本文選題：2型糖尿病 + 頸動脈內(nèi)-中膜厚度�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：[背景]近年來,我國成人糖尿病及糖尿病前期患病率逐年增加,患病人數(shù)居世界首位,為經(jīng)濟(jì)發(fā)展帶來巨大負(fù)擔(dān)。糖尿病作為一種代謝性疾病,主要損害表現(xiàn)為血管病變,與非糖尿病患者相比,2型糖尿病(type 2 diabetes,T2DM)患者合并大血管病變患病率更高,且大血管病變更為廣泛、嚴(yán)重,發(fā)病年齡更早。2型糖尿病被證實(shí)是心血管疾病的重要危險因素,合并心血管疾病(Cardiovascular disease,CVD)時致死、致殘率明顯升高。早期篩查、風(fēng)險評估及干預(yù)意義重大。頸動脈位置表淺,作為全身動脈的探測窗口,其內(nèi)-中膜增厚(carotid intima-media thickness,IMT)、動脈粥樣硬化(Atherosclerosis,AS)與冠狀動脈粥樣硬化有相似的病生理基礎(chǔ),無創(chuàng)性超聲檢測頸動脈內(nèi)膜-中膜厚度對預(yù)測心血管事件有重要意義。[目的]1.觀察入組患者基線特征;2.評估不同降糖藥物組合對頸動脈內(nèi)膜變化的影響。[方法]對來自2012年1月至2016年12月期間在北京協(xié)和醫(yī)院內(nèi)分泌科門診規(guī)律隨診的158名2型糖尿病患者進(jìn)行動脈內(nèi)膜變化及降糖藥物使用對動脈內(nèi)膜變化的影響方面的回顧性研究。2型糖尿病診斷標(biāo)準(zhǔn)根據(jù)1999年WHO糖尿病診斷標(biāo)準(zhǔn)。根據(jù)2007年歐洲高血壓治療指南,頸動脈IMT0.9mm確定為內(nèi)中膜增厚,局部IMT≥1.3mm為判定為動脈硬化斑塊。通過比較不同年份左右頸內(nèi)動脈、頸動脈分叉IMT、頸動脈斑塊的變化得出動脈IMT及斑塊變化差值,除以隨訪年份數(shù)得出頸動脈IMT及斑塊平均年變化率,IMT根據(jù)數(shù)值正負(fù)分為“變大”和“變小”。頸動脈內(nèi)膜斑塊根據(jù)正、負(fù)、零分為“變大”,“變小”,“穩(wěn)定”。通過問卷調(diào)查方式采集基本信息、生活方式及慢性并發(fā)癥診斷病史。體量指標(biāo)包括身高、體重、體脂(Fat mas,FAT)、BMI、血壓;生化指標(biāo)包括空腹血糖(Fasting blood glucose,FBG)、空腹胰島素(Fasting insulin,FINS)、空腹C肽(Fasting C-peptide,C肽)、總膽固醇(Total Cholesterol,TC)、甘油三酯(Triglyeride,TG)、高密度脂蛋白膽固醇(High density lipoprotein cholesterol,HDL-C)、低密度脂蛋白膽固醇(Low density lipoprotein cholesterol,LDL-C)、HOMAIR(Homeostasis model of assessment,HOMARI)。組間比較采用t-檢驗(yàn)、方差分析、卡方檢驗(yàn)和配對檢驗(yàn),多因素分析采用多元Logistic回歸和多因素線性逐步回歸。[結(jié)果]158例診2型糖尿病患者中,男性90例(57%),女性68例(43%)高脂血癥患病者148例(94%);高血壓患病者83例(53%);有DM家族史者96例(61%);有冠心病者10例(6%);頸動脈內(nèi)膜增厚者130例(82%);頸動脈斑塊者 88 例(56%)。第1組患者 HOMA-IR、FBG、HbA1C%、GA%、C-肽、HDL的P0.05,存在統(tǒng)計(jì)學(xué)差異,logistics回歸示HbA1C%P0.05。第2組患者體重、病程、HbA1C%、C肽的P0.05,組間比較均有統(tǒng)計(jì)學(xué)差異,logistics回歸示DM病程P0.05。第3組患者體重、病程、DBP、FBG、HbA1C%、GA%、C肽、性別、吸煙組間比較P0.05,存在統(tǒng)計(jì)學(xué)差異,logistics回歸示HbA1C%、DM病程P0.05。3組不同降糖藥與CIMT及動脈斑塊變化之間比較P均0.05,無統(tǒng)計(jì)學(xué)差異。[結(jié)論](1)2型糖尿病患者多數(shù)合并高脂血癥,高血壓,心腦血管疾病發(fā)病率高,頸動脈內(nèi)-中層厚度對預(yù)測心血管事件很有幫助。(2)本研究中,2型糖尿病患者不同降糖藥物組合對頸動脈內(nèi)膜變化的影響方面未觀察到存在明顯差異。(3)2型糖尿病患者病程越長,HbA1c越高,CIMT增厚越明顯,而平穩(wěn)血糖控制有利于減緩內(nèi)-中膜增長速度。
[Abstract]:[background] in recent years, the prevalence of diabetes and prediabetes in China is increasing year by year. The number of patients in the world is the first in the world, which brings great burden to the economic development. As a metabolic disease, the main damage of diabetes is vascular disease. Compared with non diabetic patients, patients with type 2 diabetes (type 2 diabetes, T2DM) are associated with large vascular disease. The prevalence rate is higher, and the major vascular lesions are more extensive and serious. Early onset age.2 diabetes is proved to be an important risk factor for cardiovascular disease. It is fatal when combined with cardiovascular disease (Cardiovascular disease, CVD), and the rate of disability is significantly increased. Early screening, risk assessment and intervention are of great significance. Carotid intima-media thickness (IMT), atherosclerosis (Atherosclerosis, AS) and coronary atherosclerosis are similar to the physiological basis of coronary atherosclerosis. Noninvasive ultrasound examination of the carotid artery intima medium thickness is important for predicting cardiovascular events. [Objective]1. observation was observed in the group of patients with baseline. Characteristics; 2. evaluate the effect of different