老年糖尿病患者血糖水平与颈动脉斑块的相关性研究
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摘要
目的探究老年糖尿病患者血糖水平与颈动脉斑块的相关性。方法选取2015年6月—2016年12月治疗的108例老年糖尿病患者作为研究对象,根据有无颈动脉斑块形成分为无斑块组22例和有斑块组86例。探究分析老年糖尿病患者血糖水平与颈动脉斑块的相关性。结果有斑块组病程长于无斑块组(P<0.05),且空腹血糖(FPG)、糖化血红蛋白(Hb A1c)水平明显高于无斑块组(P<0.01)。Hb A1c≤6.5%患者的颈动脉斑块积分明显低于Hb A1c>6.5%患者(P<0.01)。颈动脉斑块Ⅰ、Ⅱ、Ⅲ级患者的FPG、Hb A1c水平均明显高于0级患者,且颈动脉斑块Ⅱ、Ⅲ级患者高于Ⅰ级患者(P<0.05)。Hb A1c≤6.5%患者颈动脉斑块分级为0级和Ⅰ级所占比例较高(78.38%),而Hb A1c>6.5%的患者颈动脉分级为Ⅱ级和Ⅲ级所占比例较高(83.10%),比较差异具有统计学意义(P<0.01)。结论老年糖尿病患者血糖水平与颈动脉斑块的形成密切相关。
Objective To investigate correlation between blood glucose level and carotid plaque in elderly patients with diabetes mellitus. Methods A total of 108 elderly patients with diabetes mellitus admitted during June 2015 and December 2016 were divided into no plaque group( n = 22) and carotid plaque group( n = 86) according to whether having carotid plaque or not. Correlation between blood glucose level and carotid plaque in elderly patients with diabetes mellitus was analyzed. Results In carotid group,course of disease was longer( P < 0. 05),and levels of fasting plasma glucose( FPG) and glycated hemoglobin( Hb A1 c) were significantly higher than those in no plaque group( P < 0. 01).Value of carotid plaque integration in patients with Hb A1 c equal or less than 6. 5% was significantly lower than that in patients with Hb A1 c larger than 6. 5%( P < 0. 01). Levels of FPG and Hb A1 c in patients with gradeⅠ,Ⅱ and Ⅲ carotid plaque were significantly higher than those in patients with grade 0 carotid plaque,and the levels in patients with grade Ⅱ and Ⅲ carotid plaque were significantly higher than those in patients with gradeⅠ carotid plaque( P < 0. 05).Patients with Hb A1 c equal or less than 6. 5% had higher proportion of grade 0 andⅠcarotid plaque( 78. 38%),while patients with Hb A1 c larger than 6. 5% had higher proportion of grade Ⅱ and Ⅲ carotid plaque( 83. 10%),and the differences were statistically significant( P < 0. 01). Conclusion Blood glucose levels are closely related to formation of carotid plaque in elderly patients with diabetes mellitus.
Objective To investigate correlation between blood glucose level and carotid plaque in elderly patients with diabetes mellitus. Methods A total of 108 elderly patients with diabetes mellitus admitted during June 2015 and December 2016 were divided into no plaque group( n = 22) and carotid plaque group( n = 86) according to whether having carotid plaque or not. Correlation between blood glucose level and carotid plaque in elderly patients with diabetes mellitus was analyzed. Results In carotid group,course of disease was longer( P < 0. 05),and levels of fasting plasma glucose( FPG) and glycated hemoglobin( Hb A1 c) were significantly higher than those in no plaque group( P < 0. 01).Value of carotid plaque integration in patients with Hb A1 c equal or less than 6. 5% was significantly lower than that in patients with Hb A1 c larger than 6. 5%( P < 0. 01). Levels of FPG and Hb A1 c in patients with gradeⅠ,Ⅱ and Ⅲ carotid plaque were significantly higher than those in patients with grade 0 carotid plaque,and the levels in patients with grade Ⅱ and Ⅲ carotid plaque were significantly higher than those in patients with gradeⅠ carotid plaque( P < 0. 05).Patients with Hb A1 c equal or less than 6. 5% had higher proportion of grade 0 andⅠcarotid plaque( 78. 38%),while patients with Hb A1 c larger than 6. 5% had higher proportion of grade Ⅱ and Ⅲ carotid plaque( 83. 10%),and the differences were statistically significant( P < 0. 01). Conclusion Blood glucose levels are closely related to formation of carotid plaque in elderly patients with diabetes mellitus.
引文
[1]Lin T,Liu J C,Chang L Y,et al.Association of metabolic syndrome and diabetes with subclinical coronary stenosis and plaque subtypes in middle-aged individuals[J].Diabet Med,2011,28(4):493-499.
