【摘要】：研究背景及目的:老年2型糖尿病的患病率近年來呈快速上升趨勢,已成為影響老年人群健康及生活質(zhì)量的嚴(yán)重公共衛(wèi)生問題。糖尿病患者發(fā)生血管病變的風(fēng)險(xiǎn)顯著高于非糖尿病患者,研究糖尿病患者動脈硬化發(fā)生的危險(xiǎn)因素對于預(yù)防其心血管并發(fā)癥具有重要意義。頸動脈作為人體重要的中型動脈血管,其粥樣硬化的發(fā)生與否是觀察全身動脈粥樣硬化的一個窗口。脈搏波速度是一種無創(chuàng)性評價(jià)動脈功能,反映機(jī)體主動脈、大動脈以及中動脈血管順應(yīng)性和僵硬度的經(jīng)典指標(biāo),被認(rèn)為是心血管事件發(fā)生風(fēng)險(xiǎn)和預(yù)后的獨(dú)立預(yù)測因子。本研究通過測定老年糖尿病患者糖化血紅蛋白、血糖、血壓、血脂及頸動脈內(nèi)中膜厚度、斑塊積分、斑塊穩(wěn)定性、脈搏波速度等指標(biāo),探討老年糖尿病患者糖化血紅蛋白水平與頸動脈斑塊和脈搏波速度的相關(guān)性及其影響因素,為預(yù)防老年糖尿病患者動脈硬化的發(fā)生發(fā)展提供一定的依據(jù)。研究方法:本研究選擇2015年7月至2016年3月于山東大學(xué)齊魯醫(yī)院老年病科門診就診或住院的老年2型糖尿病患者,均符合1999年WHO糖尿病診斷標(biāo)準(zhǔn),同時(shí)排除患惡性腫瘤及血液系統(tǒng)疾病、嚴(yán)重肝腎功能損害、急性感染或其他急性疾病、近期發(fā)生過急性心肌梗死、心力衰竭或腦卒中等心腦血管意外、合并軀體功能障礙或認(rèn)知功能障礙者,共納入老年糖尿病患者130例,年齡在60～92歲,平均年齡72.38±8.79歲,其中男性59例。對所有研究對象均詳細(xì)詢問病史并查體,記錄性別、年齡、既往史等一般資料,測量身高、體質(zhì)量、血壓等指標(biāo),并計(jì)算體質(zhì)指數(shù),測定空腹血糖、糖化血紅蛋白、甘油三酯、總膽固醇、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇等指標(biāo)。對患者進(jìn)行頸動脈超聲檢查,分別觀察并記錄頸動脈斑塊部位、大小、回聲情況,測量頸動脈內(nèi)中膜厚度(IMT);按照Crouse頸動脈斑塊積分標(biāo)準(zhǔn)計(jì)算斑塊積分;根據(jù)超聲檢查斑塊回聲情況將頸動脈斑塊分類;應(yīng)用全自動動脈硬化檢測儀進(jìn)行肱踝脈搏波速度(ba-PWV)的檢測并記錄。根據(jù)糖化血紅蛋白水平將受檢者分為3組:HbAIC7%者49例,為低水平組;7%≤HbAIC8.5%者58例,為中水平組;HbAIC≥8.5%者23例,為高水平組。采用SPSS 20.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.糖化血紅蛋白低水平組、中水平組與高水平組三組間比較,收縮壓、空腹血糖、高密度脂蛋白膽固醇、頸動脈內(nèi)中膜厚度、斑塊積分、斑塊穩(wěn)定性、脈搏波速度有統(tǒng)計(jì)學(xué)差異。2.組間比較顯示,中水平組與低水平組比較,收縮壓、空腹血糖、頸動脈內(nèi)中膜厚度、斑塊積分、不穩(wěn)定斑塊比例及脈搏波速度均高于低水平組,高密度脂蛋白膽固醇低于低水平組;高水平組與低水平組比較,體質(zhì)指數(shù)、收縮壓、空腹血糖、頸動脈內(nèi)中膜厚度、斑塊積分、不穩(wěn)定斑塊比例及脈搏波速度均高于低水平組,高密度脂蛋白膽固醇低于低水平組;高水平組與中水平組比較,空腹血糖、頸動脈內(nèi)中膜厚度、斑塊積分、不穩(wěn)定斑塊比例均高于中水平組。3.相關(guān)性分析顯示:頸動脈內(nèi)中膜厚度與性別(r=0.389,P0.01)、年齡(r=0.296,P0.01)、空腹血糖(r=0.203,P0.05)、糖化血紅蛋白(r=0.405,P0.01)、高密度脂蛋白膽固醇有相關(guān)性(r=-0.208,P0.05);頸動脈斑塊積分與性別(r=0.321.P0.01)、年齡(r=0.355,P0.01)、糖化血紅蛋白(r=0.340,P0.01)和高密度脂蛋白膽固醇(r=-0.249,P0.01)有相關(guān)性;頸動脈斑塊穩(wěn)定性與體質(zhì)指數(shù)(r=-0.286,P0.01)、收縮壓(r=-0.188,P0.05)、糖化血紅蛋白(r=-0.368,P0.01)和高密度脂蛋白膽固醇(r=0.405,P0.01)有相關(guān)性;脈搏波速度與年齡(r=0.516,P0.01)、收縮壓(r=0.521,P0.01)、舒張壓(r=0.225,P0.01)、空腹血糖(r=0.181,P0.05)、糖化血紅蛋白(r=0.229,P0.01)、甘油三酯(r=-0.253,P0.01)、總膽固醇(r=-0.311,P0.01)、低密度脂蛋白膽固醇(r=-0.244,P0.01)有相關(guān)性。4.Logistic回歸分析結(jié)果顯示,性別、年齡和糖化血紅蛋白與頸動脈內(nèi)中膜增厚與否獨(dú)立相關(guān);性別、年齡、體質(zhì)指數(shù)和糖化血紅蛋白與頸動脈粥樣硬化斑塊積分大小獨(dú)立相關(guān);年齡、糖化血紅蛋白、高密度脂蛋白膽固醇與粥樣斑塊穩(wěn)定性獨(dú)立相關(guān);年齡、收縮壓與脈搏波速度大小獨(dú)立相關(guān)。5.頸動脈內(nèi)中膜厚度與脈搏波速度呈顯著正相關(guān)(r=0.234,P0.01)。斑塊積分和斑塊穩(wěn)定性與脈搏波速度無相關(guān)性。結(jié)論:1.老年糖尿病患者糖化血紅蛋白水平與頸動脈內(nèi)中膜厚度、斑塊積分、不穩(wěn)定斑塊比例、脈搏波速度呈正相關(guān)。糖化血紅蛋白是頸動脈內(nèi)中膜厚度、斑塊積分、不穩(wěn)定斑塊比例增加的獨(dú)立危險(xiǎn)因素,控制糖化血紅蛋白在合理水平有利于延緩老年糖尿病患者動脈硬化的發(fā)生、發(fā)展。2.老年糖尿病患者頸動脈內(nèi)中膜厚度與脈搏波速度呈正相關(guān),對于老年糖尿病患者同時(shí)進(jìn)行頸動脈超聲和脈搏波速度檢查可早期評估其動脈硬化情況,為早期干預(yù)和治療提供依據(jù)。3.糖化血紅蛋白、收縮壓、高密度脂蛋白膽固醇、體質(zhì)指數(shù)是老年糖尿病患者發(fā)生動脈硬化的獨(dú)立危險(xiǎn)因素,綜合控制血糖、血壓、血脂、體質(zhì)量有助于延緩老年糖尿病患者動脈硬化病變的進(jìn)展。