2型糖尿病患者發生頸動脈斑塊的影響因素分析

張蕊 趙曉冉 郭宏英 房亮 劉曉燕

[摘要] 目的 探討2型糖尿病患者頸動脈斑塊的危險因素。 方法 選取2016年1月～2018年1月于承德醫學院附屬醫院就診住院的2型糖尿病患者192例為研究對象，根據內膜中層厚度（IMT）將其分為斑塊組（n = 101）和無斑塊組（n = 91）;收集患者臨床資料及實驗室指標;比較兩組臨床資料及實驗室指標;采用二元多因素Logistic分析對頸動脈斑塊的危險因素進行分析。 結果 斑塊組年齡、腰圍、糖尿病病程、有吸煙史患者數、糖化血紅蛋白（HbA1c）、三酰甘油（TG）、低密度脂蛋白膽固醇（LDL-C）水平顯著高于無斑塊組（P < 0.05），而25羥維生素D3 [25（OH）D3]水平、服用他汀類患者數顯著低于無斑塊組，差異有統計學意義（P < 0.05）。多因素Logistic分析結果顯示，糖尿病病程（OR：1.06，95%CI：1.03～1.08，P = 0.021）、吸煙（OR：1.13，95%CI：1.10～1.16，P = 0.005）、HbA1c（OR：1.46，95%CI：1.24～1.54，P = 0.010）及LDL-C（OR：1.28，95%CI：1.16～1.42，P = 0.014）為頸動脈斑塊發生的危險因素，而25（OH）D3（OR：0.84，95%CI：0.82～0.87，P = 0.000）、服用他汀類（OR：0.78，95%CI：0.72～0.82，P = 0.039）則為其保護因素。 結論 隨著病程的延長，2型糖尿病患者頸動脈斑塊發生風險上升，吸煙、HbA1c及LDL-C水平升高均使頸動脈斑塊發生風險增加，而高25（OH）D3水平、服用他汀類則可能延緩其發生發展。

[關鍵詞] 25-羥維生素D3;2型糖尿病;內膜中層厚度;頸動脈斑塊

[中圖分類號] R587.1;R543.4? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）07（b）-0072-04

Analysis of influencing factors of carotid plaque in patients with type 2 diabetes mellitus

ZHANG Rui1? ?ZHAO Xiaoran1? ?GUO Hongying2? ?FANG Liang1? ?LIU Xiaoyan1

1.Department of Endocrine， Affiliated Hospital of Chengde Medical University， Hebei Province， Chengde? ?067000， China; 2.Department of Medical， Tianjin Medical University General Hospital Airport Hospital， Tianjin? ?300308， China

[Abstract] Objective To investigate the risk factors of carotid plaque in patients with type 2 diabetes mellitus. Methods A total of 192 patients with type 2 diabetes mellitus who were admitted and hospitalized in Affiliated Hospital of Chengde Medical University from January 2016 to January 2018 were selected for the study. They were divided into plaque group （n = 101） and non-plaque group （n = 91） according to intima-media thickness （IMT）. Clinical data and laboratory indicators were collected and compared between the two groups. Risk factors of carotid plaque were analyzed by binary multivariate Logistic analysis. Results The age， waist circumference， duration of diabetes mellitus， number of smokers， glycosylated hemoglobin （HbA1c）， triglyceride （TG）， low density lipoprotein cholesterol （LDL-C） levels in plaque group were significantly higher than those in non-plaque group （P < 0.05）， while 25-hydroxyvitamin D3 [25 （OH） D3] levels and the number of patients taking statins were significantly lower than those in non-plaque group （P < 0.05）， the differences were statistically significant （P < 0.05）. Multivariate Logistic analysis showed that the duration of diabetes mellitus （OR： 1.06， 95%CI： 1.03-1.08， P = 0.021）， smoking （OR： 1.13， 95%CI： 1.10-1.16， P = 0.005）， HbA1c （OR： 1.46， 95%CI： 1.24-1.54， P = 0.010） and LDL-C （OR： 1.28， 95%CI： 1.16-1.42， P = 0.014） were the risk factors for carotid artery plaque， and elevated level of 25（OH）D3（OR： 0.84，95%CI： 0.82-0.87， P = 0.000） and taking statins（OR： 0.78，95%CI： 0.72-0.82， P = 0.039）were the protective factors. Conclusion With the prolongation of the course of disease， the risk of carotid plaque in type 2 diabetes mellitus increased. Smoking， elevated levels of HBA1c and LDL-C all can increase the risk of carotid plaque， while high level of 25 （OH） D3 and taking statins may delay the development of carotid plaque.