[2]罗光著,黄柳明,王缉胜.颈动脉狭窄和斑块分布与缺血性脑血管病的相关性研究[J].实用心脑肺血管病杂志,2013,21(9):20-21.
[3]伍丽红,王继阳,程立山,等.应用颈动脉超声分析缺血性脑血管病危险因素与颈动脉斑块的关系[J].中国脑血管病杂志,2006,3(1):22-23.
[4]Buscemi S,Re A,Batsis J A,et al.Glycaemic variability using continuous glucose monitoring and endothelial function in the metabolic syndrome and in type 2 diabetes[J].Diabet Med,2010,27(8):872-878.
[5]Crouse J R,Harpold G H,Kahl F R,et al.Evaluation of a scoring system for extracranial carotid atherosclerosis extent with B-mode ultrasound[J].Stroke,1986,17(2):270-275.
[6]王绵,张力辉,苏胜偶.2010年内分泌代谢疾病进展[J].临床荟萃,2011,26(6):461-464.
[7]Lee E J,Kim H J,Bae J M,et al.Relevance of common carotid intima-media thickness and carotid plaque as risk factors for ischemic stroke in patients with type 2 diabetes mellitus[J].AJNR Am J Neuroradiol,2007,28(5):916-319.
[8]陆淑梅.颈动脉超声检查在糖尿病血管病变监测中的临床应用[J].血管与腔内血管外科杂志,2016,2(6):530-532.
[9]罗云,李敬伟,王翀,等.糖尿病影响脑梗死的形成与颈动脉斑块相关[J].中华神经医学杂志,2012,11(1):83-86.
[10]高赟,冉兴无.警惕糖尿病性周围动脉病变漏诊——不容忽视的危害[J].临床误诊误治,2017,30(10):1-3.
[11]Hirsch I B.Glycemic variability:it's not just about A1c anymore[J].Diabetes Technol Ther,2005,7(5):780-783.
[12]李赟,刘江华.波动性高血糖与糖尿病大血管并发症[J].国外医学:内分泌学分册,2004,24(6):400-401.
[13]李谷来,王金华,李秀娟.糖耐量异常患者血糖、血脂、胰岛素水平变化与颈动脉血管壁弹性的相关性研究[J].河北医药,2017,39(17):2647-2649.
[14]苏丽.糖化血红蛋白与糖尿病及其并发症的相关性探讨[J].临床和实验医学杂志,2011,10(10):771,773.
[15]Mc Carter R J,Hempe J M,Chalew S A.Mean blood glucose and biological variation have greater influence on Hb A1c levels than glucose instability:an analysis of data from the diabetes control and complications trial[J].Diabetes Care,2006,29(2):352-355.
[16]Piconi L,Quagliaro L,Assaloni R,et al.Constant and intermittent high glucose enhances endothelial cell apoptosis through mitochondrial superoxide overproduction[J].Diabetes Metab Res Rev,2006,22(3):198-203.
[17]Monnier L,Mas E,Ginet C,et al.Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2diabetes[J].JAMA,2006,295(14):1681-1687.
[18]乔爱敏,李乐,刘青.晚期糖基化终产物及其受体RAGE在糖尿病血管并发症中的作用机制[J].中国临床药理学与治疗学,2014,19(11):1306-1311.
[19]李斌儒,张兰,丁慧萍,等.非糖尿病患者糖化血红蛋白水平与颈动脉病变相关性[J].中华保健医学杂志,2009,11(4):275-277.
[20]Holman R R,Paul S K,Bethel M A,et al.10-year follow-up of intensive glucose control in type 2 diabetes[J].N Engl J Med,2008,359(15):1577-1589.
[21]李顺斌,郑淑莺,邱蔚,等.2型糖尿病合并大血管病变的危险因素分析[J].中国现代医生,2010,48(29):25-26,47.
[22]李艳彬,李博,杜贤兰.2型糖尿病患者高血糖状态与颈动脉粥样硬化的关系研究[J].中国全科医学,2010,13(26):2898-2899.
[23]王君玓,商广芸,何为,等.2型糖尿病病人大动脉僵硬度相关危险因素研究[J].首都医科大学学报,2017,38(5):740-743.
[24]柳治,周静,薛连彬,等.2型糖尿病下肢血管病变256层CTA成像特点及危险因素分析[J].中国煤炭工业医学杂志,2016,19(5):687-690.
[25]张燕,周雪芬,林阜远,等.探讨血浆脂联素及血液流变学改变对2型糖尿病大血管病变的影响[J].吉林医学,2012,33(32):6957-6960.