研究背景及目的:肥胖是多種代謝疾病以及部分腫瘤發(fā)生的主要危險(xiǎn)因素。隨著體質(zhì)指數(shù)的增高,糖尿病的患病風(fēng)險(xiǎn)也增加。多數(shù)糖尿病患者存在超重或肥胖,肥胖與糖尿病共存加重機(jī)體代謝紊亂,增加其心血管疾病發(fā)生風(fēng)險(xiǎn)。目前評價(jià)肥胖的常用指標(biāo)有體質(zhì)指數(shù)、腰圍、腰臀比和腰圍身高比等。脈搏波速度(PWV)是一種無創(chuàng)性評價(jià)動脈功能,反映機(jī)體動脈血管順應(yīng)性和僵硬度的經(jīng)典指標(biāo),被認(rèn)為是心血管事件發(fā)生風(fēng)險(xiǎn)和預(yù)后的獨(dú)立預(yù)測因子。本研究采用肱動脈-踝部動脈脈搏波速度作為評估患者動脈硬化的指標(biāo),分析2型糖尿病患者體質(zhì)指數(shù)、腰圍、腰臀比和腰圍身高比對脈搏波速度的影響及其相關(guān)性,為糖尿病患者預(yù)防動脈硬化提供一定依據(jù)。研究方法:本研究選擇2015年7月至2016年3月于山東大學(xué)齊魯醫(yī)院老年病科門診就診或住院的2型糖尿病患者,均符合1999年WHO糖尿病診斷標(biāo)準(zhǔn),同時(shí)排除患惡性腫瘤及血液系統(tǒng)疾病、嚴(yán)重肝腎功能損害、急性感染或其他急性疾病、近期發(fā)生過急性心肌梗死、心力衰竭或腦卒中等心腦血管意外、合并軀體功能障礙或認(rèn)知功能障礙者,共納入2型糖尿病患者136例,年齡在45～87歲,平均年齡67.40±10.33歲,其中男性61例。對所有研究對象均詳細(xì)詢問病史并查體,記錄性別、年齡、既往史等一般資料,測量身高、體質(zhì)量、腰圍、臀圍、血壓等指標(biāo),并計(jì)算體質(zhì)指數(shù)、腰臀比、腰圍身高比,測定空腹血糖、糖化血紅蛋白、甘油三酯、總膽固醇、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇等指標(biāo)。應(yīng)用全自動動脈硬化檢測儀進(jìn)行肱踝脈搏波速度的檢測并記錄。根據(jù)不同肥胖標(biāo)準(zhǔn)進(jìn)行分組分析不同組間脈搏波速度的差異。采用SPSS 20.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.男性受檢者身高、體重、腰圍、腰臀比高于女性,高密度脂蛋白膽固醇低于女性。2.根據(jù)腰圍、腰臀比、腰圍身高比分別分組比較,肥胖組脈搏波速度均高于非肥胖組。根據(jù)體質(zhì)指數(shù)分組發(fā)現(xiàn),體重正常組、超重組、肥胖組脈搏波速度逐漸增高,三組間差異有統(tǒng)計(jì)學(xué)意義。3.控制年齡的影響后,男性脈搏波速度與腰圍(r=0.333,P0.01)、腰圍身高比(r=0.290,P0.05)呈正相關(guān);女性脈搏波速度與腰圍(r=0.449,P0.01)、腰臀比(r=0.397,P0.01)、腰圍身高比(r=0.459,P0.01)、體質(zhì)指數(shù)(r=0.302,P0.01)均呈顯著正相關(guān)。4.Logistic回歸分析結(jié)果顯示,腰臀比和腰圍身高比與脈搏波速度增高獨(dú)立相關(guān)。結(jié)論:伴有肥胖的2型糖尿病患者脈搏波速度較非肥胖患者增加,腰臀比和腰圍身高比是影響動脈彈性的獨(dú)立危險(xiǎn)因素。對2型糖尿病患者進(jìn)行肥胖相關(guān)評估及早期干預(yù)可以在一定程度上控制動脈硬化的進(jìn)展。
[Abstract]:BACKGROUND AND OBJECTIVE: The prevalence of type 2 diabetes mellitus in the elderly is increasing rapidly in recent years, which has become a serious public health problem affecting the health and quality of life of the elderly. Cardiovascular complications are of great significance. As an important medium-sized artery, carotid atherosclerosis is a window to observe systemic atherosclerosis. Canonical markers are considered to be independent predictors of risk and prognosis for cardiovascular events. The aim of this study was to investigate the glycosylated hemoglobin levels in elderly diabetic patients by measuring glycosylated hemoglobin, blood glucose, blood pressure, blood lipids and carotid intima-media thickness, plaque score, plaque stability, and pulse wave velocity. The correlation between carotid artery plaque and pulse wave velocity and its influencing factors provide certain basis for preventing the occurrence and development of atherosclerosis in elderly patients with diabetes mellitus. Methods: This study selected the elderly type 2 diabetes mellitus patients from July 2015 to March 2016 in Qilu Hospital of Shandong