本文選題：2型糖尿病 + 頸動脈內(nèi)中膜增厚��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分析2型糖尿病患者頸動脈內(nèi)中膜增厚及頸動脈斑塊的流行現(xiàn)況和臨床特征,探討2型糖尿病患者頸動脈內(nèi)中膜增厚及頸動脈斑塊的相關(guān)因素,并比較兩者相關(guān)因素的差異,以期為早期發(fā)現(xiàn)高危人群并采取有效的預(yù)防或治療措施,進而減少2型糖尿病并發(fā)心血管疾病的發(fā)生提供科學(xué)研究依據(jù)。方法:回顧性查閱2008年1月1日至2013年3月1日天津醫(yī)科大學(xué)代謝病醫(yī)院住院的2型糖尿病患者(2525例)的病歷資料,摘錄相關(guān)信息,以其中進行頸動脈超聲檢測內(nèi)中膜厚度的患者(1167例)為研究對象,分析2型糖尿病住院患者頸動脈內(nèi)中膜增厚及頸動脈斑塊的檢出率及臨床特征。采用病例對照研究方法,分別以頸動脈內(nèi)中膜增厚的2型糖尿病患者(604例)及有頸動脈斑塊者(162例)作為病例組,以頸動脈內(nèi)中膜厚度正常的2型糖尿病患者(401例)作為對照組,采用非條件Logistic回歸對頸動脈內(nèi)中膜增厚及頸動脈斑塊的相關(guān)因素進行單因素和多因素分析,計算比值比(OR)及其95%可信區(qū)間(95%CI)。結(jié)果:1、1167例2型糖尿病住院患者中,604例有頸動脈內(nèi)中膜增厚,檢出率為51.8%;162例有頸動脈斑塊,檢出率為13.9%;隨著糖尿病患者年齡的增加、病程的延長,頸動脈內(nèi)中膜增厚和頸動脈斑塊的檢出率均逐漸增加。2、在2型糖尿病患者中,與頸動脈內(nèi)中膜厚度正常組相比,頸動脈斑塊組及頸動脈內(nèi)中膜增厚組的年齡較大,在職、退休者的比例較大,糖尿病病程較長,現(xiàn)患冠心病、高血壓和糖尿病視網(wǎng)膜病變者的比例較高,收縮壓(SBP),血尿素氮(BUN)、血肌酐(CRE)、血纖維蛋白原(FIB)水平較高,頸動脈斑塊組的尿蛋白(UPRO)水平較高,吸煙者比例較高,頸動脈增厚組接受胰島素治療和口服降糖藥治療者的比例較高,尿微量白蛋白(UMA)水平較高,差異均具有統(tǒng)計學(xué)意義(P0.05)。3、單因素Logistic回歸分析結(jié)果顯示:男性、高齡、退休、吸煙、肥胖、糖尿病病程長、胰島素治療、口服降糖藥治療、糖尿病視網(wǎng)膜病變、糖尿病腎病、現(xiàn)患高血壓和冠心病、血纖維蛋白原水平(FIB)4.0g/L與2型糖尿病患者頸動脈內(nèi)中膜增厚的高風(fēng)險相關(guān);男性、高齡、退休、吸煙、糖尿病病程長、糖尿病視網(wǎng)膜病變、現(xiàn)患冠心病和高血壓、血尿素氮(BUN)≥8.3 mmol/L、血纖維蛋白原水平(FIB)4.0g/L、C反應(yīng)蛋白水平(CRP)≥8 mg/L與2型糖尿病患者頸動脈斑塊的高風(fēng)險有關(guān)。對上述單因素分析有統(tǒng)計學(xué)意義的變量進行多因素非條件Logistic回歸分析,結(jié)果顯示,高齡、男性、肥胖、現(xiàn)患高血壓、現(xiàn)患冠心病與2型糖尿病患者頸動脈內(nèi)中膜增厚的高風(fēng)險相關(guān);高齡、吸煙、血漿纖維蛋白原4.0g/L和現(xiàn)患冠心病與2型糖尿病患者頸動脈斑塊的高風(fēng)險相關(guān)。結(jié)論:1、2型糖尿病住院患者中頸動脈內(nèi)中膜增厚和頸動脈斑塊的檢出率較高;年齡越大、病程越長的2型糖尿病患者頸動脈內(nèi)中膜增厚、頸動脈斑塊的檢出率越高。2、高齡、男性、肥胖、現(xiàn)患高血壓、現(xiàn)患冠心病與2型糖尿病患者頸動脈內(nèi)中膜增厚的高風(fēng)險相關(guān);高齡、吸煙、高血漿纖維蛋白原水平、現(xiàn)患冠心病與2型糖尿病患者頸動脈斑塊的高風(fēng)險相關(guān);頸動脈內(nèi)中膜增厚與合并頸動脈斑塊的風(fēng)險因素存在差異,有待于進一步研究。
[Abstract]:Objective: to analyze the current and clinical characteristics of carotid artery thickening and carotid atherosclerotic plaque in patients with type 2 diabetes, and to explore the related factors of carotid artery thickening and carotid artery plaque in type 2 diabetic patients, and to compare the difference between the two factors in order to find early high-risk groups and take effective preventive or therapeutic measures. In order to reduce the incidence of type 2 diabetes complicated with cardiovascular disease, a scientific research basis was provided. Methods: a retrospective review of the medical records of type 2 diabetic patients (2525 cases) hospitalized in the metabolic disease hospital of Medical University Of Tianjin from January 1, 2008 to March 1, 2013 was reviewed, and relevant information was excerpt from which the carotid artery ultrasound was used to detect the thickness of the middle membrane. The detection rate and clinical characteristics of carotid artery middle membrane thickening and carotid artery plaque in patients with type 2 diabetes mellitus (1167 cases) were analyzed. Case control study method was used to treat type 2 diabetes mellitus (604 cases) with carotid artery thickening (604 cases) and carotid plaque (162 cases) as case group with the thickness of carotid artery middle membrane. Normal type 2 diabetic patients (401 cases) were used as the control group. Single factor and multifactor analysis were performed on the carotid artery intima media thickening and carotid artery plaque related factors by non conditional Logistic regression. The