times the plaque formation risk of NFG [95%CI=(1.328,1.814),P<0.01]. On IFG level,patients with phlegm-dampness syndrome showed a higher percentage of plaque cases than that of non-plaque cases(P<0.05),while patients with blood-stasis syndrome and internal-fire syndrome showed a higher percentage of plaque cases than that of non-plaque cases(P <0.05)on DM level. [Conclusion] IFG and DM may both be independent risk factors to carotid plaque formation. Phlegm-dampness syndrome in IFG population,blood-stasis syndrome and internalfire syndrome in DM population might have stronger correlation with carotid plaque formation than other TCM syndromes.
[Objective] To study the effects of different fasting blood glucose(FBG) levels on carotid plaque formation and the distribution characteristics of traditional Chinese medicine(TCM) syndrome types in population with high risk of stroke. [Methods]From June 2012 to March 2015,5 090 patients with diagnosis of high risk of stroke from community health service centers of Wangzuozhen,Puhuangyu,Fangzhuang,Huaxiang,Dahongmen,and Dongtieying in Beijing were selected,applied unified questionnaire,physical examination,laboratory examination,carotid artery ultrasound examination,and TCM symptoms collection. The effects on carotid plaque formationof groups with different FBG levels and the distribution characteristics of TCM Syndrome Types were analyzed.[Results] There was a significant difference shown in the result of FBG level between patients with or without carotid plaque formation(P<0.01). After adjusting other risk factors and influencing factors,impaired fasting glucose(IFG)was 1.352 times the plaque formation risk of normal fasting glucose(NFG)[95%CI(1.165,1.570),P<0.01],and diabetes mellitus(DM) was 1.552 times the plaque formation risk of NFG [95%CI=(1.328,1.814),P<0.01]. On IFG level,patients with phlegm-dampness syndrome showed a higher percentage of plaque cases than that of non-plaque cases(P<0.05),while patients with blood-stasis syndrome and internal-fire syndrome showed a higher percentage of plaque cases than that of non-plaque cases(P <0.05)on DM level. [Conclusion] IFG and DM may both be independent risk factors to carotid plaque formation. Phlegm-dampness syndrome in IFG population,blood-stasis syndrome and internalfire syndrome in DM population might have stronger correlation with carotid plaque formation than other TCM syndromes.
引文
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[12] The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus[J]. Diabetes Care,2003:3160-3167.
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[18] American Diabetes Association. Diagnosis and classification of diabetes mellitus[J]. Diabetes Care,2014,37(Suppl 1):S81-S90.
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[20] Pollex RL,Spence JD,House AA,et al. A comparison of ultrasound measurements to assess carotid atherosclerosis development in subjects with and without type 2 diabetes[J]. Cardiovascular Ultrasound,2005,3(1):15.
[21] Tropeano AI,Boutouyrie P,Katsahian S,et al. Glucose level is a major determinant of carotid intima-media thickness in patients with hypertension and hyperglycemia[J]. Journal of Hypertension,2004,22(11):2153-2160.
[22] Sung J,Song YM,Ebrahim S,et al. Fasting Blood Glucose and the Risk of Stroke and Myocardial Infarction[J]. Circulation,2009,119(6):812-819.
[23] Kirii K,Tanaka S,Yamagishi K,et al. Associations between Cardiovascular Risk Factors and Carotid Atherosclerosis in Middleaged Japanese Men with Multiple Risk Factors[J]. Industrial Health,2008,(46):607-612.
[24] Brohall G,Schmidt C,Behre CJ,et al. Association between impaired glucose tolerance and carotid atherosclerosis:a study in 64-yearold women and a meta-analysis[J]. Nutrition Metabolism&Cardiovascular Diseases,2009,19(5):327-333.
[25] Fujii N,Tsuchihashi K,Sasao H,et al. Insulin resistance functionally limits endothelium-dependent coronary vasodilation in nondiabetic patients[J]. Heart and Vessels,2008,23(1):9-15.
[26] Reilly MP,Wolfe ML,Rhodes T,et al. Measures of insulin resistance add incremental value to the clinical diagnosis of metabolic syndrome in association with coronary atherosclerosis[J]. Circulation,2004,110(7):803-809.