University who were hospitalized or visited the geriatric department of geriatrics. WHO diabetes diagnostic criteria, excluding malignant tumors and hematological diseases, severe liver and kidney dysfunction, acute infection or other acute diseases, recent occurrence of acute myocardial infarction, heart failure or stroke and other cardiovascular and cerebrovascular accidents, combined with somatic or cognitive impairment, were included in 130 elderly diabetic patients. Fifty-nine of them were male, aged from 60 to 92, with an average age of 72.38 [8.79]. All the subjects were asked for medical history and physical examination, recorded general data such as sex, age, past history, measured height, body mass, blood pressure and other indicators, and calculated body mass index, measured fasting blood glucose, glycosylated hemoglobin, triglyceride, total cholesterol, high density. Degree lipoprotein cholesterol, low density lipoprotein cholesterol and other indicators. Carotid ultrasound examination of patients, respectively observed and recorded the location of carotid plaque, size, echo, measurement of carotid intima-media thickness (IMT); according to Crouse carotid plaque integral standard to calculate plaque integral; according to ultrasound examination of plaque echo will be carotid artery. Pulse plaque classification; brachial-ankle pulse wave velocity (ba-PWV) was measured and recorded by automatic arteriosclerosis tester. According to the level of HbAIC, the subjects were divided into three groups: 49 patients with HbAIC 7% were low level group; 58 patients with HbAIC 7% < HbAIC 8.5% were middle level group; 23 patients with HbAIC > 8.5% were high level group. SPSS 20.0 software was used for the unification. Results: 1. Systolic blood pressure, fasting blood glucose, high-density lipoprotein cholesterol, carotid intima-media thickness, plaque score, plaque stability, pulse wave velocity were significantly different between the low-glycosylated hemoglobin group, the middle-level group and the high-level group. Fasting blood glucose, carotid intima-media thickness, plaque score, unstable plaque ratio and pulse wave velocity were higher in the low-level group than in the low-level group, while high-density lipoprotein cholesterol was lower in the low-level group; body mass index, systolic blood pressure, fasting blood glucose, carotid intima-media thickness, plaque score, unstable plaque ratio and pulse velocity were higher in the high-level group than in the low-level group. Compared with the middle level group, the high level group had higher fasting blood glucose, carotid intima-media thickness, plaque score and unstable plaque ratio. 