ratio Ratio (OR) and 95% confidence interval (95%CI) were calculated. Results: among 11167 hospitalized patients with type 2 diabetes, 604 cases had carotid intima-medium increase. The detection rate was 51.8%, 162 cases with carotid artery plaque, the detection rate was 13.9%, with the increase of age, the extension of the course, the thickening of the carotid artery and the detection rate of carotid artery plaque were gradually increased by.2. In type 2 diabetic patients, the carotid artery plaque group and the carotid intima-medium membrane were compared with the normal carotid artery middle membrane thickness group. The age of the thickening group is larger, the proportion of the retirees is larger, the course of diabetes is longer, the proportion of the patients with coronary heart disease, hypertension and diabetic retinopathy is higher, the systolic pressure (SBP), blood urea nitrogen (BUN), serum creatinine (CRE), blood fibrinogen (FIB) level is higher, the level of urinary protein (UPRO) in the carotid plaque group is higher, and the proportion of smokers is higher. Higher in the carotid artery thickening group, the ratio of insulin therapy and oral hypoglycemic agents was higher, and the urinary microalbumin (UMA) level was higher, and the difference was statistically significant (P0.05).3. The single factor Logistic regression analysis showed that male, senior, retired, smoking, obese, long course of diabetes, insulin treatment, oral hypoglycemic medicine, Diabetic retinopathy, diabetic nephropathy, hypertension and coronary heart disease, the blood fibrinogen level (FIB) 4.0g/L is associated with the high risk of the thickening of the carotid artery in type 2 diabetic patients; male, senior, retired, smoking, long course of diabetes, diabetic retinopathy, coronary heart disease and hypertension, blood urea nitrogen (BUN) more than 8.3 mmol/L The blood fibrinogen level (FIB) 4.0g/L, C reactive protein level (CRP) or more than 8 mg/L was associated with the high risk of carotid plaque in type 2 diabetic patients. Multivariate non conditional Logistic regression analysis of statistically significant variables in the single factor analysis showed that high age, male, obesity, hypertension, coronary heart disease and type 2 sugar The high risk related to the thickening of the middle carotid artery of the carotid artery in patients with urinary disease; age, smoking, plasma fibrinogen 4.0g/L and high risk of carotid plaque in patients with type 2 diabetes. Conclusion: the prevalence of carotid artery thickening and carotid plaque in patients with type 1,2 diabetes mellitus is higher; the older the age, the longer the course of disease is 2. The thickening of the carotid artery middle membrane in patients with type 2 diabetes, the higher the detection rate of carotid artery plaque is, the higher the age, the male, the obesity, the high blood pressure, and the high risk associated with the thickening of the carotid artery in the patients with type 2 diabetes; the older, the smoking, the high plasma fibrin plain water, the higher carotid plaque in the patients with type 2 diabetes Risk related; the risk factors of carotid intima-media thickening and carotid plaques are different, which need further study.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2;R181.3

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