本刊稿约论文模板电子书
首页 > 过刊浏览>2024年第卷第7期 >927-933. DOI:10.7655/NYDXBNSN231145
PDF HTML阅读 XML下载 导出引用 引用提醒
新诊断2型糖尿病患者亚临床颈动脉粥样硬化的影响因素及综合治疗后的转归情况
作者:
作者单位:

1.锦州医科大学研究生学院，辽宁 锦州 121001 ;2.浙江省人民医院内分泌科，浙江 杭州 310014 ;3.嘉善县第一人民医院内分泌科，浙江 嘉善 314100 ;4.蚌埠医学院研究生学院，安徽 蚌埠 233030 ;5.浙江中医药大学研究生学院，浙江 杭州 310053

中图分类号:

R587.1

基金项目:

浙江省自然科学基金联合基金（LHDMZ23H070001）；浙江省“高层次人才特殊支持计划”科技创新领军人才项目 （2021R52022）；浙江省卫生创新人才项目（2021-CXRC07-01）


Factors influencing subclinical carotid atherosclerosis in patients with newly diagnosed type 2 diabetes mellitus and regression after comprehensive treatments
Author:
Affiliation:

1.Graduate School of Jinzhou Medical University，Jinzhou 121001 ;2.Department of Endocrinology，Zhejiang Provincial People’s Hospital，Hangzhou 310014 ;3.Department of Endocrinology，the First People’s Hospital of Jiashan，Jiashan 314100 ;4.Graduate School of Bengbu Medical College，Bengbu 233030 ;5.Graduate School of Zhejiang University of Traditional Chinese Medicine，Hangzhou 310053 ，China

  • 摘要
    • | |
  • 访问统计
    • |
  • 参考文献 [28]
    • |
  • 相似文献
    • | | |
  • 文章评论
    摘要:

    目的：探讨新诊断 2 型糖尿病（type 2 diabetes mellitus，T2DM）患者亚临床颈动脉粥样硬化（subclinical carotid atherosclerosis，SCAS）的相关影响因素及综合治疗后的转归情况。方法：收集402例新诊断T2DM患者的资料，根据有无SCAS 进行分组，比较两组间各项指标的差异。采用二元Logistic 回归分析新诊断T2DM合并SCAS的影响因素，利用受试者工作特征（receiver operating characteristic，ROC）曲线分析危险因素的截断值。对其中72例患者进行随访，比较综合治疗前后代谢指标达标情况及SCAS检出率。结果：402例新诊断T2DM住院患者中SCAS检出率为57.0%（229/402）。SCAS组与无SCAS组比较，糖尿病周围神经病变（diabetic peripheral neuropathy，DPN）、糖尿病视网膜病变（diabetic retinopathy，DR）、估算的肾小球滤过率（estimated glomerular filtration rate，eGFR）、甘油三酯（triglyceride，TG）、体重指数（body mass index，BMI）、心率的差异均有统计学意义（P < 0.05）。二元Logistic回归分析结果显示，新诊断T2DM合并SCAS 的独立影响因素包括DPN、DR、eGFR、BMI （P < 0.05）。ROC曲线分析显示，eGFR截断值为103.50 mL/（min·1.73 m2 ），BMI截断值为27.32 kg/m2 。与基线相比，干预1年后患者的颈动脉内膜-中膜厚度（carotid intima-media thickness，CIMT）、SCAS检出率及代谢指标有明显改善，两组之间差异有统计学意义（P < 0.05）。结论：新诊断T2DM住院患者SCAS检出率高，DPN、DR与新诊断T2DM合并SCAS风险呈正相关，BMI升高、eGFR下降是新诊断T2DM合并SCAS的独立危险因素。综合治疗可改善新诊断T2DM患者的代谢指标、缓解CIMT增厚、降低SCAS检出率，但颈动脉斑块未得到明显改善。

    Abstract:

    Objective：To investigate the influencing factors associated with subclinical carotid atherosclerosis（SCAS）in patients with newly diagnosed type 2 diabetes mellitus（T2DM）and regression after comprehensive treatments. Methods：Data were collected from 402 patients with newly diagnosed T2DM，grouped according to the presence or absence of SCAS，and the differences in the indicators between the two groups were compared. Using binary logistic regression to analyze factors influencing newly diagnosed T2DM combined with SCAS. Cut-off values for risk factors were analyzed using reciever operating characteristic（ROC）curves. Seventy-two of these patients were followed up to compare the target accomplishment rates of metabolic index and SCAS detection rate before and after the comprehensive treatment. Results：The SCAS detection rate among 402 newly diagnosed T2DM hospitalized patients was 57.0%（229/402）. The differences in diabetic peripheral neuropathy（DPN），diabetic retinopathy（DR），estimated glomerular filtration rate（eGFR），triglycerides（TG），body mass index（BMI），and heart rate were statistically significant（P < 0.05）when the SCAS group was compared with the non-SCAS group. Binary logistic regression analysis showed that the independent influences of newly diagnosed T2DM combined with SCAS included DPN，DR，eGFR，and BMI（P < 0.05）. ROC curve analysis showed an eGFR cut -off value of 103.50 mL/ （min·1.73 m2 ）and a BMI cut -off value of 27.32 kg/m2 . Compared with baseline，patients’carotid intima -media thickness（CIMT）， SCAS detection rate and metabolic indexes were significantly improved after one year of intervention，and the difference between the two groups was statistically significant（P < 0.05）. Conclusion：The SCAS detection rate in hospitalized patients with newly diagnosed T2DM is high. DPN and DR are positively associated with the risk of newly diagnosed T2DM combined with SCAS. Elevated BMI and decreased eGFR are independent risk factors for newly diagnosed T2DM combined with SCAS. Combination therapy improves metabolic indexes，relieves CIMT thickening，and reduces SCAS detection rate in patients with newly diagnosed T2DM，but carotid artery plaque is not significantly improved.