[2]罗光著,黄柳明,王缉胜.颈动脉狭窄和斑块分布与缺血性脑血管病的相关性研究[J].实用心脑肺血管病杂志,2013,21(9):20-21.
[3]伍丽红,王继阳,程立山,等.应用颈动脉超声分析缺血性脑血管病危险因素与颈动脉斑块的关系[J].中国脑血管病杂志,2006,3(1):22-23.
[4]Buscemi S,Re A,Batsis J A,et al.Glycaemic variability using continuous glucose monitoring and endothelial function in the metabolic syndrome and in type 2 diabetes[J].Diabet Med,2010,27(8):872-878.
[5]Crouse J R,Harpold G H,Kahl F R,et al.Evaluation of a scoring system for extracranial carotid atherosclerosis extent with B-mode ultrasound[J].Stroke,1986,17(2):270-275.
[6]王绵,张力辉,苏胜偶.2010年内分泌代谢疾病进展[J].临床荟萃,2011,26(6):461-464.
[7]Lee E J,Kim H J,Bae J M,et al.Relevance of common carotid intima-media thickness and carotid plaque as risk factors for ischemic stroke in patients with type 2 diabetes mellitus[J].AJNR Am J Neuroradiol,2007,28(5):916-319.
[8]陆淑梅.颈动脉超声检查在糖尿病血管病变监测中的临床应用[J].血管与腔内血管外科杂志,2016,2(6):530-532.
[9]罗云,李敬伟,王翀,等.糖尿病影响脑梗死的形成与颈动脉斑块相关[J].中华神经医学杂志,2012,11(1):83-86.
[10]高赟,冉兴无.警惕糖尿病性周围动脉病变漏诊——不容忽视的危害[J].临床误诊误治,2017,30(10):1-3.
[11]Hirsch I B.Glycemic variability:it's not just about A1c anymore[J].Diabetes Technol Ther,2005,7(5):780-783.
[12]李赟,刘江华.波动性高血糖与糖尿病大血管并发症[J].国外医学:内分泌学分册,2004,24(6):400-401.
[13]李谷来,王金华,李秀娟.糖耐量异常患者血糖、血脂、胰岛素水平变化与颈动脉血管壁弹性的相关性研究[J].河北医药,2017,39(17):2647-2649.
[14]苏丽.糖化血红蛋白与糖尿病及其并发症的相关性探讨[J].临床和实验医学杂志,2011,10(10):771,773.
[15]Mc Carter R J,Hempe J M,Chalew S A.Mean blood glucose and biological variation have greater influence on Hb A1c levels than glucose instability:an analysis of data from the diabetes control and complications trial[J].Diabetes Care,2006,29(2):352-355.
[16]Piconi L,Quagliaro L,Assaloni R,et al.Constant and intermittent high glucose enhances endothelial cell apoptosis through mitochondrial superoxide overproduction[J].Diabetes Metab Res Rev,2006,22(3):198-203.
[17]Monnier L,Mas E,Ginet C,et al.Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2diabetes[J].JAMA,2006,295(14):1681-1687.
[18]乔爱敏,李乐,刘青.晚期糖基化终产物及其受体RAGE在糖尿病血管并发症中的作用机制[J].中国临床药理学与治疗学,2014,19(11):1306-1311.
[19]李斌儒,张兰,丁慧萍,等.非糖尿病患者糖化血红蛋白水平与颈动脉病变相关性[J].中华保健医学杂志,2009,11(4):275-277.
[20]Holman R R,Paul S K,Bethel M A,et al.10-year follow-up of intensive glucose control in type 2 diabetes[J].N Engl J Med,2008,359(15):1577-1589.
[21]李顺斌,郑淑莺,邱蔚,等.2型糖尿病合并大血管病变的危险因素分析[J].中国现代医生,2010,48(29):25-26,47.
[22]李艳彬,李博,杜贤兰.2型糖尿病患者高血糖状态与颈动脉粥样硬化的关系研究[J].中国全科医学,2010,13(26):2898-2899.
[23]王君玓,商广芸,何为,等.2型糖尿病病人大动脉僵硬度相关危险因素研究[J].首都医科大学学报,2017,38(5):740-743.
[24]柳治,周静,薛连彬,等.2型糖尿病下肢血管病变256层CTA成像特点及危险因素分析[J].中国煤炭工业医学杂志,2016,19(5):687-690.
[25]张燕,周雪芬,林阜远,等.探讨血浆脂联素及血液流变学改变对2型糖尿病大血管病变的影响[J].吉林医学,2012,33(32):6957-6960.