颈动脉和心脏超声指标与2型糖尿病患者心脑血管疾病风险的关系

doi:10.3760/cma.j.issn.1007-1245.2023.05.007

摘要/Abstract

摘要：

目的　探讨颈动脉和心脏超声指标与2型糖尿病（T2DM）患者心脑血管疾病风险的关系。方法　选取2019年9月至2021年12月在巴彦淖尔市医院接受检查和治疗的180例T2DM患者的临床资料。随访1年，30例患者出现心脑血管事件，180例T2DM患者分为事件组（30例）、无事件组（150例）。收集一般资料［年龄、性别、体质量指数（BMI）、血糖、血脂、血压、吸烟、饮酒、药物使用情况］，检查颈动脉内膜中层厚度（IMT）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）和左心室射血分数（LVEF），检测总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇（non-HDL-C）、同型半胱氨酸（Hcy）和N端前脑钠肽（NT-proBNP）。采用logistic回归分析筛选影响T2DM患者发生心脑血管疾病的危险因素。采用χ²检验、独立样本t检验。结果　事件组吸烟比例86.7%（26/30）、BMI（27.1±3.8）kg/m²、收缩压（SBP）（149.7±15.3）mmHg（1 mmHg=0.133 kPa）、舒张压（DBP）（95.1±11.8）mmHg、non-HDL-C（6.63±2.21）mmol/L、NT-proBNP（542.38±56.73）ng/L、Hcy（25.43±5.69）μmol/L、使用抗高血压药物比例36.7%（11/30）、使用他汀类药物比例23.3%（7/30），与无事件组的30.0%（45/150）、（24.9±3.7）kg/m²、（137.9±14.9）mmHg、（89.6±8.7）mmHg、（4.42±1.39）mmol/L、（376.51±34.06）ng/L、（13.22±2.31）μmol/L、60.0%（90/150）和45.3%（68/150）比较，差异均有统计学意义（χ²=33.609，P<0.001；t=2.960，P=0.003；t=3.942，P<0.001；t=2.425，P=0.020；t=5.273，P<0.001；t=15.467，P<0.001；t=11.564，P<0.001；χ²=5.527，P=0.019；χ²=4.978，P=0.026）。事件组颈动脉斑块检出率为56.7%（17/30）、LVEDD（59.1±7.2）mm、LVESD（45.3±9.4）mm、LVEF（44.1±8.2）%，与无事件组的33.3%（50/150）、（50.8±5.3）mm、（38.3±1.3）mm和（47.7±6.3）%比较，差异均有统计学意义（χ²=5.825，P=0.016；t=6.026，P<0.001；t=4.071，P<0.001；t=2.274，P=0.029）。logistic回归分析显示，吸烟（P<0.001）、BMI（P=0.014）、SBP（P=0.003）、DBP（P=0.014）、颈动脉斑块检出率（P=0.003）、使用抗高血压药物（P=0.016）、使用他汀类药物（P=0.019）、LVEDD（P=0.011）、LVESD（P=0.031）、LVEF（P=0.024）、non-HDL-C（P<0.001）、NT-proBNP（P=0.004）、Hcy（P=0.002）均是T2DM患者发生心脑血管事件的独立危险因素。结论　吸烟、BMI、SBP、DBP、颈动脉斑块检出率、使用抗高血压药物、使用他汀类药物、LVEDD、LVESD、LVEF、non-HDL-C、NT-proBNP、Hcy均是糖尿病患者发生心脑血管事件的独立危险因素。

关键词:

2型糖尿病, 心脑血管疾病, 危险因素

Abstract:

Objective　To explore the relationships between carotid artery and cardiac ultrasonography indexes and risk of cardiovascular and cerebrovascular diseases in patients with type 2 diabetes mellitus (T2DM). Methods　The clinical data of 180 T2DM patients who were examined and treated in Bayannur Hospital from September 2019 to December 2021 were selected. Following up for one year, 30 patients suffered from cardiovascular and cerebrovascular events, and 180 T2DM patients were divided into an event group (30 cases) and an event free group (150 cases). The general data [age, gender, body mass index (BMI), blood glucose, blood lipids, blood pressure, smoking, drinking, and drug use] were collected. The carotid intima-media thickness (IMT), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and left ventricular ejection fraction (LVEF) were examined. The total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), homocysteine (Hcy), and N-terminal probrain natriuretic peptide (NT-proBNP) were measured. Logistic regression analysis was used to screen the risk factors of cardiovascular and cerebrovascular diseases in T2DM patients. χ² test and independent sample t test were used. Results　The smoking rate in the event group was 86.7% (26/30), the BMI was (27.1±3.8) kg/m², the systolic blood pressure (SBP) was (149.7±15.3) mmHg (1 mmHg=0.133 kPa), the diastolic blood pressure (DBP) was (95.1±11.8) mmHg, the non-HDL-C was (6.63±2.21) mmol/L, the NT-proBNP was (542.38±56.73) ng/L, the Hcy was (25.43±5.69) μmol/L, the proportion of antihypertensive drugs used was 36.7% (11/30), the proportion of statins used was 23.3% (7/30), and the differences were statistically significant compared with those in the event free group [30.0% (45/150), (24.9±3.7) kg/m², (137.9±14.9) mmHg, (89.6±8.7) mmHg, (4.42±1.39) mmol/L, (376.51±34.06) ng/L, (13.22±2.31) μmol/L, 60.0% (90/150), and 45.3% (68/150)] (χ²=33.609, P<0.001; t=2.960, P=0.003; t=3.942, P<0.001; t=2.425, P=0.020; t=5.273, P<0.001; t=15.467, P<0.001; t=11.564, P<0.001; χ²=5.527, P=0.019; χ²=4.978, P=0.026). The detection rate of carotid plaque in the event group was 56.7% (17/30), the LVEDD was (59.1±7.2) mm, the LVESD was (45.3±9.4) mm, the LVEF was (44.1±8.2) %, and the differences were statistically significant compared with those in the event free group [33.3% (50/150), (50.8±5.3) mm, (38.3±1.3) mm, and (47.7±6.3) %] (χ²=5.825, P=0.016; t=6.026, P<0.001; t=4.071, P<0.001; t=2.274, P=0.029). Logistic regression analysis showed that smoking (P<0.001), BMI (P=0.014), SBP (P=0.003), DBP (P=0.014), carotid plaque detection rate (P=0.003), use of antihypertensive drugs (P=0.016), use of statins (P=0.019), LVEDD (P=0.011), LVESD (P=0.031), LVEF (P=0.024), non-HDL-C (P<0.001), NT-proBNP (P=0.004), and Hcy (P=0.002) were independent risk factors for cardiovascular and cerebrovascular events in T2DM patients. Conclusion　 Smoking, BMI, SBP, DBP, carotid plaque detection rate, use of antihypertensive drugs, use of statins, LVEDD, LVESD, LVEF, non-HDL-C, NT-proBNP, and Hcy were all independent risk factors for cardiovascular and cerebrovascular events in patients with diabetes.

Key words:

Type 2 diabetes mellitus, Cardiovascular and cerebrovascular diseases, Risk factors

赵耀吴宏.

颈动脉和心脏超声指标与2型糖尿病患者心脑血管疾病风险的关系 [J]. 国际医药卫生导报, 2023, 29(5): 623-627.

Zhao Yao, Wu Hong.

Relationships between carotid artery and cardiac ultrasonography indexes and risk of cardiovascular and cerebrovascular diseases in patients with type 2 diabetes mellitus [J]. International Medicine and Health Guidance News, 2023, 29(5): 623-627.

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