3. Correlation analysis showed that carotid intima-media thickness and gender (r = 0.389, P 0.01), age (r = 0.296, P 0.01). Fasting blood glucose (r = 0.203, P 0.05), glycosylated hemoglobin (r = 0.405, P 0.01), high-density lipoprotein cholesterol (r = - 0.208, P 0.05), carotid plaque score and gender (r = 0.321.P 0.01), age (r = 0.355, P 0.01), glycosylated hemoglobin (r = 0.340, P 0.01) and high-density lipoprotein cholesterol (r = - 0.249, P 0.01) were correlated. Qualitative correlations were found with body mass index (r = - 0.286, P 0.01), systolic blood pressure (r = - 0.188, P 0.05), glycosylated hemoglobin (r = - 0.368, P 0.01) and high-density lipoprotein cholesterol (r = 0.405, P 0.01); pulse wave velocity and age (r = 0.516, P 0.01), systolic blood pressure (r = 0.521, P 0.01), diastolic blood pressure (r = 0.225, P 0.01), fasting blood glucose (r = 0.181, P 0.05), glycosylated hemoglobin (r = 0.22). 9, P 0.01, triglyceride (r = - 0.253, P 0.01), total cholesterol (r = - 0.311, P 0.01), low density lipoprotein cholesterol (r = - 0.244, P 0.01) were correlated. 4. Logistic regression analysis showed that gender, age and glycosylated hemoglobin were independently correlated with carotid intima-media thickening; gender, age, BMI and glycosylated hemoglobin were independently correlated with carotid artery intima-media thickening. Age, glycosylated hemoglobin, high-density lipoprotein cholesterol and stability of atherosclerotic plaque were independently correlated. Age, systolic blood pressure and pulse wave velocity were independently correlated. 5. Carotid intima-media thickness and pulse wave velocity were positively correlated (r = 0.234, P 0.01). Plaque integration and plaque stability were positively correlated. There was no correlation between HbA1c and carotid intima-media thickness, plaque score, unstable plaque ratio, and pulse wave velocity. HbA1c was an independent risk factor for carotid intima-media thickness, plaque score, and unstable plaque ratio. HbA1c could control glycosylated hemoglobin. Protein at a reasonable level is conducive to delaying the occurrence and development of atherosclerosis in elderly diabetic patients. 2. Carotid intima-media thickness in elderly diabetic patients is positively correlated with pulse wave velocity. Carotid ultrasound and pulse wave velocity examination can be used to evaluate early atherosclerosis in elderly diabetic patients for early intervention and intervention. 3. Glycosylated hemoglobin, systolic blood pressure, high-density lipoprotein cholesterol, body mass index are independent risk factors of atherosclerosis in elderly diabetic patients. Comprehensive control of blood sugar, blood pressure, blood lipid, body mass is helpful to delay the progress of atherosclerosis in elderly diabetic patients. Most diabetic patients are overweight or obese. The coexistence of obesity and diabetes