北京某社区2型糖尿病患者血糖控制情况与肱踝脉搏波传导速度的相关性研究

doi:10.3969/j.issn.1671-167X.2015.03.012

摘要/Abstract

摘要： 目的：探讨2型糖尿病（type 2 diabetes mellitus, T2DM）患者血糖控制与肱踝脉搏波传导速度（brachial-ankle pulse wave velocity, baPWV）的关系。方法：采用横断面研究设计，对北京市某社区40岁及以上的T2DM患者及非患者进行问卷调查、体格检查、糖化血红蛋白（glycated hemoglobin, HbA1c）及血脂等实验室指标检测、baPWV测量。根据HbA1c结果将患者分为血糖控制良好组和血糖控制不良组，分析血糖控制情况与baPWV之间的相关性。结果：共纳入1 341名研究对象，包括733名T2DM患者及608名非患者。与非患者相比，T2DM患者中baPWV异常（baPWV≥1 700 cm/s）率较高（40.8% vs. 26.8%, P<0.001）。分别以HbA1c<6.5%和HbA1c<7.0%为血糖控制目标时，非患者、血糖控制良好的T2DM患者组、血糖控制不良的T2DM患者组之间的baPWV异常率差异有统计学意义（non-diabetes vs. HbA1c<6.5% T2DM vs. HbA1c≥6.5% T2DM：26.8% vs. 32.8% vs. 42.6%，P<0.001；non-diabetes vs. HbA1c<7.0% T2DM vs. HbA1c≥7.0% T2DM: 26.8% vs. 36.0% vs. 43.4%，P<0.001）。控制性别、年龄、吸烟、糖尿病家族史、2型糖尿病病程、心血管疾病史、腰臀比、收缩压、舒张压、总甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等因素后进行多重Logistic回归分析，结果显示与非糖尿病人群相比，HbA1c<6.5%的糖尿病患者baPWV异常的OR值为0.927（95%CI 0.560~1.537），HbA1c≥6.5%的糖尿病患者baPWV异常的OR值为1.826（95%CI 1.287~2.591）；与非糖尿病人群相比，HbA1c<7.0%的糖尿病患者OR值为1.210（95%CI 0.808~1.811），HbA1c≥7.0%的糖尿病患者baPWV异常的OR值为1.898（95%CI 1.313~2.745）。结论：社区2型糖尿病患者血糖控制情况与baPWV间存在显著的关联关系，血糖控制不良是baPWV异常的危险因素，良好控制血糖可能能够降低糖尿病患者发生心血管疾病的风险。

关键词: 肱踝脉搏波传导速度, 糖尿病, 2型, 血糖, 血红蛋白A, 糖基化, 动脉硬化

Abstract: Objective：To explore the correlation between glycemic control of type 2 diabetes mellitus (T2DM) patients and brachial-ankle pulse velocity (baPWV). Methods: A community-based cross-sectional study was conducted in Beijing, China. Every subject underwent physical examinations, glycated hemoglobin (HbA1c), blood lipid and baPWV measurements and completed a standardized questionnaire. T2DM patients were divided into well controlled and poorly controlled groups according to HbA1c levels. The correlation between glycemic control of T2DM patients and baPWV was analyzed. Results: In this study, 1 341 subjects were recruited, including 733 T2DM patients and 608 non-diabetes subjects. Compared with non-diabetes subjects, abnormal baPWV (baPWV≥1 700 cm/s) rate for T2DM patients was higher (40.8% vs. 26.8%, P<0.001). With HbA1c<6.5% or <7.0% as the aim of glycemic control in T2DM patients, the abnormal baPWV rates for non-diabetes subjects, well controlled and poorly controlled T2DM patients were significantly different (non-diabetes vs. HbA1c<6.5% T2DM vs. HbA1c≥6.5% T2DM: 26.8% vs. 32.8% vs. 42.6%, P<0.001; non-diabetes vs. HbA1c<7.0% T2DM vs. HbA1c≥7.0% T2DM: 26.8% vs. 36.1% vs. 43.4%, P<0.001). After being adjusted for gender, age, smoking status, diabetes mellitus family history, T2DM duration, cardiovascular diseases (CVD), waist hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), total triglycerides (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C), the Logistic regression models suggested that glycemic control status of T2DM patients was associated with abnormal baPWV. Compared with non-diabetes subjects, the ORs for abnormal baPWV in HbA1c<6.5% T2DM patients and HbA1c≥6.5% T2DM patients were 0.927(95%CI 0.560-1.537) and 1.826 (95%CI 1.287-2.591). Compared with non-diabetes subjects, the ORs for abnormal baPWV in HbA1c<7.0% T2DM patients and HbA1c≥7.0% T2DM patients were 1.210 (95%CI 0.808-1.811) and 1.898 (95%CI 1.313-2.745). Conclusion:The glycemic control status of T2DM patients from communities is significantly associated with baPWV. Poor glycemic control is a risk factor for abnormal baPWV. Keeping HbA1c under control might lower the risk of cardiovascular diseases in T2DM patients.

Key words: Brachial-ankle pulse wave velocity, Diabetes mellitus, type 2, Blood glucose, Hemoglobin A, glycosylated, Arteriosclerosis

中图分类号:

R781.64

孙可欣, 刘志, 曹亚英, 隽娟, 项骁, 杨成, 黄少平, 刘晓芬, 李娜, 唐迅, 李劲, 吴涛, 陈大方, 胡永华 . 北京某社区2型糖尿病患者血糖控制情况与肱踝脉搏波传导速度的相关性研究[J]. 北京大学学报（医学版）, 2015, 47(3): 431-436.

SUN Ke-Xin, LIU Zhi, CAO Ya-Ying, JUAN Juan, XIANG Xiao, YANG Cheng, HUANG Shao-Ping, LIU Xiao-Fen, LI Na, TANG Xun, LI Jin, WU Tao, CHEN Da-Fang, HU Yong-Hua- . Relationship between brachial-ankle pulse wave velocity and glycemic control of type 2 diabetes mellitus patients in Beijing community population[J]. Journal of Peking University(Health Sciences), 2015, 47(3): 431-436.

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