combination of hypoglycemic agents on carotid artery intima change. [Methods] retrospective study of the changes in the intima changes of the arteries and the changes of the intimal changes in the arteria of 158 patients with type 2 diabetes from January 2012 to December 2016 in the Department of Endocrinology, Peking Union Medical College Hospital The diagnostic criteria for type.2 diabetes were based on the 1999 WHO diabetes diagnostic criteria. According to the 2007 European guidelines for hypertension treatment, the carotid IMT0.9mm was determined to be the thickening of the medial membrane, and the local IMT > 1.3mm was judged to be a atherosclerotic plaque. By comparing the carotid artery, the carotid artery bifurcation IMT, the carotid artery plaque and the arterial IMT by comparing the different years of the internal carotid artery. The average annual change rate of carotid artery IMT and plaque was divided according to the number of follow-up years. IMT was divided into "bigger" and "smaller" according to the positive and negative values. The carotid intima plaque was "bigger", "smaller" and "stable" according to the positive, negative, zero points. The basic information, life style and chronic concurrency were collected by questionnaire. The body volume index includes height, weight, body fat (Fat MAS, FAT), BMI, blood pressure, biochemical indexes including Fasting blood glucose (FBG), fasting insulin (Fasting insulin, FINS), fasting C peptide, triglyceride, triglyceride, high density lipoprotein gallbladder High density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (Low density lipoprotein cholesterol, LDL-C), HOMAIR Homeostasis (Homeostasis), variance analysis, chi square test and paired test, multivariate regression and multi factor linear stepwise analysis [results: [results] among patients with type 2 diabetes, 90 (57%) were male, 68 (43%) patients with hyperlipidemia (94%), 83 (53%) patients with hypertension, 96 patients with DM family history, 10 (6%) with coronary heart disease, carotid artery intima thickening and HOMA-IR, FBG, HbA1C%, GA%, patients with carotid artery intima thickening. C- peptide, HDL P0.05, there were statistical differences. Logistics regression showed that the body weight, course of disease, HbA1C%, P0.05 of C peptide in group HbA1C%P0.05. second were statistically different. Logistics regression showed the body weight of the P0.05. third group of DM course. There was no difference in P between the group P0.05.3 and the changes of CIMT and arterial plaque in group P0.05.3. [Conclusion] [Conclusion] [Conclusion] (1) most patients with type 2 diabetes have hyperlipidemia, high blood pressure, high incidence of cardiovascular and cerebrovascular diseases, and the thickness of the carotid artery and middle layer is helpful for the pretest of cardiovascular events. (2) in this study, type 2 diabetes mellitus, type 2 diabetes mellitus (2) There was no significant difference in the effect of different combination of hypoglycemic agents on the changes of carotid artery intima. (3) the longer the course of the patients with type 2 diabetes, the higher the HbA1c, the more obvious the thickening of the CIMT, and the smooth blood glucose control was beneficial to slow the growth of the inner and middle membrane.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1

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