exacerbates metabolic disorders and increases the risk of cardiovascular disease. The most commonly used indicators of obesity are body mass index. WHR, WHR and WHR. Pulse wave velocity (PWV) is a noninvasive evaluation of arterial function, a classical indicator of arterial compliance and stiffness, and is considered an independent predictor of cardiovascular risk and prognosis. To analyze the influence of body mass index (BMI), waist circumference, waist-hip ratio and waist-to-hip ratio on pulse wave velocity in type 2 diabetes mellitus patients, and to provide some basis for prevention of atherosclerosis. Patients with type 2 diabetes mellitus in our hospital met the WHO diagnostic criteria for diabetes mellitus in 1999. Malignant tumors and hematological diseases, severe liver and kidney impairment, acute infection or other acute diseases, recent cardio-cerebrovascular accidents such as acute myocardial infarction, heart failure or stroke, combined with somatic or cognitive impairment were excluded. 136 patients with type 2 diabetes mellitus were enrolled in the study. The average age was 67.40 (+ 10.33) years. Sixty-one of them were male. High ratio, fasting blood glucose, glycosylated hemoglobin, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and other indicators were measured. Brachial-ankle pulse wave velocity was measured and recorded by automatic atherosclerosis tester. Results: 1. The height, weight, waist circumference, waist-hip ratio of male subjects were higher than that of female subjects, and HDL-C was lower than that of female subjects. 2. According to waist circumference, waist-hip ratio and waist-to-height ratio, the pulse wave velocity of obese group was higher than that of non-obese group. There was a significant difference among the three groups. 3. After controlling the influence of age, the pulse wave velocity was positively correlated with waist circumference (r = 0.333, P 0.01), waist circumference height ratio (r = 0.290, P 0.05), waist circumference (r = 0.449, P 0.01), waist-hip ratio (r = 0.397, P 0.01), waist circumference height ratio (r = 0.459, P 0.05). Logistic regression analysis showed that waist-hip ratio and waist circumference-height ratio were independently correlated with the increase of pulse wave velocity. Conclusion: The pulse wave velocity in obese type 2 diabetes mellitus patients was higher than that in non-obese type 2 diabetes mellitus patients, and waist-hip ratio and waist circumference-height ratio were independent risk factors for arterial elasticity. Obesity-related assessment and early intervention in type 2 diabetic patients can control the progression of atherosclerosis to some extent.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1

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