[27] Ceriello A,Motz E. Is oxidative stress the pathogenic mechanism underlying insulin resistance,diabetes,and cardiovascular disease?The common soil hypothesis revisited[J]. Arteriosclerosis Thrombosis&Vascular Biology,2004,24(5):816-823.
[28] Paneni F,Beckman JA,Creager MA,et al. Diabetes and vascular disease:pathophysiology,clinical consequences,and medical therapy:partI[J]. European Heart Journal,2013,34(31):2436-2443.
[29] Nakamura K,Yamagishi S,Adachi H,et al. Serum levels of soluble form of receptor for advanced glycation end products(sRAGE)are positively associated with circulating AGEs and soluble form of VCAM-1 in patients with type 2 diabetes[J]. Microvascular Research,2008,76(1):52-56.
[30] Brites F,Rosso LG,Fornari M,et al. Alterations in cell adhesion molecules and other biomarkers of cardiovascualr disease in patients with metabolic syndrome[J]. Atherosclerosis,2008,199(2):415-423.
[31]黄世敬,王永炎.糖尿病与火毒[J].世界中西医结合杂志,2015,35(12):1750-1753.
[32]张昕洋,刘雪梅,陈志刚.内生火热之毒致病特性探讨[J].世界中医药,2018,13(8):1845-1849.
[33]王永炎,刘炳林.中风病研究进展述评[J].中医药导报,1995,4(2):51-54.
[2] De Weerd M,Greving JP,Hedblad B,et al. Prediction of Asymptomatic Carotid Artery Stenosis in the General Population:Identification of High-Risk Groups[J]. Stroke,2014,45(8):2366-2371.
[3] Shihab M,Margueritte C,Bhatt DL,et al. Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis:Findings From Get With The Guidelines-Stroke[J].Journal of the American Heart Association,2015,4(10):e2193.
[4] Ryuichi K,Hitomi T,Nobuyuki O,et al. Metabolic Syndrome,Diabetes and Subclinical Atherosclerosis as Assessed by Carotid Intima-Media Thickness[J]. Journal of Atherosclerosis and Thrombosis,2007,14(2):78-85.
[5] Pan WH,Ye WT,Hu CM. Undiagnosed diabetes mellitus in Taiwanese subjects with impaired fasting glycemia:impact of female sex,central obesity,and short stature[J]. Chin J Physiol,2001,44(1):44-51
[6] Rasmussen SS,Glumer C,Sandbaek A,et al. Progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high,risk screening programme in general practice:the ADDITION Study,Denmark[J].Diabetologia,2007,50(2):293-297.
[7] Forouhi NG,Luan J,Hennings S,et al.Incidence of type 2 diabetes in England and its association with baseline impaired fasting glucose:the Ely study 1990-2000[J].Diabet Med,2007,24(2):200-207.
[8] Lee M,Saver JL,Hong KS,et al. Effect of pre-diabetes on future risk of stroke:Meta-analysis[J]. BMJ(online),2012,344(7):e3564.
[9] Fonville S,Zandbergen AA,Koudstaal PJ,et al. Prediabetes in patients with stroke or transient ischemic attack:prevalence,risk and clinical management[J]. Cerebrovascular Diseases,2014,37(6):393-400.
[10] Tanne D,Korenmorag N,Goldbourt U. Fasting Plasma Glucose and Risk of Incident Ischemic Stroke or Transient Ischemic Attacks:A Prospective Cohort Study[J]. Stroke,2004,35(10):2351-2355.
[11] Danaei G,Lawes CM,Hoorn SV,et al. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-thanoptimum blood glucose concentration:comparative risk assessment[J]. Lancet(North American Edition),2006,368(9548):1659.
[12] The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus[J]. Diabetes Care,2003:3160-3167.
[13] Tattersall MC,Gassett A,Korcarz CE,et al. Predictors of Carotid Thickness and Plaque Progression During a Decade:The MultiEthnic Study of Atherosclerosis[J]. Stroke,2014,45(11):3257-3262.
[14] Bonora E,Kiechl S,Oberhollenzer F,et al. Impaired glucose tolerance,Type II diabetes mellitus and carotid atherosclerosis:prospective results from the Bruneck Study[J]. Diabetologia,2000,43(2):156-164.