    参考文献
    [1] WONG N D，SATTAR N.Cardiovascular risk in diabetes mellitus：epidemiology，assessment and prevention[J].Nat Rev Cardiol，2023，20（10）：685-695
    [2] 中国心血管代谢联盟.中国成人2型糖尿病及糖尿病前期患者动脉粥样硬化性心血管疾病预防与管理专家共识[J].中国糖尿病杂志，2023，31（9）：641-656
    [3] BABER U，MEHRAN R，SARTORI S，et al.Prevalence，impact，and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults：the BioImage study[J].J Am Coll Cardiol，2015，65（11）：1065-1074
    [4] 顾蕙兰，秦瑶，王悦舒，等.1型糖尿病患者亚临床心血管疾病的临床特征及相关危险因素分析[J].中华糖尿病杂志，2021，13（8）：785-790
    [5] BONORA E，TROMBETTA M，DAURIZ M，et al.Chronic complications in patients with newly diagnosed type 2 diabetes：prevalence and related metabolic and clinical features：the Verona Newly Diagnosed Type 2 Diabetes Study（VNDS）9[J].BMJ Open Diabetes Res Care，2020，8（1）：e001549
    [6] 中华医学会肾脏病学分会专家组.糖尿病肾脏疾病临床诊疗中国指南[J].中华肾脏病杂志，2021，37（3）：255-304
    [7] 中华医学会糖尿病学分会.中国2型糖尿病防治指南（2020 年版）[J].中华糖尿病杂志，2021，13（4）：315-409
    [8] SHIMODA S，KITAMURA A，IMANO H，et al.Associations of carotid intima⁃media thickness and plaque heterogeneity with the risks of stroke subtypes and coronary artery disease in the Japanese general population：the circulatory risk in communities study[J].J Am Heart Assoc，2020，9（19）：e017020
    [9] 王卫庆，王桂侠，王颜刚，等.国家标准化代谢性疾病管理中心建设规范及管理指南[J].中华内分泌代谢杂志，2019，35（11）：907-926
    [10] SONG P，FANG Z，WANG H，et al.Global and regional prevalence，burden，and risk factors for carotid atherosclerosis：a systematic review，meta ⁃ analysis，and modelling study[J].Lancet Glob Health，2020，8（5）：e721-e729
    [11] CARDOSO C R L，SALLES G C，LEITE N C，et al.Prognostic impact of carotid intima⁃media thickness and carotid plaques on the development of micro ⁃ and macrovascular complications in individuals with type 2 diabetes：the Rio de Janeiro type 2 diabetes cohort study[J].Cardiovasc Diabetol，2019，18（1）：2
    [12] CATALAN M，HERRERAS Z，PINYOL M，et al.Prevalence by sex of preclinical carotid atherosclerosis in newly diagnosed type 2 diabetes[J].Nutr Metab Cardiovasc Dis，2015，25（8）：742-748
    [13] 谭艳，夏萃，李祯，等.病程1年内2型糖尿病患者亚临床动脉粥样硬化的患病特征及影响因素分析[J].中国动脉硬化杂志，2020，28（8）：668-672
    [14] SÁNCHEZ E，SÁNCHEZ M，BETRIU À，et al.Are obesity indices useful for detecting subclinical atheromatosis in a middle ⁃aged population?[J].Obes Facts，2020，13（1）：29-39
    [15] HENNING R J.Obesity and obesity⁃induced inflammatory disease contribute to atherosclerosis：a review of the pathophysiology and treatment of obesity[J].Am J Car⁃diovasc Dis，2021，11（4）：504-529
    [16] PARK S，JEON Y J，ANN S H，et al.Comprehensive prediction of subclinical coronary atherosclerosis in subjects without traditional cardiovascular risk factors[J].Am J Cardiol，2023，198：64-71
    [17] 冯静，王祺，吴玉梅，等.基于Nomogram模型对2型糖尿病合并动脉粥样硬化的临床预测模型的初步探索[J].医学综述，2022，28（10）：2060-2064
    [18] RAWSHANI A，RAWSHANI A，FRANZÉN S，et al.Risk factors，mortality，and cardiovascular outcomes in patients with type 2 diabetes[J].N Engl J Med，2018，379（7）：633-644
    [19] ITO H，KOMATSU Y，MIFUNE M，et al.The estimated GFR，but not the stage of diabetic nephropathy graded by the urinary albumin excretion，is associated with the carotid intima ⁃media thickness in patients with type 2 diabetes mellitus：a cross⁃sectional study[J].Cardiovasc Diabetol，2010，9（1）：18
    [20] TANAKA S，KANAZAWA I，SUGIMOTO T.Nerve conduction velocity is negatively associated with intima ⁃media thickness and brachial ⁃ ankle pulse wave velocity in men with type 2 diabetes mellitus[J].PLoS One，2018，13（12）：e0209503
    [21] BEROS A，SLUYTER J，SCRAGG R K R.Association of arterial stiffness and neuropathy in diabetes：a systematic review and meta ⁃ analysis[J].BMJ Open Diabetes Res Care，2023，11（1）：e003140
    [22] FANG Q，XIANG M，SHI J，et al.Subclinical atherosclerosis associates with diabetic retinopathy incidence：a prospective study[J].Acta Diabetol，2022，59（8）：1041-1052
    [23] YUCHEN C，HEJIA Z，FANKE M，et al.Exploring the shared molecular mechanism of microvascular and macro⁃vascular complications in diabetes：Seeking the hub of circulatory system injury[J].Front Endocrinol（Lausanne），2023，14：1032015
    [24] NAKAGOMI A，SHIBUI T，KOHASHI K，et al.Differential effects of atorvastatin and pitavastatin on inflammation，insulin resistance，and the carotid intima ⁃ media thickness in patients with dyslipidemia[J].J Atheroscler Thromb，2015，22（11）：1158-1171
    [25] LU Y，YIN J，WU X，et al.Comparative effects of 2.5 mg levamlodipine and 5 mg amlodipine on vascular endothelial function and atherosclerosis[J].Pak J Pharm Sci，2019，32（5 Special）：2433-2436
    [26] 刘志文，周智广，唐炜立，等.新诊2型糖尿病亚临床动脉粥样硬化进展的影响因素[J].中华全科医师杂志，2006，5（8）：470-474
    [27] 魏晗，辛小军，王曼，等.SGLT⁃2抑制剂改善糖尿病患者心血管疾病预后的研究进展[J].南京医科大学学报（自然科学版），2020，40（5）：773-778
    [28] 廖英宏，庄晓婷，白越，等.钠⁃葡萄糖共转运蛋白2抑制剂在血管衰老中的作用[J].国际内分泌代谢杂志，2022，42（5）：373-376
    相似文献
    引证文献
引用本文

王祎洁,徐汉文,张文琼,周洁茹,金晶,武晓泓.新诊断2型糖尿病患者亚临床颈动脉粥样硬化的影响因素及综合治疗后的转归情况[J].南京医科大学学报（自然科学版）,2024,(7):927-933

复制
分享
文章指标
  • 点击次数:129
  • 下载次数: 753
  • HTML阅读次数: 120
  • 引用次数: 0
历史
  • 收稿日期:2023-12-08
  • 在线发布日期: 2024-07-10

友情链接 Links

技术支持：北京勤云科技发展有限公司
关闭