[15] Michele MD,Panico S,Celentano E,et al. Association of impaired glucose homeostasis with preclinical carotid atherosclerosis in women:Impact of the new American Diabetes Association criteria[J].Metabolism,2002,51(1):52-56.
[16]高颖,马斌,刘强,等.缺血性中风证候要素诊断量表编制及方法学探讨[J].中医杂志,2011,52(24):2097-2101.
[17] Touboul PJ,Hennerici MG,Meairs S,et al. Mannheim carotid intima-media thickness consensus(2004-2006)[J]. Cerebrovasc Dis,2007,23(1):75-80.
[18] American Diabetes Association. Diagnosis and classification of diabetes mellitus[J]. Diabetes Care,2014,37(Suppl 1):S81-S90.
[19] Crouse JR,Grobbee DE,O’Leary DH,et al. Carotid intima-media thickness in low-risk individuals with asymptomatic atherosclerosis:baseline data from the METEOR study[J]. Current Medical Research and Opinion,2007,23(3):641-648.
[20] Pollex RL,Spence JD,House AA,et al. A comparison of ultrasound measurements to assess carotid atherosclerosis development in subjects with and without type 2 diabetes[J]. Cardiovascular Ultrasound,2005,3(1):15.
[21] Tropeano AI,Boutouyrie P,Katsahian S,et al. Glucose level is a major determinant of carotid intima-media thickness in patients with hypertension and hyperglycemia[J]. Journal of Hypertension,2004,22(11):2153-2160.
[22] Sung J,Song YM,Ebrahim S,et al. Fasting Blood Glucose and the Risk of Stroke and Myocardial Infarction[J]. Circulation,2009,119(6):812-819.
[23] Kirii K,Tanaka S,Yamagishi K,et al. Associations between Cardiovascular Risk Factors and Carotid Atherosclerosis in Middleaged Japanese Men with Multiple Risk Factors[J]. Industrial Health,2008,(46):607-612.
[24] Brohall G,Schmidt C,Behre CJ,et al. Association between impaired glucose tolerance and carotid atherosclerosis:a study in 64-yearold women and a meta-analysis[J]. Nutrition Metabolism&Cardiovascular Diseases,2009,19(5):327-333.
[25] Fujii N,Tsuchihashi K,Sasao H,et al. Insulin resistance functionally limits endothelium-dependent coronary vasodilation in nondiabetic patients[J]. Heart and Vessels,2008,23(1):9-15.
[26] Reilly MP,Wolfe ML,Rhodes T,et al. Measures of insulin resistance add incremental value to the clinical diagnosis of metabolic syndrome in association with coronary atherosclerosis[J]. Circulation,2004,110(7):803-809.
[27] Ceriello A,Motz E. Is oxidative stress the pathogenic mechanism underlying insulin resistance,diabetes,and cardiovascular disease?The common soil hypothesis revisited[J]. Arteriosclerosis Thrombosis&Vascular Biology,2004,24(5):816-823.
[28] Paneni F,Beckman JA,Creager MA,et al. Diabetes and vascular disease:pathophysiology,clinical consequences,and medical therapy:partI[J]. European Heart Journal,2013,34(31):2436-2443.
[29] Nakamura K,Yamagishi S,Adachi H,et al. Serum levels of soluble form of receptor for advanced glycation end products(sRAGE)are positively associated with circulating AGEs and soluble form of VCAM-1 in patients with type 2 diabetes[J]. Microvascular Research,2008,76(1):52-56.
[30] Brites F,Rosso LG,Fornari M,et al. Alterations in cell adhesion molecules and other biomarkers of cardiovascualr disease in patients with metabolic syndrome[J]. Atherosclerosis,2008,199(2):415-423.
[31]黄世敬,王永炎.糖尿病与火毒[J].世界中西医结合杂志,2015,35(12):1750-1753.
[32]张昕洋,刘雪梅,陈志刚.内生火热之毒致病特性探讨[J].世界中医药,2018,13(8):1845-1849.
[33]王永炎,刘炳林.中风病研究进展述评[J].中医药导报,1995,4(2):51-54.